Accessory Spleen Research Articles

Search for and Extraction of Accessory Spleen in Refractory Immune Cytopenias. Effective or a Waste in Resources?

Background: Splenectomy is an effective second line therapy for patients with immune cytopenias. Fifteen percent of patients are going to relapse after splenectomy. These patients are categorized as refractory and their treatment is challenging. The incidence of an accessory spleen diagnosed by gammagraphy is estimated to be 8-20% in this scenario. Current treatment guidelines do not address the issue of searching for an accessory spleen or performing accessory splenectomy as a treatment strategy for these patients. The aim of this study was to identify risk factors for the presence of accessory spleen diagnosed by gammagraphy in patients with refractory immune cytopenias and analyze the response rate of its removal. Methods: It is a case control, single center, retrospective study. We included adult patients with refractory immune cytopenias who underwent gammagraphy to search for an accessory spleen, from 1996 to 2016. Cases were patients with a positive gammagraphy, controls were those with a negative gammagraphy. Patients who failed to have at least one year of follow-up after splenectomy or accessory splenectomy, were excluded. A logistic regression was performed to determine factors associated with the presence of an accessory spleen. Results: We analyzed 71 refractory patients with a gammagraphy performed searching for an accessory spleen, 87.3% with a diagnosis of immune thrombocytopenia (IT), 7% autoimmune hemolytic anemia (AHA) and 5.6% Evans Syndrome. Fourteen percent of the patients had secondary immune cytopenias all of them due to autoimmune diseases. There was a predominance of women with 74.6% of the subjects studied. Patients received a median of 2 (0-4) lines of treatment before the splenectomy. The majority of patients (98.6%) had received, as first line of treatment corticosteroids, with an overall response rate (ORR) of 84% and a complete response (CR) rate of 38.6%. Of the 71 patients, splenectomy achieved an ORR of 83.1% with CR in 80.3%. The incidence of accessory spleen diagnosed by gammagraphy at their relapse was 15.5% (11 patients). In the multivariate analysis, we found two factors associated with positivity of the gammagraphy: CR to corticosteroids pre-splenectomy with an OR of 5.2 (CI 95% 1.24-21.78; p=0.021) and the presence of Howell Jolly bodies (HJb) with an OR of 0.088 (CI95% 0.02-0.37; p=0.001) as a protective factor. We developed a risk score consisting of: 0 risk factors, 1 risk factor (CR to corticosterois pre-splenectomy or abscense of HJb) and 2 risk factors. The percentage of patients who were positive by gammagraphy using this score was 83.3%, 25.6% and 3% for 2, 1 and no risk factors respectively (p<0.001) (Figure1). Eight patients underwent accesory splenectomy, all of them achieved responses with CR of 87.5%, and none experienced complications associated with the procedure. Seven patients acquired the presence of HJb after accesory splenectomy (Table 1). With a median follow-up of 60.2 months (1.54-194.56), 62.5% mantained the response obtained with the accesory splenectomy. One patient didn´t acquire HJb post accesory splenectomy, he relapsed and was diagnosed with a new accesory spleen. He underwent a second accesory splenectomy and is now in CR with the presence of HJb in the blood smear. Conclusions: The search for an accesory spleen in patients with refractory immune cytopenias with risk factors (absence of Howell Jolly bodies and or complete response to steroids as first line therapy) is usefull. Accesory splenectomy is a safe and effective therapeutic strategy in the treatment of these patients. Disclosures No relevant conflicts of interest to declare.

