A rare case of pancreatic splenosis and a literature review

Splenosis is a clinical condition characterized by the presence of ectopic splenic tissue in the abdominal cavity occurring after abdominal trauma or surgical procedure involving the spleen. We present a case of an 80-year-old Caucasian male who underwent splenectomy at the age of 36, with a prior diagnosis of cancer of the left kidney associated with a pancreatic neoformation. This study compare our case with similar published and reviev the Literature. KEY WORDS: Accessory spleen, Differential diagnosis, Kidney cancer,Laparotomy, Nephrectomy, Pancreas, Pancreatic splenosis, Splenosis.

Hepatic splenosis: Rare yet important - A case report and literature review

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.

Splenosis: a great mimicker of neoplastic disease

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.

Gastric fundus splenosis with hemangioma masquerading as a gastrointestinal stromal tumor in a patient with schistosomiasis and cirrhosis who underwent splenectomy: A case report and literature review

RATIONALE

Splenosis is the heterotopic auto-transplantation of the splenic tissues. Gastric splenosis in a rare location mimics a gastrointestinal stromal tumor (GIST). Gastric splenosis with hemangioma has not been reported throughout the literature.

PATIENT CONCERNS

We report a case of a 74-year-old schistosomiasis cirrhosis splenectomy woman diagnosed with gastric fundus mass. Preoperative computed tomography and endoscopic ultrasonography revealed findings suggestive of a GIST.

DIAGNOSES

The mass located in the gastric fundus muscularis propria, measuring 3.9 × 2.8 × 2.4 cm with a dark red color, was removed by surgery. In the mass, a 1 × 1-cm red-purple nodule was also found. On microscopic examination, a well-formed splenic tissue divided into two compartments-white pulp and red pulp-separated by an ill-defined interphase known as the marginal zone. However, a nodule in the heterotopic spleen was mainly composed of larger thin-walled muscular vessels. The final diagnosis was gastric splenosis with hemangioma.

INTERVENTIONS

After discussion in a multidisciplinary conference, the patient was considered for a GIST resection under gastroscopy. In the process of peeling, the surface of the mucosal, submucosal, muscle layers and the tumor surface were diffusely oozing. The effect of electrocoagulation and hemostasis was extremely poor. Therefore, endoscopic surgery was arrested. After dealing with the patient's family, a combination of laparoscopic-gastroscope double-mirror surgery was decided in accordance with the principle of minimally invasive surgery to preserve the stomach. Owing to several adhesions and concealed the location of tumor, we stopped the double-mirror combination surgery plan. Considering the great possibility of a malignant GIST, we still decided to continue the traditional surgical resection. The tumor was then removed via surgery OUTCOMES:: The patient was favorable with healing and discharged on postoperative day 10.

LESSONS

Gastric splenosis with an associated hemangioma is the first well-documented case. Its pathogenesis may be direct implantation. Appropriate medical history taking and Tc-99 m heat-denatured RBC spleen scintigraphy (Tc-99MHDRS) are valuable for its diagnosis; however, pathology is the gold standard. Surgery is a reasonable treatment for gastric splenosis with hemangioma.

Intrahepatic splenosis mimics hepatocellular carcinoma in a patient with chronic hepatitis B: A case report and literature review

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.

Spleen implanting in the fatty liver mimicking hepatocarcinoma in a patient with hepatitis B&C: A case report and literature review

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.

Symptomatic isolated thoracic splenosis 11 years after abdominal trauma – Case report

INTRODUCTION

Thoracic splenosis is defined as the autotransplantation of splenic tissue into thorax. It occurs due to splenic rupture in association with a diaphragmatic tear on the left side after a traumatic event. It is a rare disease that most commonly remains undiscovered as it is usually asymptomatic.

CASE OUTLINE

We present a symptomatic case of thoracic splenosis in a 53-year-old smoker male patient with a medical history of abdominal surgery and splenectomy for a thoracoabdominal gunshot. Three years before the medical examination he was suffering from dyspnea, frequent coughing, left pleuritic chest pain and complained about faster fatigue. A chest radiograph obtained during a medical checkup showed a multinodular left pleura-based mass in the upper lobe. Established histopathological diagnosis after surgical removal of the nodule was splenosis. No evidence of malignancy was observed.

CONCLUSION

Splenosis should be considered as a differential diagnosis by the undertaken workup of left pulmonary nodules or masses in patients with a history of trauma.

