Splenic Mass Research Articles

腹腔鏡下脾臓摘出術を施行した卵巣癌術後孤立性脾転移の1例

A 67-year old woman underwent bilateral oophorectomy for the treatment of ovarian cancer (serous adenocarcinoma, pT3cN0M0 Stage IIIc) in 2012, and postoperative chemotherapy was started. Ten months after operation, the serum level of CA125 was elevated (57.6 U/mL). Eighteen months after operation, an abdominal CT scan showed a mass in the spleen, 15 mm in diameter. Twenty three months after operation, splenic mass had increased to 24 mm in diameter. We diagnosed solitary splenic metastasis from ovarian cancer, and performed laparoscopic splenectomy. The pathological diagnosis of the splenic tumor was serous adenocarcinoma compatible with metastasis from ovarian cancer. She was discharged on 5th postoperative days and underwent another adjuvant chemotherapy. Since solitary splenic metastasis from ovarian cancer is rare. The laparoscopic splenectomy is a safe and effective for the management of splenic tumors.

Laproscopic partial splenectomy : A rare surgery for unusual diagnosis

Laproscopic partial splenectomy is a safe, minimally invasive technique for the treatment of solitary space occupying lesion (SOL) in splenic pole. Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion, first described in the literature under this name in 2004. We report a case of upper pole splenic SOL diagnosed as SANT on HPE successfully managed by Laparoscopic partial splenectomy for the first time at INHS Asvini. The patient presented with pain left hypochondrium of 02 year duration. Ultrasonography (USG) and Contrast enhanced Computerized tomography (CECT) abdomen revealed a splenic mass in upper pole. The laproscopic partial splenectomy has proved to be both diagnostic and therapeutic.

Management of splenic “incidentalomas” found on ultrasound and computed tomography

Splenic “incidentalomas” are focal lesions of the spleen that are discovered on imaging studies that were performed for the evaluation of non-spleen related pathology. These lesions are frequently encountered on CT and ultrasound examinations. Most incidental focal splenic lesions are benign, however a systematic approach to evaluating these lesions is important, because many benign and malignant splenic masses share common imaging features [1,2].

Risk factors for perioperative death in dogs undergoing splenectomy for splenic masses: 539 cases (2001-2012).

To determine the perioperative mortality rate, causes of death, and risk factors for perioperative death in dogs undergoing splenectomy for splenic mass lesions. Retrospective case series. 539 dogs. Medical records of dogs that underwent splenectomy for known splenic masses were reviewed. Perioperative mortality rate and causes of death were determined. Associations between potential prognostic factors and perioperative death were evaluated by multivariable logistic regression analysis. 41 of 539 (7.6%) dogs died during the perioperative period. Thrombotic and coagulopathic syndromes and uncontrolled bleeding from metastatic lesions were the most common causes of death. Of the variables selected for multivariable analysis, platelet count at admission, whether PCV at admission was < 30%, and development of ventricular arrhythmias during surgery were significantly associated with outcome. For each decrease in platelet count of 10,000 platelets/μL, odds of death increased by approximately 6%. For dogs with PCV < 30%, odds of death were approximately twice those for dogs with PCV ≥ 30%, and for dogs that developed intraoperative arrhythmias, odds of death were approximately twice those for dogs that did not. Marked preoperative thrombocytopenia or anemia and development of intraoperative ventricular arrhythmias were identified as risk factors for perioperative death in dogs with splenic masses. The risk of death may be limited by efforts to prevent thrombotic and coagulopathic syndromes and to control all sources of intra-abdominal hemorrhage.

Primary Splenic Diffuse Large B-Cell Lymphoma (PS-DLBCL): Splenectomy Improves Survival