Epithelial cyst arising in an intrapancreatic accessory spleen: a case report of robotic surgery and review of minimally invasive treatment

BackgroundAn epithelial cyst in an intrapancreatic accessory spleen (ECIPAS) is rare. We report a case of ECIPAS that was treated with robot-assisted distal pancreatectomy with splenectomy.Case presentationThe case was a 59-year-old woman who was referred to our hospital after a pancreatic tail tumor was found on computed tomography prior to surgery for small bowel obstruction at another hospital. A cystic lesion in the pancreatic tail was discovered and evaluated by magnetic resonance imaging and endoscopic ultrasonography. Based on clinical and radiological features, mucinous cystic neoplasm was included in the differential diagnosis. The patient underwent robot-assisted distal pancreatectomy with splenectomy. The postoperative course was uneventful. Pathological evaluation revealed a 20-mm ECIPAS in the pancreatic tail.ConclusionsIf a pancreatic tail tumor is present, ECIPAS should be included in the differential diagnosis. However, preoperative diagnosis is difficult, and a definitive diagnosis is often not obtained until after surgery. Surgery should be minimally invasive. Laparoscopic distal pancreatectomy has become a standard surgical procedure because it is minimally invasive. Robot-assisted surgery is not only minimally invasive, but also advantageous, because it has a stereoscopic magnifying effect and allows the forceps to move smoothly. Robot-assisted distal pancreatectomy may be a good option, when performing surgery for a pancreatic tail tumor.

Pancreatic/Peripancreatic Spindle Cell Lesions Cytology: A 15-Year Review

Abstract Introduction/Objective Spindle cell lesions (SCL) are diagnostically challenging, especially on cytology specimens where entities have overlapping features. Neoplastic and non-neoplastic SCL are uncommonly encountered in the pancreas/peripancreatic tissue. The sensitivity and specificity of EUS-FNA of pancreatic lesions both approach 95%. In this study, we assess the frequency of SCL found in pancreas/peripancreatic tissue on cytology specimens, the frequency of performing IHC stains and the most useful IHC panels. We also evaluate histology-cytology discrepancies and pitfalls. Methods A retrospective analysis of all pancreas/peripancreatic cytology specimen results between January 2004 - August 2019 was conducted. A total of 5,132 cases were identified. The number of spindle cell lesions was 27 (0.52%), with surgical pathology results available for 15 cases (55%). IHC stains were performed on 18 cell blocks (66%) and 9 surgical pathology specimens (60%). Results Of the 27 SCL identified, 22 lesions were neoplastic (81%), and 5 lesions were non-neoplastic (19%). The Neoplastic cases were: 10 GISTs (37%), 4 spindle cell lesions, NOS (14.8%), 2 metastatic sarcomas (7.4%), 1 pheochromocytoma (3.7%), 1 leiomyoma (3.7%), 1 schwannoma (3.7%), 1 malignant fibrous histiocytoma (3.7%), 1 granular cell tumor (3.7%), and 1 neuroendocrine carcinoma (3.7%). Of the neoplastic cases, 10 were lesions originating in a different organ with direct extension/distant metastasis to the pancreas (71%), with the most common organ being the stomach, 6 cases (60%). The non-neoplastic cases were: 4 granulomas (14.8%), and 1 accessory spleen (3.7%). IHC stains were performed on 18 cell blocks (66%), and attempted unsuccessfully on 2 cell blocks. The most commonly utilized stains were: CD117, 15 cases (83%), SMA, 11 cases (61%), S-100, 9 cases (50%), CD34, 5 cases (27%) and Cytokeratin, 5 cases (27%). IHC stains assisted with proper classification in 9 cytology cases (50%). There was one interpretation error*, and the histology-cytology discrepancy rate was 6%. Conclusion Pancreatic and peripancreatic spindle cell lesions are uncommon (520/100,000), and are particularly challenging on cytology specimens. If neoplastic, the majority originate in an organ other than the pancreas. If non- neoplastic, the majority are granulomas. Immunohistochemical staining is required for proper classification. And in this small series, cytology is highly accurate for diagnosis (96%).