Laparoscopic surgical treatment of hepatic splenosis. A case report

AIM

Isolated hepatic splenosis is a rare but possible condition in abdominal surgery. At radiological imaging liver splenosis mimics malignant or pathological condition of the liver; obtaining a certain diagnosis prior to surgery is difficult. For this reason, the patients undergo to unnecessary operation, with a laparotomy access. We report a case of suspicious liver mass removed laparoscopically and revealed as hepatic splenosis.

CASE REPORT

A 31 years old man patient was admitted to our Institution because of upper chronic abdominal pain. Thirteen years before the recovery the patient was operated of splenectomy with laparotomic incision. Computerized Tomography and Magnetic Resonance demonstrated the presence of suspicious hepatic mass in the III segment.

RESULTS

The mass has been radically excised with laparoscopic approach. Postoperative stay was good and patient was discharged seven day after the operation. At histological examination ectopic splenic tissue on liver surface was found (socalled splenosis).

DISCUSSION AND CONCLUSION

Hepatic splenosis is not a rare condition and should be considered with the differential diagnosis especially in patients who had previous splenectomy and absence of liver cirrhosis. Laparoscopic exploration should always be preferred for the diagnosis of uncertain liver mass. Few works report laparoscopic excision for liver splenosis. For experience at our Institution laparoscopic procedure has an important role to get the diagnosis and it is also a feasible approach for minimally invasive resection.

KEY WORDS

Laparoscopy, Liver, Splenosis.

[Splenosis as a rare cause of abdominal pain]

INTRODUCTION

Splenosis is the autotransplantation of splenic tissue in atypical locations in the abdomen, chest or other parts of the body.

CASE REPORT

Authors present a case of splenosis in a 35 years old woman hospitalized with abdominal pain, who underwent splenectomy for traumatic rupture with splenic tissue implantation in the omentum 19 years ago. Surgical revision was indicated for intensive pain. Histopathology confirmed the diagnosis of splenosis in the excised tissue.

CONCLUSION

Despite the abandonment of splenic tissue autotransplantation after splenectomy, surgeons may still encounter the diagnosis of splenosis in patients after traumatic splenic rupture. Any incidental finding of splenosis during an operation for another indication should be sent for histopathology examination.

KEY WORDS

splenosis, splenectomy abdominal pain scintigraphy.

Splenosis in gastric fundus mimicking gastrointestinal stromal tumor: a report of two cases and review of the literature

Splenosis refers to heterotopic autotransplantation and implantation of splenic tissue following splenic trauma or surgery. Splenosis in gastric fundus is rare and difficult to diagnose, since splenosis has similar manifestation with gastrointestinal stromal tumor (GIST) under routine endoscopy examination. In this report, we present two quite rare case of splenosis. Both of their pre-operative diagnose under endoscopic ultrasonography was considered as GIST. Finally, one in the abdominal cavity, adhering closely to the gastric fundus, measuring 20 mm × 15 mm, was resected by surgical operation, and one in the gastric fundus, measuring 20 mm × 20 mm, was resected by endoscopic surgery. The precise diagnosis of splenosis was distinct by post-operative histopathologic examination. In addition, we also made a mini review of previously published articles, in order to provide indication to solve future doubts in diagnosing and treating splenosis.

[Thoracic splenosis]

Thoracic splenosis is a rare clinical condition consisting in the heterotopic autotransplantation of pieces of splenic tissue into the chest, following a previous trauma, with spleen and diaphragm laceration. In this paper, the authors report the clinical case of a thoracic splenosis in a 26 years old male, who had suffered a severe thoraco-abdominal trauma in childhood, leading to an emergency splenectomy. The patient, with the previous diagnosis of malignancy, namely pleural fibrotic tumors, underwent surgical management for removal of some nodular tumors of the pleura. Pathological studies confirmed the diagnosis of thoracic splenosis. The clinical diagnosis of thoracic splenosis should be suspicious facing asymptomatic patients, with a history of previous thoraco-abdominal trauma and nodular peripheral tumors in the chest x-rays.

Massive gastrointestinal bleeding due to splenotic nodule of the gastric wall. A case report

Splenosis results from autotransplantation of splenic tissue after traumatic splenic rupture or surgery. Usually asymptomatic, splenosis is an incidental finding at surgery, unrelated to the splenosis, for intestinal obstruction or suspected appendicitis or gynaecological pathology. This article describes a unique case of massive gastrointestinal bleeding caused by deep invasion of a splenotic nodule into the gastric wall.