Introduction: Although the spleen is involved in about a third of patients with non-Hodgkin’s lymphoma (NHL), primary splenic diffuse large B-cell lymphoma (PS-DLBCL) is rare having a reported incidence of less than 1% of all NHL. Most of the described series include small numbers of patients before the rituximab era and the role of splenectomy treatment in addition to immuno-chemotherapy is unknown.Methods: Data were retrospectively collected for 87 patients (pts) with PS-DLBCL treated in 7 medical centers in Israel during the years 1982-2013. Patients presenting with systemic disease with splenic involvement or those having a diagnostic biopsy from other nodal or extranodal disease were excluded.Results: The mean age was 59.6 years (range, 24-89 years); 57.5% were male. Abdominal pain was reported in 61 pts (81%), B symptoms in 49 pts (59%), ECOG performance status 0 - 1 in 85%. Stage I disease was recorded in 28%, II in 33%, III in 18%, and IV in 21%. Thrombocytopenia (<100,000/µl) was recorded in only 6 pts. Lactic dehydrogenase levels (LDH) were elevated in 69 pts (84%). Favorable International Prognostic Index (IPI) 0-2 was recorded in 62 pts (72%). The mean splenic length was 17.34±6 cm (range 7- 37 cm) and the mean splenic weight was 1216 gm±1243 gm (range 180-6000 gm). A splenic mass was found in 97% of pts, and its mean size was 9.26 cm (range 3-18 cm). The diagnostic procedure was core needle biopsy in 46 pts and splenectomy in 39 pts: 27 underwent open splenectomy and 12 laparoscopic splenectomy. Splenectomized pts had lower IPI (p<0.05) and lower stage (p<0.05) compared to non-splenectomized pts. Treatment: The CHOP regimen was given to 80 pts (92%), DA-EPOCH was given to 2 pts (2%) and 5 pts (6%) received other regimens. Rituximab was given to 68 pts (78%). Complete response was achieved in 67 pts (80%) and partial response in 8 (9%). Relapse occurred in 17 pts (22%).Survival: The median follow-up time was 7 years (range 0-19.4 years). During this period 24 pts died (27.5%). The 5-year overall survival (OS) was 76.6±4.9% and 5-year event-free survival (EFS) 67.2±5.5%. Splenectomy at diagnosis improved survival: the 5-year EFS was 85.4±6% and 54.7±8% for splenectomized and non-splenectomized pts respectively (p=0.02) and the 5-year OS was 91.2±5% and 67.9±7% respectively (p=0.08). For the 53 pts with stage I-II disease, both 5-year EFS and OS were better in the splenectomized pts (p<0.02, Fig 1). The 5-year EFS and OS in pts with stage I and II disease that were splenectomized at diagnosis was 89.6±6% and 96.4±3.5% as compared with 50.5±11% and 63.2±11% in pts who were not splenectomized (p=0.012 and 0.009). The EFS and OS were not influenced by the stage of the disease. Overall survival was associated with B symptoms (p=0.02), weight loss (p=0.04) and ECOG performance status (p=0.03). In a multivariate model, low ECOG PS and splenectomy independently predicted a better EFS (p=0.03 and 0.02 respectively), however for OS, low ECOG PS independently predicted better OS (p=0.03), while splenectomy had only marginal effect on the OS (p=0.056).Conclusions: In our group of pts, PS-DLBCL generally presented with abdominal pain, high LDH and a splenic mass. We demonstrate for the first time that splenectomy at diagnosis improves survival in early stages of PS-DLBCL. Our study is a retrospective one. Therefore, until prospective studies prove that early splenectomy in PS-DLBCL is beneficial in terms of overall survival, the risk and benefit of performing splenectomy should be weighed for each patient. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A Challenging Cause of Chronic Diarrhea

A Challenging Cause of Chronic Diarrhea

Значимость ультразвукового метода в диагностике иммунных нарушений у детей, проживающих в условиях воздействия техногенных факторов среды обитания

In this article the possibility to use ultrasound study with calculation of splenic mass index (SMI) to assess the immune status of children living in man-caused impact conditions is justified. A comparative analysis of the prevalence of enlarged spleen and SMI values CCM by ultrasound 1 225 children aged 3 to 17 years old, living in urban areas of the Perm region and in ecologically clean regions and in the resort area of the Republic of Abkhazia was carried out. The prevalence of personal anamnestic data was analyzed at 846 children, out of the total number. The number of sickly children in urban areas more and spleen have significantly increased in comparison with rarely ill. The SMI significantly increases the likelihood of changes of some indicators general and immunological analysis of blood.

