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Sykes J, Bell S, Bukavina L, Kutikov A, Wei S, Chen D. Splenosis in patient undergoing robotic assisted laparoscopic radical prostatectomy. Urol Case Rep 2022; 45:102251. [PMID: 36304725 PMCID: PMC9593728 DOI: 10.1016/j.eucr.2022.102251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Splenosis is a benign condition that is often found in patients with a history of trauma. Most cases are intra-abdominal due to direct seeding of surrounding structures. We report a case of splenosis in the pelvis found in a 59-year-old male during a robotic prostatectomy.
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Affiliation(s)
- Jennifer Sykes
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA,Corresponding author.
| | - Spencer Bell
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Laura Bukavina
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Shuanzeng Wei
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - David Chen
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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2
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Tang X, Gu P, Lu W. A rare case of adult colocolic intussusception secondary to splenosis. J Int Med Res 2022; 50:3000605221115386. [PMID: 36036154 PMCID: PMC9527533 DOI: 10.1177/03000605221115386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intussusception is the invagination of a segment of bowel
(intussusceptum) into the lumen of an adjacent segment
(intussuscipiens). Adult intussusception is rare and typically
asymptomatic, although bowel obstruction can be a predominant symptom,
making it difficult to diagnose. Splenosis is an uncommon and benign
disease, arising from the self-implantation of splenic tissue
elsewhere in the body after splenectomy or splenic trauma. Colocolic
intussusception secondary to splenosis is rare. We report a case of
colon intussusception with a mass in the intussusception detected by
ultrasound. Abdominal ultrasound identified the intussusception
location but failed to distinguish its pathological properties.
Colonoscopy revealed the exudation of necrotic and fibrous tissue.
Surgery was performed because of suspicions of a malignant tumor.
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Affiliation(s)
- Xuemei Tang
- Department of Ultrasound, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, People's Republic of China
| | - Peng Gu
- Department of Ultrasound, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, People's Republic of China
| | - Wenming Lu
- Department of Ultrasound, Huzhou First People's Hospital, Huzhou 313000, People's Republic of China
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3
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Campos NMF, Almeida V, Curvo Semedo L. Peritoneal disease: key imaging findings that help in the differential diagnosis. Br J Radiol 2022; 95:20210346. [PMID: 34767464 PMCID: PMC8822557 DOI: 10.1259/bjr.20210346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The peritoneum is a unique serosal membrane, which can be the site of primary tumors and, more commonly, secondary pathologic processes. Peritoneal carcinomatosis is the most common malignant condition to affect the peritoneal cavity, and the radiologist plays an important role in making the diagnosis and assessing the extent of disease, especially in sites that may hinder surgery. In this review, we address the role of the radiologist in the setting of peritoneal pathology, focusing on peritoneal carcinomatosis as this is the predominant malignant process, followed by revising typical imaging findings that can guide the differential diagnosis.We review the most frequent primary and secondary peritoneal tumor and tumor-like lesions, proposing a systemic approach based on clinical history and morphological appearance, namely distinguishing predominantly cystic from solid lesions, both solitary and multiple.
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Affiliation(s)
- Nuno M F Campos
- Department of Medical Imaging, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Vânia Almeida
- Department of Pathology, Coimbra Hospital and University Centre, Coimbra, Portugal
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4
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Luu S, Sheldon J, Dendle C, Ojaimi S, Jones P, Woolley I. Prevalence and distribution of functional splenic tissue after splenectomy. Intern Med J 2021; 50:556-564. [PMID: 31449712 DOI: 10.1111/imj.14621] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/20/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals splenectomised for trauma have lower infection rates than those splenectomised for other conditions. Residual functional splenic tissue (FST) after splenectomy may provide ongoing immunological protection. AIMS To quantify the prevalence and volume of residual FST post-splenectomy using standard testing. METHODS Splenectomised adults were recruited from the Spleen Australia clinical registry. Eligible individuals had been splenectomised at least 1 year prior to their visit and resided in Victoria. Splenic function was identified by evaluating Howell-Jolly bodies and IgM memory B cells. A 99m-Technetium-labelled, heat-denatured erythrocyte scintigraphic scan was performed if splenic function was detected. RESULTS Initially, 75 splenectomised individuals (all cause) were recruited, with a median of 58 years of age and who were splenectomised a median of 14 years previously. The most common indications for splenectomy were trauma (30.7%) and haematological disease (28.0%). Scintigraphy identified FST in nine individuals (12.0%). Eight had been splenectomised for trauma. In this cohort, 34.8% of individuals splenectomised for trauma had residual FST. To explore our findings further, 45 additional individuals were recruited, predominately individuals splenectomised for trauma. Twenty-five individuals completed assessments by December 2018. An additional 11 individuals had FST, of whom 9 had been splenectomised for trauma. Overall, we identified 20 individuals with residual FST. Volumes ranged from 2.2 to 216.0 cc. We saw individuals with accessory spleens and splenotic nodules and an individual with both. Seventeen individuals had been splenectomised for trauma. CONCLUSIONS Residual FST is commonly seen in individuals splenectomised for trauma. It can present in varying distributions and of varying volume. The clinical significance is unclear.
