Splenic Tumor Research Articles

Reappraisal of surgical decision-making in patients with splenic sclerosing angiomatoid nodular transformation: Case series and literature review.

BACKGROUNDMany clinicians and surgeons are unfamiliar with the sclerosing angiomatoid nodular transformation (SANT), which is gaining recognition as a benign splenic tumor. We challenge that SANT is rare and whether surgical intervention could be avoided through critical imaging review.AIMTo evaluate the incidence of SANT among splenic tumors and the decision-making process of SANT management.METHODSTwenty hospitalized patients who underwent splenectomy in 2018 and 2019 in a tertiary university hospital were retrospectively reviewed, and their data on imaging, diagnosis, surgical indications, and courses were recorded. All pathology results were confirmed by pathologist. Discriminative features differentiating SANT from other non-SANT splenic tumors were descriptively analyzed in this case series.RESULTSFourteen out of 20 patients who underwent splenectomy had splenic tumors, including 3 SANTs (21% splenic tumors), 6 non-SANT benign lesions (43%), 2 metastatic tumors, and 3 lymphomas. Hypointensity on T2-weighted magnetic resonance imaging (MRI), spoke wheel enhancing pattern in contrasted computed tomography or MRI, and cold spot (low fluorodeoxyglucose uptake) in positron emission tomography (PET) scan helped establish the diagnosis of SANT. Lymphoma, presenting with a hot spot on the PET scan were differentiated from SANT. Surgical indications were reformatted for splenic tumors. Splenectomy need not be performed in patients with typical imaging features of SANT.CONCLUSIONSANT is not a rare disease entity in clinical practice. Splenectomy should not be routinely indicated as the only management option for SANT with typical imaging features.

Canine Non-Angiogenic, Non-Myogenic Splenic Stromal Sarcoma: a Retrospective Clinicopathological Analysis and Investigation of Podoplanin as a Marker of Tumour Histogenesis

Splenic stromal sarcomas are rarely reported tumours that were previously grouped as non-angiomatous, non-lymphomatous mesenchymal neoplasms of the canine spleen. Highly variable survival times have been reported probably due to their heterogeneous nature. The purpose of this study was to assess the outcome and prognostic factors in dogs with splenic stromal sarcoma after treatment by splenectomy. Clinical data were collected retrospectively and histopathology was reviewed for 47 patients. Histological classification, based on morphology in haematoxylin and eosin-stained sections, in conjunction with immunolabelling of macrophage scavenger receptor-A (CD204), desmin, factor VIII-related antigen and smooth muscle actin ,yielded diagnoses of undifferentiated stromal sarcoma (n=22), complex nodular hyperplasia (CNH, n=9), sarcoma arising from benign complex nodular hyperplasia (n=3), histiocytic sarcoma (n=3), haemangiosarcoma (n=1) and leiomyosarcoma (n=1). Four samples were excluded from analysis due to extensive necrosis. An anti-podoplanin (PDPN) antibody was validated on canine tissue and used to assess expression of this protein as a potential indicator of the tissue of origin of the neoplasms (28/42 tumours were positive). There was a statistically significant difference in survival time between patients with stromal sarcoma (sarcoma from benign CNH and undifferentiated stromal sarcoma) and CNH (178d versus 637d, respectively; P=0.027). Dogs with stromal sarcomas and high mitotic count (≥9 per 10 high-power fields) had a significantly shorter survival time (67d versus 439d; P=0.01). Clinical diagnosis of splenic tumours should include evaluation for the presence of benign nodular hyperplasia morphology and immunohistochemistry to exclude more aggressive malignancies where adjuvant therapy is recommended. As in humans, PDPN may be an effective marker for stromal sarcomas of the canine spleen and immunopositivity suggests a fibroblastic reticular or follicular dendritic cell origin.

Prognostic impact of splenic vessel involvement and tumor size in distal pancreatectomy for adenocarcinoma: a retrospective multicentric cohort study.