Pathologic Splenic Rupture Related to Non-Hodgkin Lymphoma

Introduction: Pathologic splenic rupture (PSR) is described as the spontaneous rupture of a histologically diseased spleen in the absence of trauma. Although it is a complication that often occurs related to infectious diseases, it may rarely be observed in hematologic malignancies. A limited number of case reports about PSR exist in the current literature, even though the spleen is commonly involved in hematologic diseases. Hence, there is a lack of data in the current literature in terms of the clinical symptoms, treatment, and outcomes of the disease. In this study, we aimed to contribute to current data by discussing clinical outcomes of a case with PSR related to spleen lymphoma. Case Report: A 57-year-old woman with a 5-month history of colic left upper abdominal pain was referred to our clinic. In her imaging tests, a splenic mass with a measure of 6x4 cm was detected. The patient underwent splenectomy due to PSR while preparing for elective surgery. Conclusion: PSR should be considered a rare complication in hematologic malignancies. Early diagnosis and treatment are the major factors that determine prognosis. Splenectomy seems to be the most appropriate approach in the treatment of PSR, even though a conservative approach is suggested in some cases.

PARTIALY FUSED SPLENIC LOBULE- A CASE REPORT

AbstractSpleen is the largest lymphatic organ in humans. It is situated in the left hypochondrium and partly in the epigastrium, between the fundus of the stomach and the diaphragm. It consists of large encapsulated mass of lymphoid and vascular tissues (1). We encountered a case of partially fused splenic lobule in the anterior end with attachment to the main splenic mass through a stalk of splenic tissue. As such, the variation of this kind is rare and had various important clinical implications in the field of surgery, radio diagnosis and gastroenterology.

Impact of immediate evaluation of touch imprint cytology from computed tomography guided core needle biopsies of mass lesions: Single institution experience.

Background:Computed tomography (CT) guided core needle biopsy (CT-guided CNB) is a minimally invasive, safe and effective manner of tissue sampling in many organs. The aim of our study is to determine the impact of on-site evaluation of touch imprint cytology (TIC) to minimize the number of passes required to obtain adequate tissue for diagnosis.Design:A retrospective review of all CT-guided CNBs performed during 4 year period, where pathologists were present for on-site TIC evaluation. Each case was evaluated for the number of passes required before TIC was interpreted as adequate for diagnosis.Results:A total of 140 CT-guided CNBs were included in the study (liver, lung, kidney, sacral, paraspinal, omental, splenic and adrenal masses). Of the 140 cases, 109 were diagnosed as malignant, 28 as benign and three insufficient. In 106 cases (75.7%), the biopsies were determined adequate by TIC on the first pass, 19 cases (13%) on the second pass and 7 cases (5%) on the third pass. Only in 5 cases (3.6%), more than three passes were required before diagnostic material was obtained. Three cases (2.14%) were interpreted as inadequate both on TIC and on the final diagnosis. Of the biopsies deemed adequate on the first pass, 71% resulted in either termination of the procedure, or only one additional pass was obtained. In five cases, based on the TIC evaluation, a portion of the sample was sent for either flow cytometric analysis or cytogenetic studies.Conclusions:In the majority of cases, adequate material was obtained in the first pass of CT-guided CNB and once this was obtained, either no additional passes, or one additional pass was performed. This study demonstrates the utility of on-site evaluation in minimizing the number of passes required for obtaining adequate diagnostic material and for proper specimen triage for ancillary studies, which in turn decreases the risk to the patient and costs. However, tumor exhaustion in the tissue as a result of TIC is an important pitfall of the procedure, which occurred in 9 (8.2%) of our malignant cases.

Cross-Sectional Imaging of Nontraumatic Emergencies of the Spleen

Multiple nontraumatic splenic emergencies are encountered during the imaging of patients in emergency room. Occasionally, patients are investigated for symptoms of suspected splenic pathology, such as abscess, infarct, symptomatic splenic artery aneurysm and pseudoaneurysm, splenic torsion, or rupture. More often, however, splenic emergencies, such as splenic masses and splenic vein thrombosis, are detected in patients in the emergency room during the evaluation of nonspecific abdominal pain. It is essential for radiologists to be vigilant in the identification of nontraumatic splenic emergencies and to be familiar with interventional radiology management options for these pathologies. Our aim is to highlight factors affecting lesion detection on multiple imaging modalities and to discuss the advantages of different cross-sectional modalities for the diagnosis of splenic abnormalities. Finally, we review the management options with emphasis on interventional radiology where applicable.

