Splenic Lesions Research Articles

Incidence of splenic malignancy and hemangiosarcoma in dogs undergoing splenectomy surgery at a surgical specialty clinic: 182 cases (2017-2021).

The objectives of this study were to evaluate the risk and predictive factors of splenic malignancy and hemangiosarcoma in dogs undergoing splenectomy at a surgical specialty clinic. Medical records, hematologic results, surgical reports, and histopathologic results from 182 dogs that underwent splenectomy for the treatment of splenic masses or nodules were reviewed retrospectively. The majority of dogs (57.7%) had benign splenic diagnoses with no malignancy. Hemangiosarcoma was diagnosed in 32.4% of the dogs. A final multivariable model indicated that thrombocytopenia, anemia, and a smaller diameter of the largest splenic nodule were risk factors for hemangiosarcoma (P<0.001), and hemoperitoneum (P = 0.01) was an additional risk factor when nodule diameter was not evaluated. There were 91 dogs that had hemoperitoneum, and 60.4% of those dogs had malignant splenic lesions. Of the 33 dogs that underwent a splenectomy for incidentally identified splenic lesions, 93.9% had benign splenic lesions. Breed size was not a significant predictor of splenic malignancy risk; however, all 6 of the German shepherds included in the study had a hemangiosarcoma diagnosis. Overall prevalence of splenic malignancy including HSA may be overestimated in some canine populations.

FDG PET/CT in Papillary Intralymphatic Angioendothelioma of the Spleen.

Splenic papillary intralymphatic angioendothelioma is extremely rare. We describe FDG PET/CT and MRI findings of splenic papillary intralymphatic angioendothelioma in a young adult. The splenic tumor showed hypodensity and increased FDG uptake with SUVmax of 4 on PET/CT, heterogeneous signal intensity with internal hypointense stellate scars on T2-weighted image, and progressive centripetal enhancement on dynamic contrast-enhanced T1-weighted images. This case indicates that papillary intralymphatic angioendothelioma should be included in the differential diagnosis of FDG-avid splenic lesions.

Splenic injury associated with colonoscopy in hospitalized patients: Incidence, risk factors, management, and outcome.

Background and study aims The frequency of splenic injuries due to coloscopy is largely unknown. Therefore, the aim of this study was to give estimate the risk for hospitalized patients. Patients and methods Using the administrative database from a health insurance company with more than 10 million insured subjects, patients undergoing inpatient colonoscopy associated with a splenic injury within 2 weeks were retrieved from the administrative records based upon OPS (comparable to International Classification of Procedures in Medicine) and ICD-10 codes. In each case identified (n = 141), the individual course of the hospital stay was reconstructed and analyzed by two experienced physicians. Patients with overt other causes of splenic injuries (e. g. abominal surgery, trauma etc.) were not further evaluated. Results Among 190,927 total colonoscopies over a 5-year period, 27 splenic lesions were most likely solely due to colonoscopy. This accounts for 14.1 splenic injuries per 100,000 colonoscopies or one lesion in 7,071 patients. Afflicted patients were older and more likely to be female than male (risk in females: 1 in 5,324 colonoscopies). Surgical interventions were carried out in 17 cases, predominantly splenectomy (n = 15) whereas 10 events were managed conservatively. Transfusions and requirement for intensive care unit treatment were strong predictors of need for surgery. Most lesions (74%) were diagnosed within 48 hours after colonoscopy. Death occurred in two patients, but less likely directly due to the splenic injury. Conclusions Administrative data analysis suggests that splenic injuries due to colonoscopy are more frequent than previously estimated. Endoscopists should be aware of this rare life-threatening adverse event.

Levamisole Ameliorates Rheumatoid Arthritis by Downregulating the PI3K/Akt Pathway in SD Rats.