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Affiliation(s)
- Sarah Luu
- Monash Infectious Diseases, Monash University, Clayton, Victoria, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia
| | - James Sheldon
- Monash Imaging, Monash Health, Clayton, Victoria, Australia
| | - Claire Dendle
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Samar Ojaimi
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.,Monash Children's Infection and Immunity, Monash Health, Clayton, Victoria, Australia
| | - Penelope Jones
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Ian Woolley
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.,Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
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5
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Braga J, Pereira F, Fernandes C, Silva M, Boncoraglio T, Oliveira C. Abdominal Splenosis Mimicking a Colon Tumour. Eur J Case Rep Intern Med 2021; 8:002219. [PMID: 33585344 DOI: 10.12890/2021_002219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/23/2020] [Indexed: 11/05/2022] Open
Abstract
Splenosis is a benign condition which results from the self-implantation of splenic tissue on intra or extraperitoneal surfaces, after splenic trauma or splenectomy. Patients are usually asymptomatic but may present with varied symptoms related to the implantation site. The diagnosis is a challenge because abdominal splenosis can mimic several diseases, including neoplasm. The gold standard examination for its diagnosis is scintigraphy with 99mTc-labelled heat-denatured erythrocyte. When splenosis is found in an asymptomatic patient, surgical removal is not indicated. A 57-year-old male patient presented with sporadic epigastric pain and a suspected mass in the recto-sigmoid transition. Abdominal ultrasound, CT and MRI identified this mass, its characteristics and location, but failed to distinguish its nature. However, given the patient's past history of splenectomy and because the mass showed a similar sign to that of the splenic parenchyma, a hypothesis of abdominal splenosis was raised, which was confirmed by scintigraphy with 99mTc-labelled heat-denatured erythrocyte. In this case, the diagnosis was obtained before the patient was subjected to more invasive procedures, which are associated with high morbidity, and, as in most cases, no targeted intervention was necessary. LEARNING POINTS Increasing numbers of cases of abdominal trauma will result in more frequent splenosis.Diagnosis is sometimes complex as splenosis mimics several diseases.The usual complementary imaging studies often fail to diagnose this entity so clinical suspicion is fundamental for correct diagnosis and treatment.
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Affiliation(s)
- Joana Braga
- Department of Internal Medicine, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Francisca Pereira
- Department of Internal Medicine, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Cristiana Fernandes
- Department of Internal Medicine, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Marinha Silva
- Department of Internal Medicine, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Teresa Boncoraglio
- Department of Internal Medicine, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Carlos Oliveira
- Department of Internal Medicine, Hospital Santa Maria Maior, Barcelos, Portugal
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Pitfalls and value of organ specific approach in evaluating indeterminate lesions detected on CT in colorectal cancer by [F18] FDG PET/CT. Eur J Radiol Open 2020; 7:100264. [PMID: 32939370 PMCID: PMC7479284 DOI: 10.1016/j.ejro.2020.100264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022] Open
Abstract
Objective The objective of this study is to evaluate the value of FDG PET/CT for different involved organs showing Indeterminate/ equivocal / suspicious lesions detected on IV contrasted CT during surveillance follow up for colorectal cancer. Materials and methods A total of 67 patients with colorectal cancer how are on regular surveillance follow up by IV contrasted CT scans revealing indeterminate lesions were studied. Subsequent FDG PET/CT evaluation was performed as a problem solving modality. PET/CT results were statistically characterized when compared to biopsy results or to follow/up results. Also Statistical parameters were calculated for each organ involved. The evaluation of all CT indeterminate lesions by FDG PET/CT showed overall sensitivity of 93%, Specificity of 81%, Negative predictive value of 94%, Positive predictive value 80% and accuracy of 87%. However in an organ specific approach the highest accuracy was for lymph nodes with results showing a 100% accuracy and the lowest accuracy was for local disease at a value of 80%. Probable explanations for the falsely characterized lesions resulting in the pitfalls seen and in the imperfect accuracy were provided. Conclusion Study shows that FDG PET/CT is an excellent tool in characterizing CT indeterminate lesions during surveillance of colorectal cancer, However different organs showed variable accuracy results with the highest accuracy for our study was for lymph node status (100%) and the lowest accuracy being for local disease at the original site of primary tumor (80%).
