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zohra BF, Amine N, Hajar Z, Youssef O, Rachida L, Mouna K, Basma EK, Sanae A. Retroperitoneal pelvic schwannoma: A rare case report and review of the literature. Radiol Case Rep 2024; 19:3028-3032. [PMID: 38756950 PMCID: PMC11096702 DOI: 10.1016/j.radcr.2024.03.075] [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] [Received: 01/30/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/18/2024] Open
Abstract
Schwannoma, typically a non-cancerous tumor originating from Schwann cells, seldom occurs in the retroperitoneal area. Its clinical manifestation varies, often remaining asymptomatic for an extended period until it enlarges, exerting pressure on neighboring organs. This article presents a unique instance of retroperitoneal pelvic schwannoma in a 75-year-old woman, initially presenting with unusual lower back discomfort. Imaging was used to characterize the tumor, and anatomopathological examination established the preoperative diagnosis of pelvic schwannoma and its benign nature. The clinical, imaging, and anatomopathological aspects of this pelvic schwannoma case are elucidated herein.
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Affiliation(s)
- Benbrahim Fatima zohra
- Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Faculty of medicine and pharmacy, Mohamed V University, Rabat, Morocco
| | - Naggar Amine
- Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Faculty of medicine and pharmacy, Mohamed V University, Rabat, Morocco
| | - Zebbakh Hajar
- Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Faculty of medicine and pharmacy, Mohamed V University, Rabat, Morocco
| | - Omor Youssef
- Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Faculty of medicine and pharmacy, Mohamed V University, Rabat, Morocco
| | - Latib Rachida
- Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Faculty of medicine and pharmacy, Mohamed V University, Rabat, Morocco
| | - Khmou Mouna
- Department of Pathology, National Institute of Oncology, UHC Ibn Sina, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - El Khannoussi Basma
- Department of Pathology, National Institute of Oncology, UHC Ibn Sina, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Amalik Sanae
- Department of Radiology, National Institute of Oncology, UHC Ibn Sina, Faculty of medicine and pharmacy, Mohamed V University, Rabat, Morocco
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2
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Georgiou AC, Lisacek-Kiosoglous AB, Mariannis D, Christou S, Hadjianastassiou VG. A rare case of adrenal extramedullary haematopoiesis in a Cypriot woman with β-thalassaemia. Ann R Coll Surg Engl 2024; 106:329-337. [PMID: 34981986 PMCID: PMC10981986 DOI: 10.1308/rcsann.2021.0298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/22/2022] Open
Abstract
We report a rare case of adrenal extramedullary haematopoiesis (EMH) in a thalassaemia patient in Cyprus. A 40-year-old woman with β-thalassaemia presented with a 2-day history of non-specific right-sided abdominal pain on routine follow-up for her thalassaemia treatment. Her laboratory tests were not dissimilar to her routine results and no palpable mass was detected. Computed tomography findings revealed a 5.8×4.2×4.6cm solid lesion in the right adrenal gland. Surgical excision was advised for this symptomatic large tumour with the possibility of malignancy in a young patient, and a laparoscopic adrenalectomy was performed. Postoperative follow-up was uneventful. A review of the literature in PubMed and MEDLINE revealed 14 case reports worldwide with adrenal EMH secondary to β-thalassaemia. EMH tumours in patients with thalassaemia have been reported incidentally, which stresses the importance of considering this in the list of differentials of adrenal incidentalomas in this patient population.
