Ectopic Splenic Tissue Research Articles

Splenogonadal Fusion

We report a case of an 11-year-old boy who presented with a painless left scrotal mass of one year's duration. Clinical examination and diagnostic modalities indicated a solid left testicular mass. Exploration was done and a complete splenogonadal fusion was found. The ectopic splenic tissue was completely removed with preservation of the testis. Splenogonadal fusion is a rare and infrequently reported entity in the paediatric surgical literature. This was our first encounter with this condition. A review of the literature is briefly presented here.

Thoracic splenosis: A diagnosis by history and imaging

Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. The majority of cases of TS are asymptomatic and are diagnosed in the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive work-up and unnecessary invasive diagnostic procedures including thoracotomy. This case report describes a 40-year-old man, who was diagnosed incidentally with TS, several years after the initial injury. Multiple, asymptomatic, left-sided pleural based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert suspicion of TS, which can then simply be confirmed by a Tc-99m sulphur colloid radionuclide scan. Most patients are treated conservatively unless they are symptomatic. Physicians must recognize the key features suggesting a diagnosis of TS, order appropriate imaging studies and avoid unnecessary invasive diagnostic procedures.

Fusión esplenogonadal

To report one case of discontinuous splenogonadal fusion, an rarely referred entity, with clinical interest, without important repercussions in most cases. 23-year-old male with the diagnosis of right paratesticular mass, with negative markers for germ cell tumors. On ultrasound the mass was homogeneous and isoechoic in comparison with the adjacent testicular parenchyma. On surgical exploration, the mass was excised, with the pathologic result of splenogonadal fusion, with normal splenic tissue. Being maybe more frequent in pediatric surgery and urology practices, splenogonadal fusion presents two differentiated forms: continuous with a fibrous or nodular cord from the spleen to the gonad, retroperitoneal or intraperitoneal; and discontinuous in which there is no topographic communication between spleen and ectopic splenic tissue adjacent to the testicle. Although they are exceptional, splenic remainders fused to the testicle, epididymis or vas deferens may present the differential diagnosis with testicular and paratesticular masses.

An unclassifiable short rib‐polydactyly syndrome with acromesomelic hypomineralization and campomelia in siblings

The short rib-polydactyly (SRP) group are lethal skeletal dysplasias with an autosomal recessive inheritance pattern that can be distinguished on radiological and histological grounds. We report on two consecutive pregnancies complicated by a SRP syndrome with acromesomelic hypomineralization and campomelia that cannot be definitely categorized, yet possesses features of this group of conditions. The skeletal changes observed in both cases included markedly shortened ribs, shortened humeri and femora, limb bowing, absent ossification of the radii, ulnae, tibiae and fibulae, as well as the bony elements of the hands and feet, hypoplastic scapulae and peritoneal calcifications. In one case, the pancreas was abnormal in shape, without a tail and the spleen was not identified. Ectopic splenic tissue and intestinal malrotation were identified and were suggestive of a laterality disorder. Whether these two cases should be considered an atypical form of SRP cannot be completely resolved at this present time and will need to wait on further progress in molecular testing.

THORACIC SPLENOSIS: A DECEPTIVE DIAGNOSIS

INTRODUCTION:Thoracic splenosis is a very rare entity referring to ectopic splenic tissue in the thorax, usually due to splenic tissue seeding the pleural cavity after thoracoabdominal trauma. It is typically discovered incidentally as an asymptomatic pulmonary nodule or mass, leading to unnecessary invasive investigations.