Intra-Abdominal Splenosis Following Laparoscopic Splenectomy Causing Recurrence in a Child with Chronic Immune Thrombocytopenic Purpura

In this paper, we present the case of a 12-year-old boy with refractory, symptomatic immune thrombocytopenic purpura (ITP) who underwent a laparoscopic splenectomy (LS). During morcellation of the spleen the retrieval bag ruptured. Thirteen (13) months postoperatively, the patient developed further symptoms and was found to be thrombocytopenic. Tc-99m heat-damaged red blood cell scintigraphy showed an accumulation of heat-damaged red cells in the upper left quadrant, raising the possibility of missed accessory spleen. Laparoscopic exploration revealed widespread intra-abdominal splenosis, and a therapeutic omentectomy was carried out. Fourteen (14) months post-surgery, platelet counts improved and the patient remains well. Following an elective splenectomy, a relapse in ITP may be the result of missed accessory spleen or splenosis; in others, it may the result of ongoing platelet consumption in non-splenic, reticulo-endothelial tissue. During LS, consideration must therefore be given to the risk of not only leaving additional splenic tissue behind, but also to the possibility of accidental autotransplantation, such as that from laparoscopic bag rupture. The risk of rupture can be minimized by using blunt instruments and stronger bag materials. If a rupture does occur, immediate suction and a thorough search for splenic fragments must be undertaken. Further development is needed into new techniques for organ retrieval and stronger bag materials.

Distinguishing splenosis from local recurrence of renal cell carcinoma using a technetium sulfur colloid scan

Heterotropic splenic tissue in renal fossa is characteristically asymptomatic and is usually an incidental finding that has been reported to mimic renal or adrenal tumors. A 55-year-old man with renal cell carcinoma had undergone radical nephrectomy together with splenectomy because of disrupture of the splenic capsule. During a follow-up examination, three nodules were detected by computed tomography scan in the splenorenal area and they slowly enlarged. Although local recurrence was highly suspected, we decided to rule out splenosis. We successfully diagnosed these masses as ectopic splenic tissues by a technetium sulfur colloid scan and unnecessary surgical exploration was avoided.

Splenosis of the peritoneal cavity resembling an adnexal tumor: case report

INTRODUCTION

Splenosis is the autoimplantation of ectopic spleen tissue in various anatomic cavities of the body resulting after trauma or rupture of the splenic parenchyma. The major localization sites of this phenomenon are mainly intraperitoneal, the gastrenteric tract, genitalia, intrahepatically and the kidneys. Extraperitoneal locations occur less frequently and include the thorax and brain. Also locallization in the subcutaneous fat has been described.

CASE REPORT

We present the case of a 32-year-old woman with symptomatic peritoneal cavity splenosis occurring ten years after traumatic splenectomy. The patient was admitted to our department with the clinical presentation of an adnexal tumor. US and CT confirmed an adnexal mass. Exploratory laparotomy was performed and multiple focal lesions were noticed on the uterus, ovaries and intestinal tract. Biopsies were taken and sent for histological analysis. The pathology specimen revealed ectopic splenic tissue. After surgical intervention the patient remained asymptomatic.

CONCLUSION

Splenosis is a rare phenomenon which clinicians should be aware of in order to spare patients from pointless surgical interventions. Patients with abdominal masses and post-traumatic splenectomy should be checked for splenosis.

Minimally invasive surgery in the treatment of splenosis

Splenosis has been serious etiologic reason in the recurrence of benign hematologic diseases after elective open or laparoscopic splenectomy. Although, the incidence of splenosis in patients splenectomized for trauma is high, as long as they are asymptomatic, they do not require surgical treatment. Herein, we report a case of idiopathic thrombocytopenic purpura recurrence due to splenosis 5 years after the initial laparoscopic splenectomy. Laparoscopic treatment of splenosis was performed successfully.

Intrathoracic splenosis

Intrathoracic splenosis is a rare condition involving autotransplantation of the splenic tissue into the pleural cavity. It is typically a result of diaphragmatic and splenic rupture after blunt or penetrating abdominal trauma. The diagnosis is usually determined by surgical biopsy of an incidental asymptomatic mass on a radiograph or computed tomography. The process is benign and can be generally followed with serial chest radiographs. We herein discuss a 34-year-old male who presented with sharp chest pains.

Unique case of intramural colonic splenosis

Splenosis is usually a sequel of splenic rupture from abdominal trauma but can be associated with elective splenectomy. Recurrence of the hematological disorder for which the patient underwent splenectomy may occur, and splenic nodules can be found anywhere in the thoracic or abdominal cavity, as well as subcutaneously. We are presenting intramural colonic splenosis, a large inoculum of the splenic tissue that has been found to have the capacity to maintain anemia and thrombocytopenia, in a child previously splenectomized because of a hematological problem.