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Affiliation(s)
| | | | - D Mariannis
- Makarios Thalassemia Hospital Nicosia, Cyprus
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3
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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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4
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Zhong X, Yang L, Huang J, Deng L, Nie L, Lu Q. Contrast-enhanced ultrasonographic imaging of hepatic splenosis: A case report. Medicine (Baltimore) 2021; 100:e24243. [PMID: 33546044 PMCID: PMC7837972 DOI: 10.1097/md.0000000000024243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Hepatic splenosis or heterotopic auto-transplantation of spleen in the liver usually occurs after either spleen trauma or surgery. It is of great importance for the differential diagnosis of hepatic splenosis and other liver tumors because surgery is usually not needed if a diagnosis of splenosis is confirmed. PATIENT CONCERNS Multiple hepatic masses were revealed by grayscale ultrasound in a 55-year-old man complaining of persistent colic in the upper abdomen after greasy food. DIAGNOSIS Benign neoplasm with enlarged lymph node in the gastro-hepatic ligament was suspected by contrast enhanced US. The nature of the hepatic mass was undetermined by CECT. INTERVENTIONS The lesions were surgically removed. OUTCOMES Multiple splenic tissue implants in the liver and peritoneum were confirmed by pathology after surgery. The patient recovered well and was followed up for more than 1 year without recurrence. LESSONS Splenosis should be included in the differential diagnosis of focal liver lesion in patients with a history of spleen trauma or surgery. In spite of nonspecific findings on pre-contrast ultrasound, splenosis shows characteristic homogeneous hyperenhancement in arterial and portal phases, as well as prolonged hyperenhancement in the late phase for more than 5 minutes. Furthermore, the confidence of the diagnosis of splenosis may be enhanced by identifying multiple masses with similar enhancing patterns in other regions of the abdominal cavity.
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Affiliation(s)
| | | | | | | | - Ling Nie
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
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5
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Toh WS, Chan KS, Ding CSL, Tan CH, Shelat VG. Intrahepatic splenosis: a world review. Clin Exp Hepatol 2020; 6:185-198. [PMID: 33145425 PMCID: PMC7592095 DOI: 10.5114/ceh.2020.99509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023] Open
Abstract
Splenosis is defined as the autotransplantation of viable splenic tissue throughout various anatomic compartments. Intrahepatic splenosis (IHS) is rare and diagnosis is often challenging. This study aims to provide a comprehensive review on IHS. A literature review was performed on PubMed database. Fifty-six articles with 59 reported cases were included. The majority of the patients were male (n = 49, 83.1%). Median age was 51 years. Risk factors for hepatocellular carcinoma (HCC) included hepatitis B (n = 8, 13.6%) and cirrhosis (n = 12, 20.3%). The majority of the patients were asymptomatic (62.7%) and did not have risk factors for HCC (55.9%). We report a diagnostic triad for IHS: 1) previous history of abdominal trauma or splenectomy, 2) absence of risk factors for liver malignancy and 3) typical imaging features. Non-invasive diagnostic tests such as technetium-99m-tagged heat-damaged red blood cell scintigraphy are useful in diagnosis. Malignancy should be ruled out in the presence of risk factors for HCC.
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Affiliation(s)
| | - Kai Siang Chan
- MOH Holdings, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Address for correspondence: Dr. Kai Siang Chan, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, e-mail:
| | | | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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6
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Ananthan K, Yusuf GT, Kumar M. Intrahepatic and intra-abdominal splenosis: A case report and review of literature. World J Hepatol 2019; 11:773-779. [PMID: 31966909 PMCID: PMC6960294 DOI: 10.4254/wjh.v11.i12.773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/11/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Splenosis is defined as the process by which tissue from the spleen disseminates through the body and grows in an ectopic location following trauma or a splenectomy. Visceral sites of splenosis are rare.
CASE SUMMARY We report a case of intrahepatic splenosis in a 57-year-old man with a history of trauma over 40 years ago who initially presented with chest pain. Findings initially mimicked malignancy but a diagnosis of intrahepatic splenosis was confirmed using computed tomography and scintigraphy with technetium-99m heat-denatured red blood cells (Tc-99 DRBC).
CONCLUSION Scintigraphy with Tc-99 DRBC is a reliable technique to diagnose splenosis and should be performed before using more invasive procedures are carried out. Splenosis should be considered as a possible differential diagnosis for a hepatic nodule in any patient with a history of abdominal trauma, previous splenectomy or atypical radiological features on imaging.