Gamna‐Gandy bodies: a case of mistaken identity in the spleen of a cat

A 4-year-old, female spayed Domestic Shorthair cat was presented for a 2-day history of lethargy, anorexia, and vomiting. Diagnostic assessments revealed a severe, regenerative anemia and the presence of a solitary, 3 × 4 cm splenic mass. Cytologic examination of fine-needle aspirates of the splenic mass showed sheets of pleomorphic histiocytic cells with numerous intracellular and extracellular, negatively staining to deeply basophilic, branching structures. These structures were typically of thin uniform thickness with random angled branching that formed geometrical shapes and fragments, occasionally with sharpened ends and a crystalline appearance. Septal-like divisions were irregularly spaced along some of the linear branches. The cytology was interpreted as a probable histiocytic inflammatory response to the unidentified foreign material with histiocytic sarcoma as a differential diagnosis. Histopathologic evaluation of the splenic mass resulted in a diagnosis of histiocytic sarcoma. The branching material stained positively for both iron and calcium, indicating that the material was compatible with Gamna-Gandy bodies present secondary to tumor-associated hemorrhage and the formation of calcium-iron complexes.

Splenic malignant mesenchymoma in a dog - immunophenotypic features and clinicopathological ramifications: a case report

A 13-year-old spayed bitch was referred for evaluation of an abdominal distension with a palpable, continuously growing mass. Abdominal ultrasonography revealed a 30 &amp;times; 20 cm mass directly connected to the spleen. Surgical exploration confirmed the sonographic diagnosis with adhesions to the omentum and the liver. Pathohistological samples revealed well differentiated adipose tissue and variably differentiated collagenous and myxomatous tissue. Immunohistochemically, vimentin and in some regions alpha smooth muscle actin were expressed indicating smooth muscle differentiation. The results support the diagnosis of a malignant mesenchymoma composed of liposarcoma, mixosarcoma and leiomyosarcoma. No local recurrence or metastasis occurred during a nine month follow-up. So far, only two pathological retrospective studies describing the common prevalence and properties of canine splenic malignant mesenchymomas were found in the literature. However, this rare tumor entity has to be considered as a differential diagnosis in cases of large splenic masses. &amp;nbsp;

English

OBJECTIVES: To study the role of ultrasonography and computed tomography in the evaluation of abdominal masses, to compare their diagnostic accuracies, to evaluate the imaging features of lesions and to know the exact site of origin and extension into surrounding structures. MATERIALS AND METHODS:A prospective study of 104 patients with abdominal masses. USG was done with Toshiba SSA and Philips Envisor C machine and CT-Scan examination was performed in all patients on Philips brilliance 6-slice whole body CT scanner. RESULTS: There were 35(30.62%) cases of hepatobilliary masses, renal15(14.40%)cases, pancreatic 7(6.72%)cases, 5(4.80%) cases of splenic masses and 30(28.82%) cases of pelvic masses.8 cases with other abdominal masses. Hepatic SOL were detected in 6(5.76%) and 8(7.69%), 5(4.80%)cases of gall bladder masses and 4(3.85%), Omental caking was seen in 2(1.92%) cases and 4(3.85%), calcification was seen in 2(1.92%) cases and 4(3.85%) cases, renal calculi were seen in 4(3.84%) cases and6(5.77%) cases, on sonography and CT examination. Peritoneal deposits were seen in 3(2.88%) cases of ovarian carcinoma and unknown malignancy on US and in 5(4.88%) cases on CT. Ascites and lymphadenopathy was more accurately detected on CT as compared to US.CT detected splenicinfarcts which were missed on ultrasonography. CONCLUSION: CT is more sensitive in evaluation of site and size of lesion, detection of calcification, adjacent organ infiltration and regional lymphadenopathy. The limitations of CT are ionizing radiation, high cost and contrast administration. Hence ultrasound should be the primary screening modality and CT should be used for further characterizing the masses.