Background/Objectives: Rheumatoid arthritis (RA) is a systemic chronic autoimmune disease characterized by a protracted course, high rates of morbidity, and disability yet lacks effective therapeutic modalities. Levamisole (LVM), an immunomodulatory drug, has been clinically reported for its potential in RA treatment, while its therapeutic mechanism toward RA remains to be elucidated. Hence, this study provides theoretical support for the application of LVM in the treatment of RA. Methods: This study employed male Sprague-Dawley (SD) rats to construct the adjuvant-induced arthritis (AIA) model, administering LVM orally (5 mg/kg, 15 mg/kg, and 45 mg/kg) for 25 days. An evaluation of LVM's therapeutic effects on RA was conducted through arthritis index scores, paw pad thickness, paw volume, hematoxylin and eosin (H&E) staining, 3D microcomputed tomography (micro-CT) scans, serum levels of pro-/anti-inflammatory cytokines, and serum biochemical indicators. Western blotting and immunohistochemistry staining were utilized to measure the expression levels of phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) proteins in synovial and ankle joint tissues. Results: Treatment with the median dose of LVM (15 mg/kg, M-LVM) significantly reduced the arthritis index (p < 0.01), paw pad thickness (p < 0.001), and paw volume (p < 0.01) without affecting body weight. Additionally, M-LVM alleviated inflammatory lesions in the synovium and ankle joints and also normalized serum levels of interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and transforming growth factor-beta (TGF-β). The Model group exhibited significant increases in serum levels of alkaline phosphatase (ALP) (p < 0.01), creatine kinase (CK) (p < 0.05), and glucose (GLU) (p < 0.001) compared with the Control group; however, M-LVM effectively regulated these parameters to normal levels. Western blotting and immunohistochemistry staining revealed that PI3K-/Akt-related proteins were highly expressed in the synovial and ankle joint tissues of rats in the Model group, while treatment with M-LVM significantly reduced the expression of these proteins. Furthermore, histological examination of major organs (heart, liver, lungs, kidneys, and thymus) showed no significant pathological changes, with the exception of the spleen, where M-LVM ameliorated splenic lesions. Conclusions: We demonstrate that LVM at an optimal dose substantially relieves synovitis and bone erosion in AIA rats by inhibiting the PI3K/Akt signaling pathway.

The protective effect of Auricularia auricula polysaccharides on cyclophosphamide-induced immunosuppression and intestinal injury: A fecal microbiota transplantation study

Auricularia auricula polysaccharides (AHP) have potential immunomodulatory activities. However, the relationship between polysaccharides, intestinal microbiota, and immune activity remains unclear. Therefore, to explore this relationship, we performed immunosuppressive donor, fecal microbiota transplantation (FMT), and pseudo-sterile mouse validation experiments. Our results showed that AHP enhanced immunomodulatory activity, as evidenced by the alleviation of cyclophosphamide (Cy)-induced body weight loss, spleen and thymus atrophy, and splenic and colonic lesions. Additionally, AHP effectively regulated antioxidant enzyme activities (SOD, T-AOC, CAT, GSH-Px), lipid peroxidation product content (MDA), levels of immune factors (TNF-α, IFN-γ, IL-2, IL-4, IL-6), immunoglobulins (sIgA), and the expression of tight junction proteins (Muc2, ZO-1, Occuldin, and Claudin-1) in the colon of immunosuppressed mice. FMT results demonstrated that FAHP displayed superior immunomodulatory ability and could further affect the abundance of Dehydroepiandrosterone, Prostaglandin E2, Cholesterol and Pregnenolone by increasing the abundance of unclassified_Muribaculaceae, Desulfovibrio, Alloprevotella, and unclassified_Oscillospiraceae and decreasing that of Staphylococcus, Bacteroides, and Corynebacterium. Pseudo-sterilization experiments showed that AHP was unable to increase antioxidant enzyme activity, reduce lipid peroxidation content, or promote the release of immune factors. In brief, AHP did not alleviate Cy-induced immunosuppression after microbiota elimination. In summary, AHP exerted a protective effect against Cy-induced immunosuppression and intestinal damage by modulating intestinal microbiota and its metabolites. These findings provide new insights into the mechanisms by which AHP, as a functional food or drug, promotes immune response regulation and maintains intestinal health.