S2932 Ectopic Spleen Tissue Mimicking Gastrointestinal Stromal Tumor, a Case Report of a Gastric Subepithelial Lesion

INTRODUCTION: Gastric subepithelial lesions (SEL) are found as often as 1 in 300 endoscopies. Indolent growing gastric splenosis mimicking a gastrointestinal stromal tumor (GIST) is rare. We present a case of a patient with a gastric SEL with growth concerning for a GIST that ultimately was diagnosed as ectopic splenic tissue (splenosis). This case highlights the importance of considering splenosis as a possible etiology for enlarging gastric SEL in patients with prior splenectomy. CASE DESCRIPTION/METHODS: A 52-year-old female with a remote history of solid pseudopapillary neoplasm (SPN) of the pancreas who received distal pancreatectomy and splenectomy 15 years ago presented with dyspepsia. 10 years ago, an esophagogastroduodenoscopy (EGD) revealed a 10-mm SEL in the gastric fundus. On endoscopic ultrasound (EUS) the lesion was described as a hypoechoic mass in the muscularis propria. Fine needle aspiration (FNA) was not performed given its challenging location. The patient opted for 4 years of annually computed tomography surveillance with stability of the lesion which was thought to be an accessory spleen. However, one year ago she presented to our clinic with dyspepsia. EUS revealed growth of the mass to 22.5 × 13.5 mm in the fourth layer with minimal vascularity suggestive of a GIST. Again, FNA was unsuccessful given its location in the greater curvature of the gastric fundus. Exploratory laparotomy was performed, the mass was excised, and pathology showed benign splenic tissue, consistent with splenosis. DISCUSSION: Splenosis and accessory spleen were considered initially as differential diagnoses in our patient given her splenectomy history. However, the indolent growth of the SEL and EUS appearance raised the concern of GIST. It is imperative to distinguish a GIST from other types of tumors to assess its malignant potential and treatment. Surgical excision was ultimately performed in our patient and the diagnosis of splenosis was made. Splenosis is a subtype of ectopic splenic tissue differentiated from accessory spleen, in that splenosis is acquired heterotopic autotransplantation and implantation of splenic tissue (usually after splenic trauma or splenectomy) while accessory spleen is a congenital anomaly with splenic arterial supply. Clinicians should be aware of the growth potential of splenosis as a mimicker of GISTs and other gastric SELs and consider ectopic splenic tissue a cause of SEL in patients without spleen.Figure 1.: EGD findings: Subepithelial nodule in the gastric fundus (year 0 vs year 9).Figure 2.: EUS findings (year 9): 22.5 × 13.5 mm well-defined hypoechoic and homogeneous mass arising from the fourth layer.Figure 3.: Histopathologic findings of subepithelial lesion: Benign splenic tissue, consistent with splenosis. (Hematoxylin-eosin x 100).