A Newborn Presents With a Scrotal Mass

A newborn presents with a scrotal mass.The baby was sent home after 2 days in the well baby nursery with instruction for surgical follow-up for the scrotal mass, which was believed to be a left inguinal hernia. At 6-month follow-up, the infant was normally developed for his age. On genital examination, the right testis was not palpable in the scrotum, the left testis was in the scrotum, and an elastic mass was identified at the upper pole of the left testis. No other physical abnormalities were detected. Results of all laboratory investigations were normal.Surgery revealed a red-brown encapsulated mass fused to the left testis. No connection could be seen between the spleen and the mass. There was no testicular torsion (Fig 1-4). Biopsy was performed after informed consent was obtained from his parents, and pathology identified the mass as splenic tissue.Approximately 150 cases of SGF are reported in the literature. The first description was by Pommer in 1889 in an infant who had limb abnormalities. SGF results from abnormal connection of splenic tissue with gonadal-mesonephric structures. The ectopic spleen generally is found within the tunica albuginea, separated from the testicular tissue by a fibrous capsule.SGF is far more common in males, in whom the appearance usually is a scrotal mass. The higher prevalence among males probably is due to the anatomic location of the testes, allowing ready and frequent palpation. Putschar and Manion classified SGF into two types: continuous (direct connection between the spleen and gonad) and discontinuous (no anatomic connection between ectopic splenic tissue and the principal spleen). Limb defects, micrognathia, or other congenital malformations such as cryptorchidism, ventricular septal defects, anal atresia, microgastria, spina bifida, or continuous type craniosynostosis often accompany SGF.SGF is assumed to occur between 5 and 8 weeks of gestation, before the beginning of gonadal descent. Its cause remains unclear, but two theories predominate. Sneath has suggested that slight inflammation of the peritoneal surfaces over the spleen and gonadal ridge can produce partial fusion of the two organs. von Hochstetter postulated that a retroperitoneal pathway for splenic anlage cells may allow contact with the gonadal anlage.Ultrasonography is the current imaging modality of choice for assessment of scrotal abnormalities, but findings are not conclusive. If SGF is suspected clinically before surgery, the diagnosis may be confirmed by 99m Tc-sulfur colloid imaging, which shows uptake in both the spleen and the accessory splenic tissue within the scrotum. Symptoms attributable to the presence of SGF include testicular pain after gastroenteritis, bowel obstruction, and acute scrotal pain resembling testicular torsion. Because of the rarity of SGF, it usually is not diagnosed preoperatively.This uncommon congenital abnormality is difficult to diagnose both clinically and with imaging. If a patient has congenital limb defects in conjunction with cryptorchidism or high ectopia, the possibility of SGF should be considered. Awareness of the entity is crucial to avoid misdiagnosis of a tumor.Ultrasonography, laparoscopic exploration, and scintigraphic scanning generally are necessary to demonstrate the distribution of splenic tissue, thereby allowing proper diagnosis and treatment. If intraoperative biopsy reveals splenic tissue, orchiectomy is not indicated. Surgery is necessary for the usual or unusual indications, such as hernia, cryptorchidism, and torsion. The ectopic spleen usually can be dissected away and the testis salvaged. Laparoscopic surgery should be considered for most uncomplicated cases.JoDee M. Anderson, MD, Division of Neonatal Medicine, Oregon Health & Science University, Portland, OR

Evaluation of the changes in signals from the spleen using ferucarbotran

Because superparamagnetic iron oxide is actively taken into the reticuloendothelial system, the signal intensity observed on T2-weighted images is reduced not only in the liver but also in the spleen. There is no difference in the reduction in signal intensity in the liver after contrast between the ferumoxides and ferucarbotran, but the reduction in signal intensity in the spleen is considerable. In the present study, we examined the efficacy of T2*-weighted imaging to compensate for the reduction in signal intensity in the spleen by administering ferucarbotran. We examined the images obtained from 35 patients who underwent MRI with ferucarbotran. T2-weighted images and T2*-weighted images were obtained before and after administration of ferucarbotran, and the changes in signal intensity in the liver and spleen were then analyzed. A reduction in signal intensity was observed in the liver by both T2- and T2*-weighted imaging. In the spleen, the signal intensity was reduced on T2-weighted images but was not reduced on T2*-weighted images. The reduction in signal intensity due to administration of ferucarbotran is low in the spleen. Thus, it was considered necessary to approach the problem of diagnosing ectopic splenic tissue using ferucarbotran with caution.