The safety and feasibility of laparoscopic partial splenectomy: analysis of perioperative indications from different vascular subtypes and improvement of surgical approach

IntroductionWhile laparoscopic splenectomy (LS) has been widely used in benign splenic tumor, more concerns have been raised for postoperatively short-term and long-term complications. Laparoscopic partial splenectomy (LPS) is a surgical option, to preserve splenic function, and reduce postoperative complications. The aim of our study was to retrospectively identify the safety and feasibility of LPS compared with LS in patients with splenic benign tumor.Materials and methodsFrom 2014 to 2024, a total of 165 patients diagnosed with occupational splenic lesions underwent splenectomy, of whom 87 underwent LPS and 78 underwent LS. We compare the perioperative parameters and long term follow up between these two groups.ResultsThe etiology of splenic space-occupying lesions was nonparasitic splenic cysts, followed by splenic lymphangioma and splenic hemangioma. Of the patients with LPS, 55 underwent conventional surgery with blockage of the splenic arterial branch and resection along the ischemic line (RAIL), and 32 underwent with our modified total splenic blood supply blockade followed by resection alone the tumor edge (RATE). The tumor size, the operative time and estimated blood loss were comparable between the LPS and LS groups. One patient developed abnormal signs during the LPS procedure and was promptly referred for LS. The LPS group had fewer pancreatic leakage, incision infection, and pulmonary infection. As for different vascular types, patients with LS under all branches of the splenic artery had a longer time to resume postoperative feeding. As for the comparison of RAIL and RATE, estimated blood and operative time were significantly reduced in patients receiving RATE. Postoperative complications were the same in patients underwent each surgical procedures.ConclusionLPS is a viable approach for patients with splenic benign tumor. We introduce the tumor artery supply types to indicate the resection region. Our RATE technique has proven to be clinically effective and safety.

Diagnostic insights into splenic pathologies: the role of multiparametric ultrasound.

Ultrasound(US) evaluation of the spleen is mandatory in the assessment of patients with chronic liver disease, and splenomegaly can be a sign of systemic diseases. However, due to the lack of distinctive ultrasound findings in specific splenic pathologies, clinical diagnosis can be very challenging. Splenomegaly, defined by increased splenic dimensions, can indicate underlying systemic conditions and is a common manifestation of portal hypertension (PH). Ultrasound and Doppler techniques help assessing splenic involvement in PH. Splenic stiffness measurement, using elastography, offers additional diagnostic accuracy, especially when liver stiffness measurements are inconclusive. CEUS enhances the diagnostic capability for focal splenic lesions, differentiating between benign and malignant lesions by their distinct enhancement patterns, and plays also a critical role in the context of splenic traumatic pathology. Overall, CEUS significantly improves the characterization of splenic pathology, reducing the need for invasive procedures and ensuring appropriate patient management. This review article describes the normal US findings of the spleen and examines the role of multiparametric US in the evaluation of the most common splenic pathologies encountered in the daily clinical practice.