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Affiliation(s)
- Kiruthika Ananthan
- GKT School of Medical Education, King’s College London, London WC2R 2LS, United Kingdom
| | - Gibran Timothy Yusuf
- Department of Radiology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Kent BR6 8ND, United Kingdom
| | - Mayur Kumar
- Department of Gastroenterology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Kent BR6 8ND, United Kingdom
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7
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Luo X, Zeng J, Wang Y, Min Y, Shen A, Zhang Y, Deng H, Gong N. Hepatic splenosis: Rare yet important - A case report and literature review. J Int Med Res 2019; 47:1793-1801. [PMID: 30810057 PMCID: PMC6460629 DOI: 10.1177/0300060519828901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/15/2019] [Indexed: 12/12/2022] Open
Abstract
Hepatic splenosis is an uncommon condition that occurs following traumatic splenic rupture or splenectomy. The case of a 41-year-old male patient with multiple isolated liver masses indistinguishable from primary and metastatic liver tumours is reported. Following laparotomy, the liver lesions were resected and histopathology confirmed a diagnosis of hepatic splenosis. At an 18-month follow-up examination, no abnormalities in routine blood test, liver function, and liver computed tomography (CT) scanning were observed. After review of the literature, the following diagnostic criteria for hepatic splenosis are proposed: (1) a history of splenic trauma or splenectomy; (2) lesion(s) with a surrounding rim, particularly near the liver capsule identified by CT scanning; (3) findings on superparamagnetic iron oxide-enhanced magnetic resonance imaging or technetium-99m heat-damaged red cell scanning; and (4) histopathological findings (needle biopsy or surgical pathology). The following diagnostic process is also proposed: suspect diagnosis when criteria 1 and 2 are met; make diagnosis when criterion 3 is met; confirm diagnosis when criterion 4 is met. Laparotomy is recommended for either diagnosis or treatment when invasive procedures are necessary.
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Affiliation(s)
- Xianzhang Luo
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Jianting Zeng
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Yu Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Ye Min
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Ai Shen
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Yi Zhang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Hejun Deng
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Nianqiao Gong
- Institute of Organ Transplantation, Key Laboratory of the Ministry of Health and Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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8
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Bhogal RH, Wotherspoon A, Zerizer I, Khan AZ. Pancreatic tail splenunculus: Case report and review of the literature. Int J Surg Case Rep 2019; 57:36-38. [PMID: 30884375 PMCID: PMC6424060 DOI: 10.1016/j.ijscr.2019.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 11/24/2022] Open
Abstract
Solitary pancreatic tail lesion should undergo nuclear scintigraphy to assess whether the lesion is compatible with a splenunculus.
Introduction Mass lesions in the pancreatic tail are increasingly identified upon radiological imaging. However the diagnosis of these lesions can be challenging and impact significantly upon patient management. Presentation of case We report a case of an intrapancreatic accessory spleen initially diagnosed as a neuroendocrine tumour of the pancreas tail following nuclear scintigraphy. Discussion The investigation of solitary pancreatic tail lesions and the potential management paradigms are discussed. Conclusion Solitary lesions within the pancreatic tail should have splenunculus included in the differential diagnosis.
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Affiliation(s)
- Ricky H Bhogal
- Department of Academic Surgery, The Royal Marsden Hospital, Fulham Road, Chelsea, London, SW3 6JJ, United Kingdom.