Splenosis mimicking pelvic mass

BACKGROUND

Splenosis is a rare complication after splenectomy and generally does not cause clinical symptoms.

CASE

A 34-year-old woman who had splenectomy in childhood after trauma presented with a pelvic mass. Ultrasound examination demonstrated a right adnexal mass and a myomatous uterus. Exploratory laparotomy revealed multiple splenic implants along the small and large bowel and in the ileocecal region, including the appendix. Total hysterectomy, right salphengectomy, and appendectomy were performed.

CONCLUSION

After splenectomy, splenic implants may mimic benign or malignant tumors of the pelvis and may require surgical exploration.

Laparoscopic management of abdominal pelvic splenosis

BACKGROUND

Splenosis is an unusual cause of pelvic pain.

CASE

A 37-year-old nulligravida presented with a 10-year history of chronic pelvic and abdominal pain that was diagnosed as splenosis via laparoscopy. The patient was previously advised against surgical intervention. We report our experience with laparoscopic excision of the above splenosis.

CONCLUSION

Splenosis should be considered in patients with a history of splenic injury and abdominal pain. Laparoscopic excision of splenic nodules with the argon beam coagulator is a well-suited method of treatment for symptomatic splenosis.

Intrathoracic splenosis secondary to previous penetrating thoracoabdominal trauma diagnosed during delayed diaphragmatic hernia repair

Although intraperitoneal splenosis is a very common disease, intrathoracic splenosis is very rare. It is generally an asymptomatic disease that occurs after thoracoabdominal trauma, and is diagnosed as an intrathoracic mass that leads to unnecessary investigations to be differentiated from other benign or malignant lesions of the chest. We present a patient with an intrathoracic mass which was preoperatively diagnosed as a diaphragmatic hernia on chest X-ray and magnetic resonance imaging. We have intraoperatively recognized that many pieces of splenic tissue have been herniated through a diaphragmatic defect, and formed intrathoracic splenosis. We repaired the diaphragmatic hernia defect after excision of fragments of the spleen.

A rare diagnosis for a pancreatic mass: splenosis

Splenosis, the autotransplantation of splenic tissue, has been designed to preserve organ functions after splenectomy. We present the first case of laparoscopic resection of a pancreatic splenosis, in a patient who had undergone a splenectomy 31 years before, complaining of abdominal pain and diarrhea. Abdominal computed tomography (CT) scan showed an enhancing hypervascular 3-cm solid mass in the body of the pancreas, mimicking a pancreatic cancer or a neuroendocrine tumor. A diagnostic laparoscopy was planned, and a 3-cm peripancreatic nodule with a long pedicle was visualized, with many nodules close to the tail of the pancreas and in the greater omentum. They were all resected, and the specimens obtained were immediately sent for frozen-section examination, which confirmed the diagnosis of heterotopic splenic tissue. Splenosis should be included in the differential diagnosis of the pancreatic masses in patients with previous splenic surgery. A hypervascular mass on CT scan should be regarded as an adenocarcinoma of the pancreas until proven otherwise. The possibility of a neuroendocrine tumor mandates an octreotide scan and gastrointestinal hormones dosage. In the unlikely event that all tests may produce equivocal results, a diagnostic laparoscopy is mandatory, in order to obtain an accurate histopathologic diagnosis.

An interesting hepatic mass: splenosis mimicking a hepatocellular carcinoma (2003:9b)

We report a splenosis mimicking hepatocellular carcinoma in a patient with chronic liver disease. Knowledge of these imaging findings, including helical CT, angiography, CT hepatic arteriogram, CT arterioportogram, and iodized-oil CT, may obviate unnecessary surgery.

[Splenosis and pelvic pain. A report of a case and literature review]

Initially described by Buchbinder and Lipkoff in 1929, esplenosis is the transplant of the splenic heterotopy weave in the abdominal cavity. It is observed after the splenic traumatic rupture and appendectomy. It occurs also during the embryonic development. The most frequent places where it takes place are: the intrathoraxic cavity, intraperitoneal, retroperitoneo, and brain. Although the presence of this ectopic splenic weave is symptomatic, this pathology can be evident by pain in the pelvis or it can be confused with other pathologies such as hemangiomas of intestine, and endometriosis including metastasis carcinoma. It is impossible to predict which patients will develop the splenosis after the splenic trauma. The time of rupture or damage of the splectonomy and the amount of blood in the peritoneal cavity are not related with the number of implants. The symptoms are the clue. When the splenosis is diagnosed incidentally in a symptomatic patient, the complete surgery removal is not indicated. However this surgery is recommended when the abdominal pain or the diagnosis is uncertain. In this paper a case with a secondary pelvic pain, probably due to a tubaric abortion, agreeing with secondary splenosis and a traumatic splenic rupture, is reported.