Ectopic splenic tissue presenting as a scrotal mass

Ectopic splenic tissue presenting as a scrotal mass

Unusual subcutaneous splenosis occurring in a gunshot wound scar: Pathology and immunohistochemical identification

Splenosis usually occurs after traumatic rupture of the spleen with autotransplantation of splenic tissue to ectopic sites. Most commonly, it occurs as intraperitoneal nodules, which are found either incidentally or after symptomatic complications. Subcutaneous splenosis is a rare condition mostly observed in abdominal surgical scars. Reported herein is a case of subcutaneous splenosis developed in an exit gunshot wound scar on the left lower chest wall 9 years after splenectomy. The lesion presented as an asymptomatic subcutaneous nodule, which was excised under the impression of a skin tumor. Microscopically, there were multiple subcutaneous nodules resembling splenic tissue with red and white pulp. They were confirmed to be ectopic splenic tissue by immunohistochemical staining of the vascular lining cells (CD8+, CD31+, and CD34-). Only 11 cases of subcutaneous splenosis have been reported before. The present case was the third case occurring in an exit gunshot wound scar, and the diagnosis was confirmed by immunohistochemical study.

Contrast-Enhanced Low-Mechanical-Index Ultrasonography in Hepatic Splenosis

Splenosis refers to the autotransplantation of splenic tissue in a heterotopic location after splenic trauma or surgery. 1 The implants are rarely clinically important and are incidental findings. Ectopic splenic tissue implants into the liver must be differentiated from other benign or malignant hepatic lesions.

Right-Sided Intrarenal Splenosis Mimicking a Renal Carcinoma

We describe a patient who underwent nephrectomy for an enhancing right renal mass that was subsequently pathologically confirmed as right renal splenosis. Since renal splenosis is quite rare and has previously been reported only in the left kidney, we did not consider splenosis in our differential diagnosis during the evaluation of the renal mass. Magnetic resonance imaging, as well as radionucleotide scan using 99mTc-labelled red blood cells, has been utilized for identifying ectopic splenic tissue. An elevated index of suspicion must be present in patients with a history of splenectomy or traumatic splenic rupture to avoid undue nephrectomy.

Fc-receptor function after human splenic autotransplantation.

Mononuclear phagocytic function was studied using the Fc-receptor test in 24 patients who underwent splenectomy, ten of whom underwent splenic autotransplantation. All patients undergoing autotransplantation had mononuclear phagocyte system (MPS) activity at the transplantation sites. In eight of the 14 patients who did not undergo autotransplantation there was also scintigraphic MPS activity indicative of ectopic splenic tissue. Although the Fc-receptor test showed delayed and monoexponential blood clearance in all patients after splenectomy, there were no significant differences between the patient groups. Autotransplantation of small amounts of splenic tissue after splenectomy provides some MPS activity but is inadequate for blood clearance.

Splenogonadal fusion: Report of a case and review of the literature

We report a case of splenogonadal fusion masquerading as a testicular tumor and review the etiology, the pathogenesis and the management of this rare disease. A 20-year-old male patient presented with clinical and radiological findings of a left testicular mass for which he underwent a left radical inguinal orchidectomy. Histopathology of the removed testicle revealed no tumor. The gonad was fused to ectopic splenic tissue, the later forming a distinct encapsulated mass attached to the lower pole of the testicle inside the tunica vaginalis. Splenogonadal fusion, although a rare condition, may account for a non-malignant testicular mass and should be suspected in young patients with other congenital anomalies.

Epidermoid cyst in an intrapancreatic accessory spleen: a case report

Ectopic splenic tissue in the abdominal cavity is a common entity, with a reported incidence of 10% in the general population. However, an intrapancreatic accessory spleen is a rare disease, and moreover cyst formation in it is exceedingly rare. A 58-year-old woman with a 25-mm multilocular cyst in the tail of the pancreas detected incidentally by ultrasonography was admitted for further evaluation. Because malignancy could not be ruled out, a spleen-preserving distal pancreatectomy was performed. The cut surface of the surgical specimen showed a multilocular cyst surrounded by brown solid tissue resembling normal spleen. Pathological examination revealed it was stratified squamous epithelium and was surrounded by splenic tissue. The final pathological diagnosis was epidermoid cyst in an accessory spleen in the pancreas. This cyst has no characteristic features on diagnostic imaging. Consequently, it is not possible to make a definite preoperative diagnosis in most cases. Epidermoid cyst in intrapancreatic splenic tissue is another lesion to be considered in the differential diagnosis of pancreatic tail tumors.