| | - Andrew Wotherspoon
- Department of Histopathology, The Royal Marsden Hospital, Fulham Road, Chelsea, London, SW3 6JJ, United Kingdom
| | - I Zerizer
- Department of Nuclear Medicine and Radiology, The Royal Marsden Hospital, Fulham Road, Chelsea, London, SW3 6JJ, United Kingdom
| | - Aamir Z Khan
- Department of Academic Surgery, The Royal Marsden Hospital, Fulham Road, Chelsea, London, SW3 6JJ, United Kingdom
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9
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Ding Q, Ren Z, Wang J, Ma X, Zhang J, Sun G, Zuo C, Gu H, Jiang H. Intrapancreatic accessory spleen: Evaluation with CT and MRI. Exp Ther Med 2018; 16:3623-3631. [PMID: 30250526 DOI: 10.3892/etm.2018.6613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/23/2018] [Indexed: 01/05/2023] Open
Abstract
The aim of the present study was to evaluate the characteristics of computed tomography (CT) and magnetic resonance imaging (MRI), particularly diffusion-weighted imaging (DWI), in the imaging of intrapancreatic accessory spleen (IPAS). The clinical and pathological records of 9 patients, including 8 patients with IPAS and 1 patient with splenosis, were reviewed. The patients had undergone plain and triple-phase enhanced CT scanning (n=9) and MRI scanning (n=8). The lesions of the 8 IPAS patients were located in the pancreatic tail, and were round (n=3), oval (n=4) or triangular (n=1) in shape. The CT and/or MRI densities, signal intensities and dynamic enhanced patterns of the lesions were similar to those of the orthotopic spleen. In DWI images (n=5), the IPAS regions presented high signal intensity (SI), and no significant difference in the apparent diffusion coefficient determined using a b-value of 600 sec/mm2 was identified between the IPAS and orthotopic spleen (P>0.05). One patient with splenosis complicated with cirrhosis had a nodule located in the pancreatic tail with an unenhanced CT value of 65 HU. In MRI examination, with the exception of the dynamic enhancement pattern, the T1-weighted, T2-weighted and DWI signals of splenosis were inconsistent with those of the normal spleen. In conclusion, in pre-contrast and post-contrast-enhanced CT and MRI images, IPAS exhibits similar characteristics to the orthotopic spleen. CT and MRI used in combination with DWI are important in the diagnosis of IPAS.
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Affiliation(s)
- Qianjiang Ding
- Department of Radiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Zhihao Ren
- Department of Radiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Jianhua Wang
- Department of Radiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315020, P.R. China
| | - Xiaolong Ma
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Jian Zhang
- Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Gaofeng Sun
- Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Changjing Zuo
- Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Hao Gu
- Department of Pathology, Ningbo Second Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Hui Jiang
- Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
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10
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Xuan Z, Chen J, Song P, Du Y, Wang L, Wan D, Zheng S. Management of intrahepatic splenosis:a case report and review of the literature. World J Surg Oncol 2018; 16:119. [PMID: 29954390 PMCID: PMC6022698 DOI: 10.1186/s12957-018-1419-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/22/2018] [Indexed: 12/12/2022] Open
Abstract
Background Splenosis is the heterotopic autotransplantation and implantation of splenic tissue after splenic trauma or splenectomy. Considering that splenosis often occurs in the mesentery, omentum, and peritoneum, intrahepatic splenosis has seldom been reported. We report a rare case of isolated intrahepatic splenosis in a 54-year-old man who presented with a liver mass thought to be hepatocellular carcinoma. Case presentation A 54-year-old man was referred to our hospital for further evaluation of a liver lesion. The patient was asymptomatic and had a history of emergent splenectomy after a high-altitude falling accident. Abdominal contrast-enhanced computed tomography revealed a 4.5 × 3.3 cm lesion that was located in segment IV of the left liver lobe. The lesion had an inhomogeneous enhancement during the arterial phase and diminished enhancement during the portal and equilibrium phases. Similar radiological features were also observed on a contrast magnetic resonance imaging scan. Partial hepatectomy was performed with the suspicion of hepatocellular carcinoma. Pathological examination of the liver specimen revealed intrahepatic splenosis. Conclusion Splenosis should be considered in differential diagnosis of a liver mass discovered years after splenic trauma or surgery. A proposed scoring system may be helpful in evaluating the suspicious degree of intrahepatic mass to be splenosis. Invasive treatments are not recommended for asymptomatic patients, since the splenosis can provide beneficial immunologic function.
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Affiliation(s)
- Zefeng Xuan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Jian Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Penghong Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Yehui Du
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Lijun Wang
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Dalong Wan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China. .,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.