S1484 Masquerading Masses

INTRODUCTION: Amongst isolated solid pancreatic masses identified radiologically in middle aged adults, common diagnoses rendered on histology include adenocarcinoma and neuroendocrine tumors. Ninety percent of all pancreatic solid masses are pancreatic adenocarcinomas which carry a grim prognosis. Herein, we present two cases of isolated solid pancreatic masses radiologically masquerading as carcinomas that highlight the importance of clinico-pathologic correlation in directing management of patients with pancreatic lesions. CASE DESCRIPTION/METHODS: Case 1 is of a 51-year-old male with benign prostatic hyperplasia who presented to his urologist for recurrent urinary tract infection. Computed tomography (CT) was performed and showed a 9.5 × 4.9 cm mass in the pancreatic body and tail concerning for adenocarcinoma. Magnetic resonance image (MRI) showed enhancing rind of soft tissue in the body and tail without peripancreatic vascular attenuation (Figure 1a) and endoscopic ultrasound (EUS) showed diffuse heterogeneous echogenicity suggestive of autoimmune pancreatitis. IgG4 serum levels were within normal range. Fine needle aspiration (FNA) of the mass showed a CD10+ B-cell lymphoproliferative disorder and final pathologic diagnosis of low-grade follicular lymphoma was rendered (Figure 2a). The patient is currently on chemotherapy and responding favorably. Case 2 is of a 70-year-old male who presented with abdominal discomfort. A CT abdomen and pelvis revealed a well-delineated 1.9 × 1.5cm distal pancreatic tail mass. MRI showed that the lesion was isointense to the spleen and pancreas with prominent solid arterial phase enhancement and moderate diffusion restriction suggestive of a neuroendocrine tumor. PET NETSPOT scan also supported a somatostatin receptor avid tumor. An EUS with FNA demonstrated benign splenic tissue consistent with the diagnosis of intrapancreatic accessory spleen (Figure 2b). DISCUSSION: Increased use of imaging has led to a growing number of identified pancreatic abnormalities. While ductal adenocarcinoma of the pancreas is commonly encountered in the presence of isolated solid pancreatic masses, rare malignant entities such as lymphoma and non-malignant entities such as intrapancreatic accessory spleen should remain on the differential diagnosis. These cases illustrate that despite characteristic radiologic findings, tissue diagnosis is prudent prior to management of any pancreatic lesion as consequences of erroneous therapy can be dire.Figure 1a.: MRI abdomen showing normal diameter pancreatic duct with thickening of pancreatic tail and encasement of splenic vein.Figure 2a.: Pancreatic body/tail mass biopsy showing small atypical lymphocytic infiltrate surrounding pancreatic parenchyma, immunophenotypically consistent with low grade follicular lymphoma.Figure 3b.: Pancreatic tail mass fine needle aspiration showing benign splenic tissue. CD8 highlights splenic sinusoidal cells in the secondary image.

Museu de Ciência Animal como espaço de popularização e descobertas científicas

Museus de ciência constituem um espaço cultural predominante visitado por crianças e adolescentes, e na maioria das vezes são utilizados para consolidar conhecimentos adquiridos na educação formal, bem como os conhecimentos de origem empírica. O acervo do museu de ciências da UNIPAR, possui animais selvagens, da fauna Brasileira taxidermizados, que por sua vez, com destaque a fauna da região noroeste do estado do Paraná, cumprindo o papel das coleções museológicas, pois além de ser uma coleção, as peças neles encontradas devem ser conservadas e pesquisadas, contribuindo para o conhecimento e aprimoramento do estudo científico na educação básica, popularizando o conhecimento. Dentro da dinâmica do museu ainda é possível desenvolver pesquisas científicas que podem resultar em descobertas como a de um baço acessório encontrado em uma espécie de Felídeo, a descrição de tal estrutura é muito escassa na literatura. Assim os museus de ciência colaboram diretamente com o ensino, a pesquisa e a extensão universitária.

Inflammatory and tumor-like lesions of the pancreas.

SummaryInflammatory/tumor-like lesions of the pancreas represent a heterogeneous group of diseases that can variably involve the pancreatic gland determining different signs and symptoms. In the category of inflammatory/tumor-like lesions of the pancreas, the most important entities are represented by chronic pancreatitis, which includes alcoholic, obstructive and hereditary pancreatitis, paraduodenal (groove) pancreatitis, autoimmune pancreatitis, lymphoepithelial cyst, pancreatic hamartoma and intrapancreatic accessory spleen. An in-depth knowledge of such diseases is essential, since they can cause severe morbidity and may represent a potential life-threatening risk for patients. Furthermore, in some cases the differential diagnosis with malignant tumors may be challenging. Herein we provide a general overview of all these categories, with the specific aim of highlighting their most important clinic-pathological hallmarks to be used in routine diagnostic activities and clinical practice.