The umblicus says it all

Abstract Introduction/Objective Umbilical nodules can be divided into benign and malignant. Malignant lesions of the umbilicus are very rare. They can arise from primary tumors or secondary to abdominal and pelvic malignancies. Literature review suggests that these umbilical lesions can present as primary tumor in 38% of the cases, endometriosis in 32%, and metastatic lesions in 30%. Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is known as Sister Mary Joseph’s nodule (SMJN). It is a very rare finding and the incidence of SMJN is 1- 3% in people diagnosed with intra-abdominal or pelvic malignancies. Methods/Case Report A 31-year-old male with no past medical history presented to the emergency room with 3 months history of umbilical nodule and 60 pounds weight loss. He experienced early satiety, abdominal pain, nausea and generalized fatigue. CT abdomen showed hepatomegaly with numerous hypoattenuating lesions throughout the liver with peripheral enhancement, and hypoattenuating mass within the pancreatic tail and body measuring approximately 2.1 x 5.8 cm that appears contiguous with hilar splenic lesion. CT chest showed multiple pulmonary metastases with prominent precarinal and subcarinal lymph nodes. Serologic tests revealed elevated Alpha fetoprotein, ALP, ALT, and CA19-9. Patient underwent umbilical nodule core biopsy and right liver core biopsy. Microscopic evaluation of the specimens revealed pancreatic acinic cell carcinoma with two different morphological variants. Umbilical nodule with glandular pattern and liver lesion with trabecular pattern. Immunohistochemical stains were performed with tumor cells positive for CK 7, Trypsin and BCL-10 and negative for Glypican 3, CK 20, AFP and CD56. The prognosis is poor, with an average survival time of about 19 months. After the diagnosis patient underwent chemotherapy. Results (if a Case Study enter NA) NA Conclusion Umbilical nodules can be diagnosed with careful clinical and histopathological evaluation. The prognosis of patients presenting with SMJN is generally poor as it is a sign of advanced malignancy. Sometimes it may be the first and only sign of an internal neoplasm. Therefore, this is an important differential diagnosis to consider.

Ten-year experience of laparoscopic partial splenectomy for patients with splenic benign lesions

BackgroundThe increasing comprehension of spleen function has led to the gradual endorsement of laparoscopic partial splenectomy (LPS) as a treatment option for benign spleen lesions. However, it is important to note that the LPS technique remains challenging. This study explores the standardized process and surgical techniques in LPS, aiming to promote the application of this technique. MethodsThe clinical data of 20 patients with benign cystic or solid spleen lesions who underwent LPS at Shunde Hospital, Southern Medical University were retrospectively collected. Data include age, gender, imaging data, surgical process, and postoperative complications. Additionally, the surgical techniques and standardization process were recorded in detail. ResultsAll 20 cases completed LPS without conversion to laparotomy or splenectomy. The surgical time was 162.25 ± 37.96 min, the intraoperative blood loss was 93.00 ± 58.40 mL, no blood products were transfused during the operations, and the removed volume of the spleen was about 34.75 ± 12.19 %. There were no postoperative complications such as intra-abdominal bleeding, intra-abdominal infection, pancreatic fistula, and residual splenic infarction. Postoperative pleural effusion occurred in four cases, and symptoms improved after symptomatic treatment. The postoperative hospital stay was 7.0 ± 1.4 days. There were no perioperative deaths. The residual splenic vessels were normal during the follow-up period, and no vascular embolism occurred. ConclusionsLPS is a safe, feasible, and effective surgical method for patients with benign cystic or solid spleen lesions. Subsequently, mastering related surgical techniques and standardized surgical procedures can control the surgical risks in suitable cases, making LPS the standard procedure for treating benign spleen diseases.

Hemangioendothelioma of the spleen and liver in a 1-year-old child.

Concurrent occurrence of hemangioendothelioma in the spleen and liver of a 1-year-old child is a rare clinical case.She had a history of good health. Laboratory tests showed elevated inflammatory markers, but all other parameters were within normal range.In this article, we exhibit the typical clinical presentation and Pathology imaging features of this disease.CT imaging revealed a 9.8 cm×8.6 cm mass in the spleen, with areas of non-enhancing liquefactive necrosis. The mass exhibited heterogeneous enhancement during the arterial phase and progressive enhancement during the venous phase. Multiple nodules were observed in liver segments S2 and S4, the largest being approximately 3.7 cm×3.5 mm, with enhancement patterns similar to the splenic lesion. The patient underwent splenectomy, left hemihepatectomy, and cholecystectomy. Intraoperatively, the splenic mass exhibited some areas appearing spongy. Multiple nodules were observed in the left liver, presenting as gray-brown solid masses with a spongy texture. Pathology confirmed a diagnosis of hemangioendothelioma, supported by positive immunohistochemical staining for CD31, CD34, ERG, and FLI-1.