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11
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Wang WC, Li XF, Yan ZL, Wang Y, Ma JY, Shi LH, Zhang XF. Intrahepatic splenosis mimics hepatocellular carcinoma in a patient with chronic hepatitis B: A case report and literature review. Medicine (Baltimore) 2017; 96:e8680. [PMID: 29381947 PMCID: PMC5708946 DOI: 10.1097/md.0000000000008680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Splenosis is a benign and relatively uncommon condition caused by trauma or splenectomy or other procedures involving splenic tissue. It is usually asymptomatic, and often diagnosed accidentally, especially misdiagnosed as malignant tumor. METHODS A 54-year-old man with prior history of chronic hepatitis B virus infection and underwent splenectomy for traumatic splenic rupture following a traffic accident 23 years previously was admitted to our hospital and found a hepatic mass in the right upper quadrant during an imaging examination. The diagnosis of his was not clear and finally he agreed to receive a surgical treatment. RESULTS During the operation, we found a mass in the right posterior lobe of the liver and a hard nodule on the right side of the diaphragm, both were completely resected, and postoperative histopathologic examination revealed that all excised tissues were proved to have histological structure typical for the spleen. CONCLUSIONS The occurrence of intrahepatic splenosis is rare with only few cases previously reported in the literature. It is a benign disease and sometimes difficult to distinguish from diseases of the liver. The need for positive surgical resection of splenosis is still controversial.
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Affiliation(s)
- Wen-Chao Wang
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
- Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xi-Feng Li
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
| | - Zhen-Lin Yan
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
| | - Yu Wang
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
| | - Jun-Yong Ma
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
| | - Le-Hua Shi
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
| | - Xiao-Feng Zhang
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University
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12
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Wang MY, Li B, Chen D, Liu AL, Qamar S, Sun MY. Spleen implanting in the fatty liver mimicking hepatocarcinoma in a patient with hepatitis B&C: A case report and literature review. Medicine (Baltimore) 2017; 96:e7217. [PMID: 28640113 PMCID: PMC5484221 DOI: 10.1097/md.0000000000007217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Ectopic splenic autotransplantation refers to the heterotopic autotransplantation of splenic tissue and no treatment is necessary for it when patient is asymptomatic. Its incidence rate is reported up to 67% among patients with a history of splenic trauma and splenic surgery. The diagnosis of it before operation is really difficult, and it is easy to mimic as other tumors. PATIENT CONCERNS We reported a 42-year-old man with hepatic splenosis, with history of splenectomy for traumatic splenic rupture 16 years ago and hepatitis B&C. The patient was enrolled with recurrent low back pain for more than 1 month without any treatment. DIAGNOSES Radiological imaging revealed a subcapsular hepatic nodule, showing "fast-in and fast-out" enhancement. Surgery was performed, and the result of histological diagnosis was hepatic splenosis. INTERVENTIONS No intervention before segmentectomy of the liver. LESSONS When imaging of a patient with history of traumatic splenic rupture or splenectomy shows1 or few well circumscribed hepatic nodules with enhancement in dynamic study, we should suspect hepatic splenosis, for the purpose of avoiding unnecessary surgery.
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Affiliation(s)
| | | | - Dan Chen
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
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Foreman D, Plagakis SA. Splenunculi mimicking metastases in a patient with locally advanced prostate cancer. World J Clin Urol 2016; 5:93-96. [DOI: 10.5410/wjcu.v5.i3.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
A 61-year-old man with locally advanced prostate cancer was found to have multiple solid intra-abdominal solid lesions during staging investigations. While some were in the pelvis, they were not located in the common landing sites for prostate cancer metastases, and his prostate specific antigen was not significantly elevated to suggest a high burden of metastatic disease. He reported a history of a blunt abdominal trauma due to a motor vehicle accident more than forty years ago which had been conservatively managed. His staging imaging revealed a lack of a discrete spleen in his left upper abdomen and this raised the suspicion that these solid lesions may represent ectopic splenic tissue. Imaging with nuclear medicine scintigraphy confirmed the lesions in his upper abdomen and pelvis to be splenunculi. He proceeded with a combination of androgen deprivation therapy and external beam radiotherapy for locally advanced, non-metastatic prostate cancer. Although it has been described in patients with low risk prostate cancer, this is the first case report of splenunculi mimicking metastases in a patient with locally advanced prostate cancer.