Diffuse Large B cell Lymphoma with Primary Spleen Involvement: Report of Three Cases

The spleen is the primary organ of lymphoma in only 1–2 % of all lymphoma patients. We presented three cases of primary splenic involvement of lymphoma that were treated. Presentation of cases: In the first case, four solid lesions were detected, and in the second case, a hypodense lesion of 3 cm was detected in the spleen. Two cases underwent splenectomy. No complication and recurrence were observed during 22 - 21 months follow-up, respectively. In the third case, a splenic mass invading pancreas was detected. Splenectomy and distal pancreatectomy were performed. No recurrence was observed during 8-year follow-up. In postoperative period, all cases were treated with cyclophosphamide, vincristine, doxorubicin, prednisone plus rituximab for 6 cycles. Primary splenic lymphoma refers to the involvement of the spleen only or with splenic hilar lymph node or local invasion without liver involvement. The pathologic diagnosis was diffuse large B-cell non-Hodgkin’s lymphoma in the all cases. Splenic mass biopsy has some complication risks. Aspiration biopsy of splenic mass was performed in one of the three cases. Invasions should be evaluated in terms of malignity during splenectomy, and liver biopsy and biopsies of lymph nodes can be performed in case of lymphoma. Additionally diagnosis should be confirmed via post-operative bone marrow biopsy and positron emission tomography screening. Primary splenic involved lymphoma must be kept in mind for differential diagnosis in cases with splenic mass. Splenectomy is one of the most common modality for primary splenic lymphomas in terms of both diagnostic and curative treatment.

Classical hodgkin lymphoma (nodular sclerosis type) associated with langerhans cell histiocytosis: a case report on fine-needle aspiration cytologic features

Langerhans cell histiocytosis (LCH) can be associated with a variety of malignant neoplasms, the most common being malignant lymphoma, especially Hodgkin lymphoma (HL). In the present report we describe the fine needle aspiration (FNA) cytologic features of a case with concurrent LCH and HL in a lymph node. A 20-year-old man presented with an enlarged left upper cervical lymph node. FNA smears from the swelling revealed numerous CD1a+ and S-100+ Langerhans histiocytes (LCs) along with many eosinophils, neutrophils, and lymphocytes; there were also large atypical cells with enlarged nuclei having prominent nucleoli. The cytodiagnosis was LCH and the possibility of association with or trans-differentiation into a lymphoma was suggested. The histopathological diagnosis of the excised lymph node was classical Hodgkin lymphoma-nodular sclerosis type (CHL-NS) with LCH. The lacunar type Reed-Sternberg (RS) cells were positive for CD30 and CD15 while the LCs were positive for CD1a and S-100 protein. PET/CT imaging of vertex to mid-thigh demonstrated hypermetabolic lymph nodes in the neck, abdomen, thorax and pelvis as well as pulmonary nodules and a splenic mass. The patient received courses of chemotherapy and two years later, the enhanced CT of neck, chest, abdomen and pelvis revealed regressive course of the disease.

Fever of Unknown Origin and a Splenic Mass: When Infection and Incidental Findings Coalesce

Fever of Unknown Origin and a Splenic Mass: When Infection and Incidental Findings Coalesce

A case of inflammatory pseudotumour of the spleen with EBV infection complicated by idiopathic thrombocytopenic purpura

Reports of inflammatory pseudotumour (IPT) of the spleen with Epstein-Barr virus (EBV) infection complicated by idiopathic thrombocytopenic purpura (ITP) are very rare. The pathogenesis of this tumour has remained obscure, with most authors agreeing that IPT of the spleen is a non-neoplastic, reactive condition. IPT of the spleen often poses diagnostic difficulty because it forms an infiltrative mass which has clinical, radiological and gross pathologic features that suggest a malignant lymphoma, vascular malformations, but also inflammatory myofibroblastic tumour (IMT) and inflammatory pseudotumour-like follicular dendritic cell tumour (IPT-FDC). Herein, we report a case of IPT of the spleen with EBV infection in a 51-year-old woman who presented with symptoms of ITP. The results of abdominal ultrasonography and computed tomography (CT) showed the presence of a splenic mass. She had been observed for 12 months with the diagnosis of a possibly benign neoplasm such as haemangioma or granulomatous disease; the tumour grew, necessitating an open splenectomy for diagnostic and curative goals. Histopathologic examination showed an inflammatory pseudotumour with spindle cells positive for EBV by in situ hybridization. When examined immunohistochemically, the spindle cells were focally positive for SMA, vimentin and CD68, and negative for CD21, CD23, CD35 and ALK, thus excluding IMT and IPT-FDC tumour. No evidence of recurrence of thrombocytopenia or subsequent development of other neoplasm was noted 18 months after splenectomy. Splenic IPT can be considered as a benign reactive tumoral lesion. It is important to distinguish it from other conditions using a combination of clinical, histologic, and immunophenotyping findings. We believe that EBV infection may have played a role in the pathogenesis of splenic IPT and the development of thrombocytopenic purpura.