Cystic splenic lesions: a sonographic approach-retrospective study in 111 patients.

To describe and categorize splenic cystic-appearing lesions (S-CAL) with B-mode and contrast-enhanced ultrasound (CEUS). This retrospective study investigated S-CALs in 111 patients between 2003 and 2023 in an interdisciplinary ultrasound center with B-mode ultrasound, color Doppler sonography (CDS), and CEUS. S-CAL was characterized by echogenicity, diameter, and shape, as well as additional features like septation, calcification, or wall thickening, and CDS/CEUS were used to identify perfusion. Histological examination or imaging follow-up was necessary to determine the nature of S-CAL. Moreover, 'S-CAL with risk' was defined, necessitating further procedures. Four types (0-III) of S-CALs were defined based on ultrasound parameters. Fisher's exact test was used to compare non-parametric data. S-CAL of 111 patients (58 female, 53 men-average age: 58.6 years) was examined. Final diagnoses were: splenic cyst (n = 64, 57.7%); splenic abscess (n = 10, 9.0%); intrasplenic pseudoaneurysm (n = 10, 9.0%); splenic metastasis (n = 10, 9.0%); splenic infarction (n = 6, 5.4%); splenic hematoma (n = 4, 3.6%); other (n = 7, 6.3%). S-CAL groupings were type 0 (n = 11, 9.9%), type I (n = 33, 29.7%), type II (n = 24, 21.6%), and type III (n = 43, 38.7%). 'S-CAL with risk' was diagnosed in n = 41 (36.9%). Malignant S-CAL was only seen in type II (n = 2, 8.2%) and type III (n = 9, 20.9%) (p < 0.001). 'S-CALs with risk' were found more frequently in type 0 (n = 11, 100%), type II (n = 16, 66.7%) and type III (n = 13, 30.2%) than in type I (n = 1, 3%) (p < 0.001). B-mode ultrasound, CDS, and CEUS are useful to further characterize and follow-up S-CAL and identify 'S-CAL with risk', requiring further procedures. Ultrasound imaging is valuable for the detection, categorization, and monitoring of cystic-appearing lesions of the spleen, as well as for the identification of those with risk. An S-CAL may introduce uncertainty in clinical practice as imaging-based risk stratification is missing. B-mode and CEUS, along with the clinical context and follow-up, assist in characterizing and identifying 'S-CAL with risk'. S-CALs encompass various lesions, including simple cysts, metastases, abscesses, and intrasplenic pseudoaneurysms.

Circulating nucleosomes as a potential cancer biomarker in dogs with splenic nodular lesions

Splenic nodular lesions in dogs can be either benign or malignant. They might be discovered incidentally or, in case of rupture, they may lead to hemoabdomen. Nevertheless, splenectomy followed by histopathology is essential for diagnosis and to prevent rupture. Yet, this invasive procedure might be postponed for dogs with benign splenic nodular lesions. Conversely, owners may opt for euthanasia over surgery for malignancies with poor prognosis like hemangiosarcoma. Thus, anticipating diagnosis with non-invasive biomarkers is crucial for proper patient management. In this prospective study, plasma samples were collected from 66 dogs with histologically confirmed splenic nodular lesions. A canine-specific ELISA kit was applied to assess nucleosome concentration, with histopathology of the spleen serving as the gold standard. Nucleosome concentration was found to be significantly higher in dogs with malignant splenic nodular lesions, particularly in those with hemangiosarcoma and other malignancies. The presence of hemoabdomen, more prevalent in dogs with splenic malignancy, also resulted in increased plasmatic nucleosome concentrations. Plasma nucleosomes could serve as a biomarker for detecting malignant splenic nodular lesions in dogs. More research is needed to understand how nucleosome concentration relate to disease stage and prognosis in dogs with hemangiosarcoma.

Gadoxetate disodium (Gd-EOB-DTPA) contrast-enhanced magnetic resonance imaging for differentiation between benign and malignant splenic lesions in dogs.