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Sufian SN, Masroor I, Mirza W, Butt S, Afzal S, Sajjad Z. Evaluation of Common Risk Factors for Breast Carcinoma in Females: a Hospital Based Study in Karachi, Pakistan. Asian Pac J Cancer Prev 2016; 16:6347-52. [PMID: 26434841 DOI: 10.7314/apjcp.2015.16.15.6347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast malignancies are one of the leading causes of deaths in females worldwide. There are a number of risk factors associated with breast cancer but in Karachi Pakistan there are insufficient data available. MATERIALS AND METHODS A case control study was conducted on females in age group between 30-80 years. This study was accomplished by retrospective data collection in Aga Khan University Hospital Karachi, Pakistan. A total of 108 females with primary malignancy of breast were included along with 108 matched controls. Relationship of various factors with disease was studied using logistic regression to calculate odds ratios with 95 % confidence intervals. RESULTS A total of 14 variables were analyzed and based on and 7 were found to be risk factors: old age, family history of breast cancer, family history of other carcinomas, personal history of breast carcinoma, early age of menarche, older age of mother at first delivery and lower number of children. Five factors, parity, breast feeding, history of oral contraceptive pills intake, past history of oophorectomy and hysterectomy showed protective associations. One variable, use of hormonal replacement therapy, showed a controversial link and one other, marital status, was not significant in this study. CONCLUSIONS It is concluded that most of the well-known risk factors for breast cancer are also associated with the disease in the female population of Karachi, Pakistan. High risk patients should be the focus with the help of this study so that screening can be more effective for early diagnosis before clinically evident breast malignancy.
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Affiliation(s)
- Saira Naz Sufian
- Department of Diagnostic Radiology, Aga Khan University Hospital Karachi, Pakistan E-mail :
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15
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Hepatic splenosis mimicking liver metastases in a patient with history of childhood immature teratoma. Radiol Oncol 2016; 50:212-7. [PMID: 27247554 PMCID: PMC4852965 DOI: 10.2478/raon-2014-0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/28/2014] [Indexed: 12/12/2022] Open
Abstract
Background Hepatic splenosis is rare condition, preceded by splenectomy or spleen trauma, the term refers to nodular implantation of normal splenic tissue in the liver. In patients with history of malignancy in particular, it can be mistaken for metastases and can lead to unnecessary diagnostic procedures or inappropriate treatment. Case report Twenty-two-year old male was treated for immature teratoma linked to undescended right testicle after birth. On regular follow-up examinations no signs of disease relapse or long-term consequences were observed. He was presented with incidental finding of mature cystic teratoma after elective surgery for what appeared to be left-sided inguinal hernia. The tumour was most likely a metastasis of childhood teratoma. Origin within remaining left testicle was not found. Upon further imaging diagnostics, several intrahepatic lesions were revealed. Based on radiologic appearance they were suspicious to be metastases. The patient underwent two ultrasound guided fine-needle aspiration biopsies. Cytologic diagnosis was inconclusive. Histology of laparoscopically obtained tissue disclosed presence of normal splenic tissue and led to diagnosis of hepatic splenosis. Conclusions Though hepatic splenosis is rare, it needs to be included in differential diagnosis of nodular hepatic lesions. Accurate interpretation of those lesions is crucial for appropriate management of the patient. If diagnosis eludes after cytologic diagnostics alone, laparoscopic excision of nodular lesion is warranted before considering more extensive liver resection.
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Abstract
We present a patient with a remote history of splenectomy and recent hemicolectomy for colon adenocarcinoma. On routine surveillance chest/abdomen/pelvis CT, a lesion suspicious for hepatic metastasis was identified. Followup MRI was inconclusive. For more specific tissue characterization, imaging with Tc-99m heat-damaged RBCs was obtained to guide further patient management. Tc-99m–labeled, heat-damaged RBC scintigraphy is an underused modality that is highly specific for detecting ectopic or accessory splenic tissue. There have been many reported cases of patients undergoing unnecessary biopsies or laparotomies to remove suspicious masses that were subsequently found to be ectopic splenic tissue.