Congenital intrathoracic accessory spleen is a very rare trick of nature: a case report

BackgroundCongenital intrathoracic accessory spleen (CIAS) refers to a developmental anomaly resulting in the presence of splenic tissue within the chest. The differential diagnoses for the resulting mass are pulmonary malformations, or lesions with malignant potential. To our knowledge, only four cases of presumed CIAS have been described in literature to date, and no cases were reported in the United States.Case presentationWe report on a 14-year-old Caucasian female with a left chest mass discovered incidentally on a CT scan performed following an all-terrain vehicle accident. Following resection, the mass was diagnosed as a CIAS.ConclusionsFrom our review of literature, we found that CIAS can pose a diagnostic dilemma as it is rare, difficult to distinguish from pulmonary sequestration, or malignancy, and biopsy is often inconclusive. Resection is required to rule out malignancy and determine the diagnosis. Pediatric thoracic surgeons should consider CIAS in their differential for an intrathoracic mass with an inconclusive biopsy.

Differentiation of Insulinoma from accessory spleen by 99mTc-labelled heat-denaturated red blood cell scintigraphy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Epidermoid cyst within an intrapancreatic accessory spleen exhibiting abrupt changes in serum carbohydrate antigen 19-9 level: a case report

BackgroundEpidermoid cyst within an intrapancreatic accessory spleen (ECIAS) is a rare disease. While the detection of solid components relevant to an accessory spleen is a key diagnostic finding, the differential diagnosis between ECIAS and malignant tumors is difficult without resection in patients with no other findings of an accessory spleen.Case presentationA 73-year-old male was found to have an elevated carbohydrate antigen (CA) 19-9 level (95 U/mL) at an annual checkup, and a cystic lesion in the pancreatic tail was located by abdominal ultrasound. Abdominal magnetic resonance imaging (MRI) revealed a multicystic mass, 24 mm in diameter, which exhibited varying intensities on T2-weighted images. There were no findings suggesting solid components on contrast-enhanced computed tomography and magnetic resonance imaging. Re-evaluation of serum CA 19-9 level revealed a rapid increase to 901 U/mL, which declined to 213 U/mL 3 weeks later. Ruling out the lesion’s malignant potential was difficult, and the patient underwent distal pancreatectomy with splenectomy. Histological findings revealed an ECIAS including multiple cysts, with the mucinous component of each cyst exhibiting different stages of biological reaction; one ruptured cyst exhibited inflammatory changes.ConclusionsCareful observation for changes in serum CA 19-9 level and MRI findings might facilitate the diagnosis of ECIAS without a solid component by imaging studies.

Laparoscopic Staple-less Splenectomy: feasibility and benefits

Background: The surgical procedures of the spleen include open splenectomy (OS) laparoscopic splenectomy (LS). Several techniques for control of splenic vessels during LS have been developed, such as Clips, sutures, bipolar vessel sealing devices as Liga-Sure and ultrasonic devices as Harmonic have. The vessel sealing devices shows some advantages if compared with other methods such as staplers and clips as shorter hospital stay, safer, feasible and excellent cosmetic results. And vessel sealing devices (Liga-Sure) LS is cheap alternative to the use of endo-staplers which is expensive. Objectives: The study is to evaluate feasibility, merits and demerits of staple-less laparoscopic splenectomy in cases of non-traumatic disorders of spleen and assess operative time, need for blood transfusion, rate of conversion to open splenectomy or use stapler, period of hospital stay and associated complications. Patients and Methods: The study was conducted on 32 patients, underwent laparoscopic splenectomy using vessel sealing devices (Ligasure) for splenic pedicle control. Informed consent was obtained for all patients. Results: The study was conducted on 32 patients. 30 patients (93.80%) were females and 2 patients (6.3%) were males. 30 patient with immune thrombocytopenic purpura (ITP) and 2 patients with hereditary spherocytosis (HS). Two cases (6.3%) detected with accessory spleen (splenule) at the splenic hilum. Two cases (6.3%) were converted to open splenectomy. To control bleeding, we used stapler in two cases (6.3%). Cost of staple-less LS is less expensive than stapler laparoscopic splenectomy as the stapler LS is more than staple-less LS by about 12000 EGP (700$). Conclusion: In a report in early 1990s, the dissection of the hilum of the spleen was generally achieved by surgical clips or endo-gastrointestinal staplers. Subsequently, new surgical tools such as ultrasonic devices or bipolar electrosurgical devices such as LigaSure had been employed as supporting device that can seal blood vessels with supra-physiologic burst pressures equal to those obtained with surgical clips or ligatures. We, in this series, believe that it is, with a statistical significance, safe and effective, reduces blood loss, minimize operating time, fewer costs and is a valid. Moreover, it reduced conversion rates in selected patients. Last but not least, the use of the vessel sealing devices (Ligasure) resulted in no post-operative complications or need of blood transfusion.