Malignant splenic lesions in dogs are common, with hemangiosarcoma diagnosed most frequently, and there have been no consistent clinicopathologic, gross, or imaging characteristics identified that differentiate malignant from benign splenic lesions. Histopathology is required for definitive diagnosis, and given the poor long-term prognosis of malignant splenic lesions, a noninvasive tool to aid in diagnosis would be valuable. This prospective cohort study utilized gadoxetate disodium, a liver-specific contrast agent (Gd-EOB-DPTA; Eovist), to identify the general lesion and pre- and postcontrast signal characteristics of benign and malignant splenic and hepatic lesions in dogs with naturally occurring disease. Twenty-five dogs were enrolled, Eovist-enhanced MRI was performed, and dogs were taken to surgery for splenectomy and other organ biopsy. All histopathology and MRI studies were evaluated by a single pathologist and a single radiologist, respectively. The associations between the tumor type and numerous variables defined on MRI were evaluated using Fisher's exact tests, and the significance was identified at a P-value of.05. Malignant splenic masses were identified in 11/25 (44%) dogs, and 5/11 malignancies represented hemangiosarcoma. The presence of abdominal effusion (P=.017) and the presence of hepatic nodules on MRI (P=.009) were associated with splenic malignancy. There were no benign T2 hyperintense and no malignant T2 hypointense lesions (P=.021). Utilization of the T2 W MRI sequence may aid in the identification of malignant splenic lesions, particularly when accompanied by abdominal effusion and hepatic lesions.

Spleen anomalies and lesions in CT and MRI: essentials for radiologists and clinicians-a pictorial review.

The precise evaluation of splenic lesions using cross-sectional imaging presents a complex challenge due to the overlapping imaging characteristics of most splenic diseases and the absence of specific symptoms, complicating the diagnosis process. This pictorial review highlights the essential elements that should be included in a radiology report to interpret cross-sectional imaging studies of splenic lesions. To augment the diagnostic accuracy, we propose the implementation of a stepwise algorithmic approach. This approach offers a comprehensive analysis of splenic anomalies and lesions, providing an invaluable tool for radiologists and clinicians.

Diagnostic ability of [18F]FDG PET/CT for distinguishing benign from malignant spleen lesions.

[18F]Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a non-invasive imaging modality used in the differential diagnosis of splenic lesions, although ideal parameters and thresholds remain unclear. The present study evaluated the ability of [18F]FDG PET/CT, including its visual and quantitative parameters, to differentiate between benign and malignant splenic lesions. Patients who underwent [18F]FDG PET/CT following the detection of splenic lesions on contrast-enhanced CT were retrospectively analysed. Visual parameters assessed on [18F]FDG PET/CT included whole spleen uptake intensity, lesion multiplicity, and lesion uptake, and quantitative parameters included maximum standardised uptake value (SUVmax), lesion-to-background ratio (LBR), metabolic tumour volume (MTV), total lesion glycolysis (TLG), and lesion size. Parameters differentiating between benign and malignant lesions were evaluated by Pearson's chi-square test, Mann-Whitney U-test, and receiver operating characteristics (ROC) curve analysis. Splenic lesion uptake (p = 0.001) was the only visual parameter significantly distinguishing between benign and malignant lesions. ROC curve analysis demonstrated that SUVmax had the largest area under the ROC, 0.91 (p < 0.001), with an optimal cut-off > 5.3 having a sensitivity of 90.3% and a specificity of 80.6%. Subgroup analysis of malignant lesions showed that SUVmax (p = 0.013), LBR (p = 0.012), and TLG (p = 0.034) were significantly higher in splenic lymphomas than in splenic metastases. Of the [18F]FDG PET/CT parameters investigated, SUVmax had the highest accuracy in diagnosing malignant splenic lesions and was significantly higher in splenic lymphomas than in splenic metastases. Visual determination of [18F]FDG uptake by splenic lesions may be an easily evaluated parameter. SUVmax and visual grade of [18F]FDG PET/CT help to differentiate spleen lesions. [18F]FDG PET/CT is useful for discriminating between benign and malignant spleen lesions. Many splenic lesions are difficult to diagnose on anatomical imaging, with histopathologic analyses are required. SUVmax of PET/CT provided the diagnostic ability to differentiate between benign and malignant splenic lesions. More than normal spleen uptake can be a convenient parameter to diagnose malignant spleen lesions.