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Gul A, Ustundag H, Andsoy II, Kalkanli S. Anxiety and Pain in Surgically Treated Breast Cancer Patients. Asian Pac J Cancer Prev 2015; 16:4261-4. [DOI: 10.7314/apjcp.2015.16.10.4261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Wu C, Zhang B, Chen L, Zhang B, Chen X. Solitary perihepatic splenosis mimicking liver lesion: a case report and literature review. Medicine (Baltimore) 2015; 94:e586. [PMID: 25738479 PMCID: PMC4553962 DOI: 10.1097/md.0000000000000586] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic splenosis, one type of manifestation of ectopic spleen tissue, is rarely reported. It cannot be distinguished from hepatic malignancies because of lack of significant radiological features. By means of this case report and 31 literature reviews, potential treatment modalities concerning clinical diagnostics, patient's management could be discussed.The report presents the case of a 33-year-old man with a liver lesion. Finally, after a mini-incision laparotomy, the lesion was resected and the diagnosis confirmed it as hepatic splenosis. A literature search for case reports published between January 1, 1900, and August 1, 2014, was performed on PubMed.Approximately 80% (27/34) of patients diagnosed with hepatic splenosis had a history of splenectomy. The mean time interval between splenectomy and hepatic splenosis detection was 25 (1.5-47) years. The median size of reported hepatic splenosis is 30 mm in diameter. Technetium-99m-labeled heat denatured red-blood-cells scintigraphy or superparamagnetic iron oxide-enhanced magnetic resonance imaging is now considered to be the optimal method of diagnosing splenosis.Hepatic splenosis requires no treatment in most cases. Operation should be performed if it is accompanied by hypersplenism in hematological diseases. When the diagnosis remains unclear, further biopsy or laparoscopy is recommended. If hepatic splenosis is confirmed, careful follow-up is beneficial.
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Affiliation(s)
- Chao Wu
- From the Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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19
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Sato N, Abe T, Suzuki N, Waragai M, Teranishi Y, Takano Y, Sato A, Azami A, Gotoh M. Intrahepatic splenosis in a chronic hepatitis C patient with no history of splenic trauma mimicking hepatocellular carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:416-20. [PMID: 25261602 PMCID: PMC4179547 DOI: 10.12659/ajcr.890999] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intrahepatic splenosis (IHS) is the autotransplantation of splenic tissue that mostly develops after abdominal injury and is often misdiagnosed as hepatocellular carcinoma (HCC) because of similarities in radiological features. We had an opportunity to treat an extremely rare case of intrahepatic splenosis, which were found in a patient without any history of splenic injury. To the best of our knowledge, this is the first such case report in the world. CASE REPORT A 58-year-old man with chronic hepatitis C was referred to our hospital for further examination of liver function abnormality. Abdominal ultrasonography incidentally revealed a low echoic tumor in the posterior segment of the liver, with high echoic capsule, which is possibly different from tumor capsule of HCC, known as halo. Abdominal contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging showed that the tumor had an inhomogeneous enhancement in the arterial phase and diminished enhancement in the equilibrium phase, diagnosed as HCC. The patient underwent right lateral segmentectomy of the liver, and histopathological study confirmed a diagnosis of intrahepatic splenosis. CONCLUSIONS This case presents a new understanding of IHS in a patient without any splenic injury. We also focused on the differences in echo patterns of the tumor capsule between HCC and IHS, which can be used to efficiently diagnose IHS.
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Affiliation(s)
- Naoya Sato
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Tsuyoshi Abe
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Nobuyasu Suzuki
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Mitsuru Waragai
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Yasushi Teranishi
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Yoshinao Takano
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Atai Sato
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Ayaka Azami
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Mitsukazu Gotoh
- Department of Regenerative Surgery, Fukushima Medical University, Fukushima, Japan
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Sorensen SF, Mortensen FV, Hellberg Y, Ladekarl M. Diffuse abdominal splenosis mimicking peritoneal metastases in a 35-year-old man with a resectable carcinoma of the ampulla of vater. Case Rep Oncol 2013; 6:467-71. [PMID: 24163662 PMCID: PMC3806701 DOI: 10.1159/000355233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 35-year-old man with a history of blunt abdominal trauma and splenic rupture was diagnosed with an ampullary adenocarcinoma. At workup, a CT scan showed multiple intra-abdominal lesions similar to peritoneal carcinosis, and the patient was referred for palliative chemotherapy. On clinical suspicion, however, a biopsy was performed on an intra-abdominal lesion, establishing the diagnosis of abdominal splenosis. A radical pancreaticoduodenectomy ad modum Whipple was performed, followed by adjuvant chemotherapy with gemcitabine. At the 18-month follow-up, the patient was free from recurrent disease. We conclude that splenosis should be considered as a differential diagnosis of peritoneal metastases in cancer patients with a history of abdominal trauma and/or splenectomy. Other reports on splenosis in cancer patients and diagnostic workup are discussed.
