Inferior Pole Of Spleen Research Articles

Differentiation of insulinoma from accessory spleen by 99mTc-labelled heat-denaturated red blood cell scintigraphy: case report

BackgroundNeuroendocrine tumors (NETs) are rare tumors harboring overexpression of somatostatin receptors (SSTRs) on their cell membrane. Because some organs, such as the spleen, adrenal glands and liver, physiologically express SSTR, it might be challenging to distinguish some pancreatic NETs located in the pancreatic tail from the accessory spleen next to the splenic hilum. In this manuscript, we report a case with hypoglycemia attack and 2 different masses displayed by Gallium 68-tetraazacyclododecane tetraacetic acid-octreotate (68Ga-DOTATATE) positron emission tomography/computed tomography (PET/CT).Case presentationA 63-year-old woman presented to the hospital with confusion and profuse sweating. Biochemical diagnosis of insulinoma was established. 68Ga-DOTATATE PET/CT revealed two masses with increased tracer uptake located adjacent to the splenic hilum and inferior pole of the spleen which were initially reported as two separate accessory spleens. Then, 99mTc-labelled heat-denaturated red blood cell (99mTc-HDRBC) scintigraphy-single-photon emission computed tomography (SPECT)/CT was performed to distinguish a NET in the pancreatic tail from accessory spleen at the splenic hilum. Enhanced tracer uptake remained in the inferior pole of spleen, but not in the splenic hilum. The lesions were suggestive of insulinoma in the pancreatic tail and an accessory spleen adjacent to the inferior pole of the spleen.ConclusionApproximately 10% of the population have an accessory spleen which can show similar imaging characteristics with pancreatic NETs, especially if located in the pancreatic tail. In our presented case, 99mTc-HDRBC scintigraphy-SPECT/CT is a useful nuclear medicine method to differentiate a NET in the pancreatic tail from accessory spleen at the splenic hilum which may avoid unnecessary surgeries in the presence of enhanced tracer uptake or vice versa.

Splenic marginal zone B-cell lymphoma in a HIV-positive patient: a case report

Dear Editor, A 47-year-old man was hospitalized in November 2006 for hyperthermia into the Division of Tropical Infectious Diseases. The patient had been diagnosed with HIV infection 14 years before and was in antiretroviral therapy since 9 years; his CD4-positive cells ranged between 300 and 650 cells per microliter and viral load remained less than <50 copies per microliter with didanosine, lamivudine, and atazanavir. Since the diagnosis, he did not show any relevant HIV-related clinical event. At admission, the physical exam revealed organic decay, weight loss, multiple small superficial adenopathies and marked splenomegaly (spleen palpable in left iliac region). The patient was initially treated with antipyretics, hydration, and continued antiretroviral therapy. The blood cell count showed white blood cells 3,840 per microliter (lymphocytes 66%, absolute count 2,534 per microliter), platelets 1,233,000 per microliter, and hemoglobin 10.3 g/dl. The biochemistry showed lactate dehydrogenase 818 mU/ml, β2-microglobulin 4,100 μg/l, alkaline phosphatase 1,093 U/l, erythrocyte sedimentation rate 17, C-reactive protein 0.6 mg/dl, total protein 6.1 g/dl, αfraction 8%, gamma globulin 10%; microbiological analyses of blood and urine were negative as well as hepatitis C virus (HCV) serology; hepatitis B virus (HBV) serology showed HbsAg, HBsAb, and HbcAb positive. Computed tomography (CT) scan documented splenomegaly (diameter 30×22 cm) without any focal lesion and an accessory spleen (diameters 10×4 cm), multiple adenopathies at splenic hilus and along the spleen vessels, ectasia of the spleen–portal system, and little ascites in the pelvic cavity. Bone marrow biopsy revealed a nodular lymphoid infiltration suspicious for lymphoma involvement. In December 2006, the patient underwent splenectomy. At laparotomy, spleen appeared occupying the whole left hemiabdomen and displacing the stomach and bowel with an accessory spleen (diameter 10 cm) at inferior pole of spleen (Fig. 1a); at the splenic hilus, multiple confluent lymph nodes surrounded splenic artery and vein and the tail of the pancreas. Spleen, accessory spleen, and hilus lymph nodes were removed; distal pancreasectomy and a wedge-shaped biopsy of third hepatic segment were also performed. The resected spleen (38×22×8 cm) weighted 4,400 g and showed, on the cut section, a multimicronodular pattern. Histologically, the micronodular lymphoma infiltrate involved both the white pulp and the red one (partially). Nodules consisted of a prevalent smallto medium-sized lymphoid population with round nuclei and moderate clear cytoplasm; a minority (<10%) of large blastic cells were present. The lymphoma cells were positive for CD20+, CD79a+, bcl2+, DBA44+/−; immunostainings for CD5, CD10, cyclin D1, bcl6, CD23, CD25, TRAP, IgM, and IgD were negative. The growth fraction (evaluated by means of MiB1/Ki67) was 10%. Immunohistochemistry and in situ hybridization search for Epstein-Barr virus (EBV) was negative. A diagnosis of Ann Hematol (2009) 88:379–381 DOI 10.1007/s00277-008-0587-4

TWO CASES OF DELAYED RUPTURE OF THE SPLEEN

We report two cases of delayed rupture of the spleen which is relatively rare. A 21-year-old man was seen at the hospital because of acute diffuse abdominal pain which occurred on the 27th day after an abdominal trauma. Since his vital signs were stable, he was treated conservatively and remained uneventful. He was discharged on the 16th hospital day. Another patient, a 29-year-old man who was receiving a conservative therapy for acute splenic and left renal injuries suddenly felt an abdominal pain on the seventh hospital day. CT scan revealed a fluid collection in the intraabdominal space. With a diagnosis of delayed rupture of the spleen, a conservative therapy was started, but further increase in volume of ascites was noted 5.5 hours after the therapy. So an emergency splenectomy was conducted when a deep injured portion was found in the inferior pole of spleen. He followed an uneventful postoperative course and was discharged 21 days after the operation. The patients with delayed rupture of the spleen are operated on frequently, because the association of trauma is not obvious. Although conservative therapy for delayed rupture of the spleen has been increasingly employed like for acute splenic rupture, the indication of conservative therapy should be restricted.