Prevalence and distribution of functional splenic tissue after splenectomy.

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. To quantify the prevalence and volume of residual FST post-splenectomy using standard testing. 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. 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. 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.

Clinical and Pathological Data of 17 Non-Epithelial Pancreatic Tumors in Cats.

Tumors of mesenchymal origin are rarely reported in the pancreas. Therefore, this study characterized 17 feline non-epithelial pancreatic tumors, including clinical data, histopathology, and immunohistochemistry. Seventeen feline pancreatic tissue samples were investigated histopathologically and immunohistochemically. Selected pancreatic and inflammatory serum parameters, e.g., feline pancreatic lipase immunoreactivity (fPLI), 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR) lipase and serum amyloid A (SAA), were recorded, when available. The neoplasms were characterized as round (n = 13) or spindle (n = 4) cell tumors. Round cell tumors included 12 lymphomas and one mast cell tumor in ectopic splenic tissue within the pancreas. Lymphomas were of T-cell (n = 9) or B-cell (n = 3) origin. These cats showed leukocytosis (3/3) and increased fPLI (5/5), DGGR lipase (3/5) and SAA (4/5) values. Spindle cell tumors included two hemangiosarcomas, one pleomorphic sarcoma and one fibrosarcoma. The cat with pleomorphic sarcoma showed increased SAA value. Overall survival time was two weeks to seven months. These are the first descriptions of a pancreatic pleomorphic sarcoma and a mast cell tumor in accessory spleens within feline pancreas. Although rare, pancreatic tumors should be considered in cats presenting with clinical signs and clinical pathology changes of pancreatitis. Only histopathology can certainly distinguish solitary pancreatitis from a neoplasm with inflammation.

Endoscopic ultrasound-guided fine needle aspiration of accessory spleen: Cytomorphologic features and diagnostic considerations.

Accessory spleen/or splenule (AS) can involve pancreas/or peripancreatic tissue and present as a mass-forming lesion, and on imaging studies, it stimulates concern for a neoplastic process. The current study reported the largest cohort of AS cases evaluated by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). We retrospectively reviewed our data base system for cases underwent EUS-FNA for pancreatic/or peripancreatic lesions, with "AS" in diagnosis or in note/or with a clinical concern in the history, from January 2010 to August 2019. Corresponding cytology slides were re-reviewed to identify the key cytomorphologic features. We identified 25 AS cases from 15 female and 10 male patients with a mean age of 55 years. Most patients presented with non-specific clinical symptoms or were identified as an incidental mass lesion. Majority of the lesions were located in or around the pancreatic tail region (68%) while the remainder in perisplenic region (32%). Rapid on-site evaluation (ROSE) was performed in nearly half of the cases (48%). Cytologically, AS shows a mixed population of medium to small-sized lymphocytes, clusters of lymphoid cells (LC), prominent vascularity (PV), scattered mixed inflammatory cells including eosinophils, and large platelet aggregates (LPAs). Among them, LC (P = .0079), PV and LPAs were the most helpful features for cytological diagnosis. AS is a benign entity and may pose a diagnostic challenge due to its resemblance to a neoplastic process on imaging studies. EUS-FNA is an important tool to recognize AS by identifying its key cytologic features, thus may help to avoid unnecessary surgical management.