Clinical and morphological analysis of splenic neoplasms

The relevance of this study arises from the pressing need for a deeper investigation into the morphological aspects of identifying focal and localised lesions in the spleen. The spleen performs several vital functions, including immune, haematological, storage, metabolic, haemostatic, hormonal, and antiblastic roles, among others. Therefore, this study aimed to determine the clinical characteristics of splenic tumour lesions and their structural changes, as well as to identify the macroscopic appearance of the organ post-splenectomy. In diagnosing splenic diseases, a key instrumental method was employed – ultrasound examination with Doppler imaging – which enabled comprehensive investigation, analysis, and characterisation of parenchymal pathologies. Animals underwent clinical examinations during routine health checks or upon presentation of symptoms. When a splenic neoplasm was detected, surgical treatment was carried out, specifically through an open laparotomy and splenectomy. The surgery was performed under combined general anaesthesia (using both non-inhalational and inhalational anaesthetics). The intraoperatively collected material from the affected organ was subjected to histological examination. It was found that the pathomorphosis of splenic lesions varies, and the author's pathological and histological studies highlight the key morphological characteristics of the neoplasms. Accordingly, any splenic neoplasm can pose a life-threatening condition for several reasons: organ rupture and haemorrhage, organ torsion, and malignancy, among others. The findings are crucial for verifying splenic pathology, enabling the establishment of a definitive clinical diagnosis, facilitating treatment of the animal, and extending its lifespan. The practical significance of the results lies in identifying the need for comprehensive clinical and morphological investigations in diagnosing splenic diseases, as well as examining histological preparations for cellular and tissue changes. In veterinary medicine, the method of surgical treatment for splenic lesions in animals may be a subject of debate. In contrast, in human medicine, established protocols exist for performing organ-destructive operations such as splenectomy (by open or laparoscopic approach), organ-preserving procedures like splenic resection or splenectomy with autotransplantation of splenic tissue into the greater omentum (by open or laparoscopic approach), and percutaneous punctures for splenic cysts

Tuberculosis-induced Autoimmune Hemolytic Anemia

Abstract Autoimmune hemolytic anemia (AIHA) is a rare disorder characterized by antibodies against one’s own red blood cells, often difficult to diagnose and treat in the elderly. It can be secondary to an infection, drug, or a myeloproliferative disorder. We report a rare case of tuberculosis (TB)-induced AIHA in an older woman. A 70-year-old woman complained of progressive weakness, weight loss, and abdominal pain over 6 months. Examination revealed anemia, jaundice, and splenomegaly. Routine blood investigations showed pancytopenia and Coombs test that was positive for autoantibodies. Workup for autoimmune disease like systemic lupus erythematosis was negative. Lymphoma, disseminated TB, and lymphoproliferative disorders were considered. Bone marrow biopsy was reported as normal. Mycobacterium tuberculosis was isolated from the bronchoalveolar lavage. A diagnosis of autoimmune hemolytic anemia secondary to disseminated TB was made. She was treated with steroids and antitubercular therapy, which improved her health and laboratory parameters. A positron emission tomography–computed tomography showed the resolution of splenic lesions and reduced metabolic activity of mediastinal and abdominal lymph nodes.

Differentiating malignant from benign splenic lesions: a meta-analysis and pictorial review of imaging features.