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Khan A, Khan S, Pillai S. Symptomatic Intrathoracic Splenosis More than Forty Years After a Gunshot Injury. Cureus 2019; 11:e5985. [PMID: 31807373 PMCID: PMC6876915 DOI: 10.7759/cureus.5985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Thoracic splenosis is a rare heterotopic autotransplantation of the spleen into the thorax that occurs after trauma or surgery involving the spleen. It is most commonly found incidentally on imaging in the left hemithorax. To the best of our knowledge, only six symptomatic cases of thoracic splenosis have been described in the literature so far. We present a case of thoracic splenosis in a male with a remote history of a gunshot injury during childhood, who presented with chest pain and shortness of breath.
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Affiliation(s)
- Adnan Khan
- Critical Care, Freeman Health System, Joplin, USA
| | - Sana Khan
- Internal Medicine, Sindh Medical College, Karachi, PAK
| | - Saran Pillai
- Emergency Medicine, Kerala Institute of Medical Sciences Hospital, Trivandrum, IND
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Downs EM, Reeves S. Sonographic Discovery of Autotransplanted Splenic Implants in a Pregnant Patient. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318812032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is important to include splenic implants in the differential diagnosis of patients with a history of splenic trauma. Autotransplanted splenic implants may have a sonographic appearance similar to that of pathologies such as lymphadenopathy or carcinomatosis. This is the first known case to discuss a pregnant patient with a history of autologous autotransplanted splenic tissue, which was discovered on sonography and confirmed during the patient’s cesearean section.
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Affiliation(s)
- Emily M. Downs
- Department of Ultrasound and Maternal Fetal Medicine, University of Colorado Hospital, Aurora, CO, USA
| | - Shane Reeves
- Department of Ultrasound and Maternal Fetal Medicine, University of Colorado Hospital, Aurora, CO, USA
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9
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Abstract
Splenosis is a benign condition that can occur after splenic trauma or after surgery involving the spleen. These splenic implants are most often seen within the abdominal and pelvic cavities. On imaging, splenosis can be confused with multiple additional entities including metastatic disease, peritoneal carcinomatosis, peritoneal mesothelioma, abdominal lymphoma, renal cancer, hepatic adenomas, or endometriosis depending on its distribution. In all patients with history of splenic surgery or trauma, splenosis should be on the differential diagnosis of soft tissue nodules in the abdomen and pelvis, especially in the absence of systemic symptoms, to avoid unnecessary biopsy, chemotherapy, or surgery.
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Affiliation(s)
- Yasmeen K Tandon
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
| | - Christopher P Coppa
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Andrei S Purysko
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA
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Xiao SM, Xu R, Tang XL, Ding Z, Li JM, Zhou X. Splenosis with lower gastrointestinal bleeding mimicking colonical gastrointestinal stromal tumour. World J Surg Oncol 2017; 15:78. [PMID: 28399879 PMCID: PMC5387232 DOI: 10.1186/s12957-017-1153-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/02/2017] [Indexed: 12/19/2022] Open
Abstract
Background Splenosis refers to the heterotopic transplantation of splenic tissue following splenic trauma or splenectomy. Splenosis is typically asymptomatic and is often identified incidentally. Case presentation We report a case of splenosis with colon and stomach invasion presenting as lower gastrointestinal bleeding and mimicking colonic gastrointestinal stromal tumour (GIST). The importance of suspicion for splenosis in patients with a history of splenic injury should be highlighted. Computed tomography (CT)-guided biopsy, nuclear scintigraphy and ferumoxide-enhanced magnetic resonance imaging (MRI) can support an accurate diagnosis. Conclusions An accurate diagnosis of splenosis is important to avoid unnecessary operations, especially in patients with previous histories of splenic trauma or splenectomy.
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Affiliation(s)
- Shuo-Meng Xiao
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Rui Xu
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Xiao-Li Tang
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Zhi Ding
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Ji-Man Li
- Department of Pathology, Sichuan Cancer Hospital, Chengdu, China
| | - Xiang Zhou
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China.
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