Splenic vessel involvement occurs frequently in pancreatic ductal adenocarcinoma (PDAC) of the body and the tail (B/T) but the impact on survival is unknown. We assessed the influence of radiological and pathologic involvement of splenic artery (p-SA +) and vein (p-SV +) on patient outcomes after distal pancreatectomy (DP) for PDAC. From 2013 to 2019, all DP for PDAC in five centers were included. Factors associated with overall (OS) and disease-free (DFS) survival were identified. Among the 76 patients included, 5 (6.6%) had p-SA + only, 11 (14.5%) had p-SV + only, and 24 (31.6%) had both p-SA + and p-SV + . The preoperative CT-scan accuracy to predict p-SV + and p-SA + was high (sensitivity: 91.4% and 82.8%, respectively; negative predictive value: 89.7% and 88.3%, respectively). The 5-year OS and DFS rates were 3.9% and 8.3%, respectively. Multivariate analysis identified splenic vessel involvement (i.e., p-SA + or p-SV + , or both p-SA + and p-SV +) as the only independent factor influencing DFS (HR 4.04; 95% CI [1.22-13.44], p = 0.023). Tumor size ≥ 30mm was the only independent factor influencing OS (HR 4.04; 95% CI [1.26-12.95], p = 0.019) and was associated with a high risk of p-SA + (p = 0.001) and p-SV + (p < 0.001). Tumor size ≥ 30mm and splenic vessel involvement occurred in more than half of the patients who underwent DP for PDAC and had negative impact on long-term survival. Preoperative CT-scan was reliable to identify splenic vessel involvement in B/T PDAC. Large tumor size and radiological splenic vessel involvement could be taken into account to propose a neoadjuvant treatment.

Abstract 3169: The therapeutically inflamed tumor microenvironment drives melanoma progression

Abstract Even the most therapy responsive melanomas eventually evade immune checkpoint inhibition. Interestingly, initial responses seem to benefit from localized inflammation, but this can become prohibitive when treating advanced disease. Subsequently, there is an urgent need to elucidate how inflammation impacts the tumor microenvironment (TME). Here, inhibition of EGFR and Ras/Raf/MEK is shown to drive the release of a pro-inflammatory secretome that activates the TME to promote progression. This secretome was enriched with immune recruiting cytokines and members of the transforming growth factor beta (TGFβ) superfamily. Both healthy and cancer associated fibroblasts (CAFs) were hyperactivated in response to the inflamed secretome with induction of the inflammatory marker, alpha smooth muscle actin (αSMA). Pharmacologic inhibition of TGFβ receptor type I (TGFβRI) using SB431542 or clinically relevant TEW-7197, diminished CAF αSMA phenotype, disrupted TGFβ and phospo-SMAD2/3 signaling, and blunted CAF expression of tumor promoting extracellular matrix and adhesion molecules. Invasion of melanoma spheroids was enhanced ~2.5-fold in CAF coculture transwells. However, treatment with MEK inhibitor AZD6244 and TEW-7197 only limited invasion of mixed melanoma and CAF multi-cell spheroids in vitro. Prompted by this, the extracellular matrix of patient-derived and melanoma xenograft tumors was analyzed for inflammatory protein expression. Micrometastatic foci were flanked by peri-tumor αSMA+ CAFs and enriched for inflammatory Tenascin-C (TNC) at the invasive front. The analysis of human melanoma tissue microarrays corroborated the experimentally observed expression of αSMA CAFs and TNC which statistically increase with malignant tumor grade. Conversely, the anti-invasive Decorin (DCN), decreased in malignant melanoma while collagen-1 increased during late stage tumor fibrosis. These findings prompted the use of ex vivo human skin organ cultures (SOCs) to define how cell matrix impacted melanoma. Addition of DCN to the SOC eliminated melanoma vertical invasion whereas pathological TNC promoted progression. Thus, a BRAFV600E resistant patient-derived metastatic cell line was used to establish intrasplenic xenografts that were treated after one week using AZD6244 and TEW-7197. Both monotherapy and combination therapy were well tolerated and resulted in reduced splenic tumor burden, αSMA staining, and halted metastasis to the liver. Citation Format: Andrew M. Bradshaw, Erica Kuo, Jelena Grahovac, Kyle Sylakowski, Cindy Sander, Howard Edington, John M. Kirkwood, Alan Wells. The therapeutically inflamed tumor microenvironment drives melanoma progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 3169.