Distinguishing splenosis from renal masses using ferumoxide-enhanced magnetic resonance imaging

A 43-year-old man with a history of splenectomy was found to have a solid renal mass on computed tomography. Magnetic resonance imaging with ferumoxide characterized this mass as ectopic splenic tissue and nephrectomy was avoided.

Thoracic splenosis: Mimicry of a neurogenic tumor

J Thorac Cadiovasc Surg 2003;125:1155-6

Pseudomasa renal izquierda infrecuente: ectopia esplénica

Ectopic splenic tissue is uncommon in clinical practice, usually asymptomatic and generally unsuspected diagnosed. Intereset from urological point of wiew is due to the posibilitty of mimicking left renal, adrenal and retroperitoneal tumours; as well as intrapelvic, inguinal and genital masses.We repor a 42-years-old gemale patient with seudotumoral upper pole left kidney mass with final diagnosis of ectopic spleen. Ethipatogenic, diagnostic and therapeutical aspects are briefly reviewed in literature.We emphasized opportunity to include ectopic splenic tissue in differential diagnosis of left renal, adrenal and retroperitoneal masses. We recommend imaging studies as CT and MRI, complemented if necessary with liver/splenn radionuclide scan. We advocate for non-aggressive actitude in selected cases with asymptomatic extrapelvic ectopic spleen under confirmated diagnosis, defering splenectomy in symptomatyc instances or secondary portal hypertension cases.

Laparoscopic-assisted splenectomy using a hand-access port

SummaryAdvanced laparoscopic procedures, such as laparoscopic splenectomy (LS) are well described, but are generally not used outside units with a special interest in laparoscopic surgery. This particularly applies to LS, because of difficulties controlling the splenic pedicle and removing the spleen when completing the procedure. We describe five prospective cases of laparoscopic-assisted splenectomy (LAS) for idiopathic thrombocytopaenic purpura (ITP), using a new, specialised port which allows repeated insertion and removal of the surgeon's hand into the abdomen without loss of pneumoperitoneum. Spleens were removed intact through the hand-access port. No patient developed any respiratory or other complications. Oral fluids were tolerated at a mean of 1.0 ± 0.0 days and oral diet was tolerated at 1.4 ± 0.5 days post-operatively. Patients were discharged from hospital 3.2 ± 1.9 days post-operatively. LAS appears to offer the benefits of minimal hospital stay and analgesia requirements which have previously been associated with LS. Additional benefits, in comparison with LS, include increased tactile and retractile ability, easier control of the splenic pedicle, removal of an intact specimen for histological analysis and possibly easier location of ectopic splenic tissue. This novel device may facilitate minimally-invasive splenectomy outside specialised laparoscopic units.

Case report: Portal hypertension causing massive enlargement of an accessory spleen — a rare cause of splenic pseudotumour

Ectopic splenic tissue simulating renal, pancreatic, hepatic and even pelvic malignant tumours have been reported previously [1-4]. Autopsy studies have demonstrated that the pathological entities that affect the spleen also affect the accessory spleen [5]. To our knowledge this is the first reported case of an accessory spleen, markedly enlarged by portal hypertension, presenting as a splenic pseudotumour. The patient had a TIPS (transjugular intrahepatic portosystemic shunt) procedure prior to its operative removal and the role of pre-resectional TIPS is also discussed.

Intrahepatic splenic tissue.

Intrahepatic splenic tissue is uncommon being reported to date in three humans and one pig. This report is of a 54 year old man with chronic asthma who died from...