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Laparoscopic resection of isolated hepatic splenosis mimicking liver tumors: case report with a literature review. Surg Laparosc Endosc Percutan Tech 2013; 22:e307-11. [PMID: 23047415 DOI: 10.1097/sle.0b013e318263a3f3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Isolated hepatic splenosis is a rare condition in hepatobiliary surgery. In this study, we report a case of this condition managed by laparoscopic surgery. A 38-year-old male hepatitis B virus carrier, who had a motorcycle accident and splenectomy 14 years before the current incident, was hospitalized due to a hepatic mass. His laboratory tests were consistent with a hyposplenic state, whereas radiologic images revealed a benign tumor in the left liver lobe located in a site difficult to access with preoperative biopsy. Therefore, we performed a laparoscopic exploration and total resection, which revealed a bluish oval encapsulated nodule in the narrow gap between the diaphragm, falciform ligament, and left hepatic capsule. The pathologic diagnosis was hepatic splenosis. Unlike other patients with multiple intraperitoneal lesions and relatively normal splenism, this is the first case of isolated hepatic splenosis with evident hyposplenism managed by laparoscopic approach in the English literature.
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Interleukin 6 (IL6) as a predictor outcome in patients with compensated cirrhosis and symptomatic gall stones after cholecystectomy. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2012. [DOI: 10.1016/j.ejmhg.2012.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kang KC, Cho GS, Chung GA, Kang GH, Kim YJ, Lee MS, Kim HK, Park SJ. Intrahepatic splenosis mimicking liver metastasis in a patient with gastric cancer. J Gastric Cancer 2011; 11:64-8. [PMID: 22076204 PMCID: PMC3204479 DOI: 10.5230/jgc.2011.11.1.64] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/03/2011] [Indexed: 12/13/2022] Open
Abstract
A 54 year old man was referred to our hospital with gastric cancer. The patient had a history of splenectomy and a left nephrectomy as a result of a traffic accident 15 years earlier. The endoscopic findings were advanced gastric cancer at the lower body of the stomach. Abdominal ultrasonography (USG) and magnetic resonance imaging demonstrated a metastatic nodule in the S2 segment of the liver. Eventually, the clinical stage was determined to be cT2cN1cM1 and a radical distal gastrectomy, lateral segmentectomy of the liver were performed. The histopathology findings confirmed the diagnosis of intrahepatic splenosis, omental splenosis. Hepatic splenosis is not rare in patients with a history of splenic trauma or splenectomy. Nevertheless, this is the first report describing a patient with gastric cancer and intrahepatic splenosis that was misinterpreted as a liver metastatic nodule. Intra-operative USG guided fine needle aspiration should be considered to avoid unnecessary liver resections in patients with a suspicious hepatic metastasis.
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Affiliation(s)
- Kyu Chul Kang
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
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Abstract
Hepatic splenosis is a nodular implant of normal spleen tissue in the liver. This innocent liver nodule is frequently misinterpreted as a malignancy. Almost all hepatic splenoses have been associated with a clinical history of splenic trauma or prior surgery. This report describes two cases of hepatic splenosis. In both patients, the nodular lesions were initially thought to be liver malignancies and they were ultimately assessed by histology. The clinico-pathological findings of all published cases of liver splenosis underwent critical review. Although they are rare, hepatic spleen nodules should always be included in the diagnostic spectrum of nodular liver lesions because of their impact on treatment decisions.
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Affiliation(s)
- Claudia Mescoli
- Department of Pathology, University of Padova, Padova, Italy
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