[Complicated omental splenosis]

Splenosis results from autotransplantation of splenic tissue, usually after traumatic splenic rupture. The diagnosis is suggested by the history and the presence of multiple nodules on computed tomography. Selective splenic scintigraphy utilising heat denatured red blood cells confirm the diagnosis. Treatment is usually conservative with surgical excision reserved for complicated cases. We report a case of splenosis associated with phlegmon and infectious process, requiring surgical intervention.

[Laparoscopic therapy of symptomatic splenic implants in the minor pelvis]

OBJECTIVE

The radical laparoscopic treatment of the aforementioned pathology has made it possible to eliminate recurrent pelvic pain of the 24 years old patient.

SUBJECT

Case report.

METHODS AND RESULTS

24 year old, nulligravid patient, had primary laparoscopy in 1998 because of chronic pelvic pain. Histology has confirmed both, the infiltrative endometriosis and the pelvic splenosis. While the endometriosis has been radically excised, splenic implants have been, in accordance with the current opinions in the literature, left in situ. Only their biopsy has been done. Due to recurrent pelvic pain after 15 months and the growth of the splenical implants, the second look laparoscopy was performed with the radical excision of these foci.

CONCLUSION

The patient, 4 months after the intervention is asymptomatic. At variance with most of the literature, we assume that the pelvic splenosis in contrast to the abdominal is in many cases symptomatic. It causes especially pelvic pain and dyspareunia in connection with the contingent implant growth. In such cases the radical excision is indicated, where the laparoscopy is the chosen method. Authors are discussing the differentiational diagnosis of this syndrome especially concerning endometriosis, peritoneal carcinomatosis, accessory spleen and the manifestation of the lymphoma.

Splenosis in a port site after laparoscopic splenectomy

Splenosis, the autotransplantation of splenic tissue, is most commonly seen after traumatic splenic rupture and splenectomy. It also can occur during embryonic development. Intraperitoneal, intrathoracic, and retroperitoneal sites have been reported. Although the presence of the splenic tissue often is asymptomatic and an incidental finding, it may present with pain or be confused with various pathologies including neoplasia. Because most pediatric splenectomies are performed for hemolytic disorders, parenchymal disruption must be contained to avoid recurrent disease. We present a case in which the devascularized spleen was contained in a bag and fragmented in situ. Splenosis developed in the retrieval port site after laparoscopic splenectomy and cholecystectomy. Port-site splenosis needs to be considered in the differential diagnosis of port-site pain and a palpable nodule postsplenectomy.

Splenosis and the gynecologic patient: a case report and review of literature

A 23-year-old woman with pelvic pain and a preoperative assessment of endometriosis eventually diagnosed as splenosis is presented. Hysterectomy, removal of the ovaries and of the splenic pelvic mass resolved her complaint. The pelvic mass in this patient was clinically mistaken for endometriosis. Use of more specific diagnostic techniques can more clearly guide therapy.

Splenosis as a cause of testicular pain: laparoscopic management

This is a case report of a 37-year-old man with severe testicular pain unresolved after conventional investigative and therapeutic methods. On the basis of his history of abdominal trauma followed by emergency splenectomy and evidence of functioning splenic tissue on a radionuclide scan, the diagnosis of splenosis was established. Laparoscopic exploration was done, and the initial diagnosis confirmed. Splenic tissue located at the right inguinal ring was removed. Testicular pain abated after the procedure.

Splenosis presenting as an ulcerated gastric mass: endoscopic and endoscopic ultrasonographic imaging

A case of an ulcerated gastric wall mass ultimately found to be splenosis is presented in which the index patient had endoscopic and endoscopic ultrasonographic evaluation prior to resection. Although no visual features identified this mass as a splenic implant preoperatively, the lesion appeared to be atypical for leiomyoma, which led to surgical intervention. The role of endoscopic ultrasonography in assessing isolated gastric masses is discussed.

Thoracic splenosis

Thoracic splenosis is rare, with fewer than two dozen reported cases. Patients uniformly have a history of splenectomy with combined abdominal and thoracic trauma. Clinical signs and symptoms are usually absent, and the condition is most often discovered on routine chest radiography. The interval between trauma and clinical discovery has ranged from 2.7 to 42 years. There is no documented benefit to removal of the splenic nodules unless the patient is symptomatic.