Comparison of Serological and Molecular Assays for Bartonella Species in Dogs with Hemangiosarcoma.

Currently, a gold standard diagnostic test for Bartonella infection in dogs is lacking. This represents a critical limitation for the development and evaluation of new diagnostic tests, as well as for the diagnosis of, and research on, bartonellosis in dogs. This retrospective observational study aims to compare the results of commonly performed and newly-reported Bartonella spp. diagnostic tests in banked clinical specimens from 90 dogs with hemangiosarcoma (HSA) using composite reference standard (CRS) and random effects latent class analysis (RE-LCA) techniques. Samples from each dog were tested using six serological or molecular diagnostic assays, including indirect fluorescent antibody (IFA) and Western blot (WB) for the detection of antibodies in serum, and qPCR and droplet digital PCR (ddPCR) in blood and fresh frozen tissue biopsy samples (mainly splenic HSA tumors and histopathologically normal spleen or skin/adipose tissue). Bartonella infection prevalence was estimated to be 78% based on the CRS (parallel testing with all six assays), and 64% based on the RE-LCA model. The assay with the highest diagnostic accuracy was qPCR performed on fresh frozen tissue biopsy samples (sensitivity: 94% by RE-LCA and 80% by CRS; specificity: 100%). When comparing newly-reported to traditional Bartonella diagnostic assays, ddPCR was more sensitive for the detection of Bartonella DNA than qPCR when testing blood samples (36% vs. 0%, p < 0.0001). Dogs that were positive on serological assays alone with negative molecular assays were highly unlikely (<3%) to be classified as infected by the RE-LCA model. These data indicate that Bartonella spp. DNA can be PCR amplified from fresh frozen tissues from a majority of dogs with HSA using both qPCR and ddPCR, supporting the use of these methods for future controlled studies comparing the prevalence of Bartonella spp. DNA in the tissue of dogs with HSA to that of unaffected controls.

Influence of Crescentia cujete and Launaea taraxacifolia leaves on growth, immune indices, gut microbiota, blood chemistry, carcass, and meat quality in broilerchickens.

The rising concerns pertaining to the safety of synthetic supplements in livestock production have encouraged the exploration of potential alternatives. This study investigated the growth, gut microbiota, blood chemistry, immune indices, meat quality, and antioxidant status in broiler chickens supplemented with Crescentia cujete leaf (CCL), Launaea taraxacifolia leaf (LTL), and a combination of antibiotic (70% oxytetracycline + 30% neomycin) and tert-Butylhydroxyanisole. One-day-old Ross 308 chicks (n = 420) were randomly assigned to either T-1, basal diet (BD) only; T-2, BD + 0.4g/kg antibiotic + 0.13g/kg tert-butylhydroxyanisole; T-3, BD + 2.5g/kg LTL; T-4, BD + 5g/kg LTL; T-5, BD + 2.5g/kg CCL; or T-6, BD + 5g/kg CCL for 42days. Each dietary group had seven replicates with ten chicks per replicate. Body weight gain and carcass weight were higher (P < 0.05) in the T-2, T-4, T-5, and T-6 birds compared with those of other birds. At 1-21days, the T-2 and T-4 birds consumed more feed than the T-1 and T-3 birds. At 22-42days, the T-4 birds consumed more (P < 0.05) feed than the T-1 and T-3 birds. During 1-42days, the T-1 and T-3 birds consumed less (P < 0.05) feed than other birds. At 22-42days and 1-42days, the T-1 had lower feed efficiency (P < 0.05) than other birds except for the T-3 birds. The CCL and LTL birds had lower (P < 0.05) serum LDL cholesterol and higher HDL cholesterol compared with other birds. Hematology, splenic interleukin-1β, immunoglobulin M, ileal and caecal total aerobic bacteria counts, caecal Lactobacillus spp., and meat physicochemical properties were unaffected by diets. The T-1 birds had higher (P < 0.05) ileal and caecal Clostridium spp., E. coli, and Salmonella spp. compared with birds fed other diets. The CCL and LTL birds had higher ileal Lactobacillus counts. Splenic IL-10 was higher (P < 0.05) in the T-2, T-4, and T-6 birds compared with that in other birds. Dietary supplementation with CCL, LTL, and a combination of antibiotic and tert-butylhydroxyanisole repressed (P < 0.05) splenic tumor necrosis-α and immunoglobulin G. The T-1 breast meat had lower glutathione peroxidase and catalase. The T-4 meat had higher (P < 0.05) superoxide dismutase, glutathione peroxidase, catalase, and total antioxidant capacity compared with other meats. On day 3 postmortem, meats obtained from birds supplemented with CCL, LTL, and a combination of antibiotic and tert-butylhydroxyanisole had lower (P < 0.05) carbonyl and malondialdehyde contents than the meat from the non-supplemented birds. The 5g/kg CCL and 5g/kg LTL could be used as antimicrobial and antioxidant in broiler diets.