Splenectomy to treat splenic lesions: An analysis of 148 cases at a cancer center

Solid and cystic splenic masses discovered on imaging studies often pose diagnostic and management dilemmas. This study analyses a large series of splenectomies to identify preoperative factors associated with malignant splenic masses. Pathology records at a single institution were reviewed for all splenectomies. Those performed as a component of a larger resection, such as staging or debulking were excluded. Demographic and clinicopathologic factors were obtained. Univariate and multivariate analyses identified factors associated with an increased risk of malignancy. Between 1986 and 2012, 2,743 patients underwent a splenectomy, 148 of which were performed for lesions identified on imaging. The indications were suspicion of malignancy (120, 81%), growth over time (28, 19%), or symptoms (39, 26%). Resected splenic lesions were malignant in 93 patients (63%); the most common pathologies included ovarian cancer (n = 39), melanoma (n = 14), and colorectal cancer (n = 9). On multivariate analysis of clinicopathologic factors, a previous history of cancer was the only independent predictor of malignancy in the splenic lesion (odds ratio 6.3; 95% CI, 2.32-16.97; P = 0.001). While the spleen is an uncommon site of metastatic disease, in patients with a history of cancer, splenic masses selected for resection are frequently malignant.

Effectiveness and safety of minilaparoscopy-guided spleen biopsy: a retrospective series of 57 cases

Minilaparoscopy is an accepted method for liver biopsy. We report our experience with minilaparoscopy for splenic biopsy.We reviewed the records of all minilaparoscopy procedures performed from 1996 to 2004 at the University of Mainz Medical Center and from 2005 to mid-2011 at the University of Hamburg Medical Center to identify patients who underwent a minilaparoscopy-guided splenic biopsy. All procedures were performed using the previously described method (2.75-mm trocar, 2.3-mm Veress needle, 1.9-mm laparoscope) with the patient under conscious sedation (midazolam/meperidine/propofol). Splenic biopsies were performed using a second trocar with an 18-G Tru-Cut needle. Argon plasma coagulation (APC) and/or fibrin glue (FG) were used to control postbiopsy bleeding.Fifty-seven patients underwent minilaparoscopy-guided biopsy of the spleen (27 females, 30 males; median age = 41 years, range = 16-76). A specimen suitable for histopathologic evaluation was obtained in all patients. Grouped by preprocedure indication, a definitive diagnosis was obtained in 70% (7/10) of patients who had splenic mass lesions in prior imaging (3 B-NHL, 2 hemangioma, 1 tuberculosis, 1 sarcoidosis; p < 0.01) compared to 29% (10/34) in the group with unexplained fever or suspected lymphoma (3 tuberculosis, 2 B-NHL, 1 hepatosplenic T-cell lymphoma, 1 sarcoidosis, 1 Still's disease, 1 EBV, 1 Q-fever) and 0/13 with unexplained splenomegaly. Focal lesions noted at laparoscopy yielded to a histologic diagnosis in 38% (11/29) of 42 patients compared to 21% (6/28) without laparoscopic abnormality (p = 0.25). Bleeding from the biopsy site was noted in 96.5% (55/57) and was classified as brisk in 9. Control of hemorrhage was achieved in all patients (APC: 47, FG: 1, APC/FG: 7). There was no postprocedure bleeding or other complications.Splenic biopsy guided by minilaparoscopy can be performed safely. Postprocedure bleeding is readily controlled with APC with or without fibrin glue. The highest diagnostic yield is in patients with focal splenic lesions.