Splenic lesions might exhibit overlapping imaging features, varying from benign entities like cysts and hemangiomas to malignancies such as lymphoma and angiosarcoma. This meta-analysis aims to delineate imaging characteristics that distinguish malignant from benign splenic lesions. Adhering to PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for studies on imaging features differentiating malignant from benign splenic lesions. We extracted data on splenic pathology and imaging characteristics and assessed the methodological quality via QUADAS-2. Odds ratio meta-analyses were performed using STATA (Version 17.0, Stata Corp, College Station, TX). Portal phase hypoenhancement, hypovascular enhancement pattern, diffusion restriction, and late phase hypoenhancement, with odds ratios above 10, highly indicate malignancy. Other features suggestive of malignancy include solid morphology, lymphadenopathy, presence of perisplenic fluid, arterial hypoenhancement, hypoechogenicity on ultrasound, splenomegaly, and presence of multiple lesions. In contrast, cystic morphology, hypervascular-washout and hypervascular-persistent pattern of enhancement, late phase hyperenhancement, anechogenicity on ultrasound, portal phase hyperenhancement, well-defined borders, and calcification are in favour of benign pathology. The study underscores the critical role of contrast-enhanced and diffusion-weighted imaging in distinguishing malignant from benign splenic lesions, emphasizing the role of features like portal phase hypoenhancement and restricted diffusion in diagnosing malignancies. Additionally, the study emphasizes the value of contrast-enhanced ultrasound, which allows for the visualization of key contrast-enhancement patterns without the risk of ionizing radiation exposure.

Imaging findings in a rare case of alveolar, hepatic and splenic sarcoidosis presenting with thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura (TTP) is an acute haematological disorder characterized by severe ADAMTS13 enzyme deficiency, leading to consumptive thrombocytopenia, mechanical haemolysis, and organ damage. Its association with multisystemic sarcoidosis is extremely rare and, to the best of our knowledge, described in only two cases so far. We present the case of a 52-year-old woman with TTP and antibodies anti-ADAMTS13, showing computed tomography (CT) and magnetic resonance imaging (MRI) evidence of pulmonary, hepatic, and splenic lesions initially reported as ischemic/inflammatory changes. A follow-up MRI of the abdomen revealed increased evidence of the liver lesions, focal intrahepatic bile duct dilatation, splenic lesions, and enlarged hepatic hilar nodes. The follow-up chest CT showed increased evidence of the parenchymal lung consolidations. Given the radiological persistence of those alterations and the history of TTP, the hypothesis of an IgG4-related disease was then made. The IgG4 levels were found to be normal, while the histological examination of the liver revealed non-necrotizing granulomatous chronic inflammation. Elevated levels of angiotensin-converting enzyme were found, and the QuantiFERON-TB Gold test was negative for tuberculosis infection. Thus, the overall clinical picture was consistent with multisystemic sarcoidosis (alveolar, hepatic, and splenic). The diagnosis of sarcoidosis, already challenging due to the variability of its clinical presentation, can become even more complicated when it manifests with uncommon haematological manifestations such as TTP, along with non-specific extra-pulmonary involvement. While imaging aids in documenting organ damage, the definitive diagnosis of sarcoidosis necessitates histologic confirmation of noncaseating granulomas and the exclusion of other possible granulomatous diseases.

Benign splenic lesions in BAP1-tumor predisposition syndrome: a case series

BAP1-Tumor Predisposition Syndrome (TPDS) is caused by germline variants in BAP1 and predisposes to solid tumors. After observation of a radiologically malignant-appearing splenic mass with benign pathology in a patient with BAP1-TPDS, we sought to retrospectively characterize splenic lesions in individuals with BAP1-TPDS seen at a comprehensive cancer center. A dedicated radiology review for splenic abnormalities was performed. We identified 37 individuals with BAP1-TPDS, 81% with a history of cancer. Of 33 individuals with abdominal imaging, 10 (30%) had splenic lesions, and none were shown to be malignant on follow-up. Splenectomy in an individual with suspected splenic angiosarcoma showed a benign vascular neoplasm with loss of nuclear staining for BAP1 in a subset of cells. Benign splenic lesions appear to be common and potentially BAP1-driven in individuals with BAP1-TPDS; confirmation of these findings could lead to more conservative management and avoidance of splenectomy.