İntraoperatif splenik hilus kanaması ve splenomegali robotik ve laparoskopik splenektomiden açık cerrahiye geçişe etki eden risk faktörleridir

Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum dissection technique. A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8). Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity. No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease, operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p <0.05) were higher in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to open surgery. Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.

Re: A Case of Splenogonadal Fusion Accompanied by Accessory Spleen in a 4-Year-Old Boy.

Re: A Case of Splenogonadal Fusion Accompanied by Accessory Spleen in a 4-Year-Old Boy.

Laparoscopic splenectomy in the treatment of the splenic pseudotumor and preservation accessory spleen

Laparoscopic splenectomy in the treatment of the splenic pseudotumor and preservation accessory spleen

Giant accessory spleen and rotating ectopic kidney: A rare association

The accessory spleen is a congenital disability characterized by a separated ectopic splenic parenchyma. Wandering spleen (WS) is a rare condition where the spleen, free from its ligaments, is allowed to move inside the abdomen, predisposing the patient to life-threatening complications due to torsion of the vascular pedicle; splenic infarction, portal hypertension, bleeding and acute abdomen may occur. WS or Accessory Spleen (AS) is rarely suspected at presentation since symptoms are usually not specific, and definitive diagnosis is often reached only by imaging technologies such as color flow ultrasonography and angio-spiral computed tomography. The size is rarely more than 4cm. Patients rarely present symptoms, and the diagnosis can be accidental when faced with ectopia in radiological or intraoperative investigations. It is an essential clinical entity since abdomen-pelvic tumors must always be considered as differential diagnoses, requiring detailed evaluation. Surgical treatment is indicated for symptomatic patients or those with complications. On the other hand, the ectopic kidney with rotation abnormality also consists of a singular entity. Congenital anomalies of the upper urinary tract occur in 3%-4% of those born, most of which are followed up clinically. The present study discusses a case of symptomatic intrapelvic WS associated with an ectopic kidney with rotation anomaly, a rare union, and still with scarce reports in the literature. This study aimed to present the case of a patient with an isolated oversized accessory spleen and a review of the literature.

Giant accessory spleen and rotating ectopic kidney: A rare association

Giant accessory spleen and rotating ectopic kidney: A rare association

Factors affecting the ability of abdominal ultrasonography to detect focal pancreatic lesions identified using endoscopic ultrasonography.

PurposeThis study was conducted to determine which factors influence the ability of abdominal ultrasonography (US) to detect focal pancreatic lesions identified using endoscopic ultrasonography (EUS).MethodsIn this study, 338 consecutive patients with focal pancreatic lesions (cyst, n=253; adenocarcinoma, n=54; pancreatic neuroendocrine tumor, n=24; solid pseudopapillary neoplasm, n=4; intrapancreatic accessory spleen, n=1; metastasis, n=1; and lymphoma, n=1) detected by EUS who underwent US were enrolled. We reviewed their radiologic reports and assessed the presence or absence of a focal lesion, the multiplicity of the lesions, and their size and location on US. We evaluated how these parameters differed depending on whether the lesion was solid or cystic. Univariate and multivariate logistic regression analysis were performed.ResultsThe overall detection rate of focal pancreatic lesions by US was 61.5% (208 of 338). Using US, the detection rate of cystic lesions was 58.5% (148 of 253), while that of solid lesions was 70.6% (60 of 85). In the univariate analysis, location in the neck or body, solid characteristics, and a relatively large size (15.50±10.08 mm vs. 23.09±12.93 mm) were associated with a significantly higher detection rate (P<0.001, P=0.047, and P<0.001, respectively). In the multivariate analysis, location in the neck or body (odds ratio [OR], 3.238; 95% confidence interval [CI], 1.926 to 5.443; P<0.001) and size (OR, 1.070; 95% CI, 1.044 to 1.096; P<0.001) were proven to be significant predictors of detectability (P<0.001).ConclusionUS is useful for detecting focal pancreatic lesions, especially when they are located in the neck or body and are relatively large.