Ral GTPase–activating protein regulates the malignancy of pancreatic ductal adenocarcinoma

The small GTPases RalA and RalB are members of the Ras family and activated downstream of Ras. Ral proteins are found in GTP‐bound active and GDP‐bound inactive forms. The activation process is executed by guanine nucleotide exchange factors, while inactivation is mediated by GTPase‐activating proteins (GAPs). RalGAPs are complexes that consist of a catalytic α1 or α2 subunit together with a common β subunit. Several reports implicate the importance of Ral in pancreatic ductal adenocarcinoma (PDAC). However, there are few reports on the relationship between levels of RalGAP expression and malignancy in PDAC. We generated RalGAPβ‐deficient PDAC cells by CRISPR‐Cas9 genome editing to investigate how increased Ral activity affects malignant phenotypes of PDAC cells. RalGAPβ‐deficient PDAC cells exhibited several‐fold higher Ral activity relative to control cells. They had a high migratory and invasive capacity. The RalGAPβ‐deficient cells grew more rapidly than control cells when injected subcutaneously into nude mice. When injected into the spleen, the RalGAPβ‐deficient cells formed larger splenic tumors with more liver metastases, and unlike controls, they disseminated into the abdominal cavity. These results indicate that RalGAPβ deficiency in PDAC cells contributes to high activities of RalA and RalB, leading to enhanced cell migration and invasion in vitro, and tumor growth and metastasis in vivo.

Recurrent Epistaxis and Diffuse Hepatic and Splenic Vascular Malformations

Question: A 48-year-old man was admitted to emergency department because of left upper abdominal pain for 3 weeks and yellow urine for 1 week. The patient was diagnosed with splenic hemangioma for 3 years and recurrent epistaxis for 5 years, without further treatment. Physical examination showed tenderness and rebound pain in the left upper abdomen, no muscle tension, with shifting dullness. Laboratory studies showed a neutrophil count of 8990/mm3 (reference range, 1900–8000/mm3), a hemoglobin level of 66 g/L (reference range, 131–172 g/L), a total bilirubin level of 57.23 μmol/L (reference range, 5.1–20 μmol/L), a serum alanine aminotransferase level of 302.9 U/L (reference range, 9–50 U/L), a serum aspartate aminotransferase level of 117.5 U/L (reference range, 15–40 U/L), an activated partial prothrombin time of 34.6 (reference range, 25–34), and a quantitative D-dimer level of 361.23 (reference range, 0–0.55). Emergency abdominal computed tomography scan showed diffuse hepatic and splenic vascular malformations (Figure A), and a ruptured splenic tumor (Figure B, arrow). It is worth noting that the patient's father had the same disease during his lifetime after asking about the family history. What is the most likely diagnosis? Look on page 808 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and images in GI. After consultation with the patient, he underwent emergency splenectomy and liver biopsy. Histopathology demonstrated the dilatation of hepatic capillaries, showing hemangioma-like changes (Figure C). The ruptured splenic tumor was confirmed pathologically as hemangioendothelioma. After a multidisciplinary consultation, the patient was diagnosed with hereditary hemorrhagic telangiectasia (HHT) according to the Curaçao criteria.1Faughnan M.E. Palda V.A. Garcia-Tsao G. et al.International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia.J Med Genet. 2011; 48: 73-87Crossref PubMed Scopus (745) Google Scholar HHT, also called Osler–Weber–Rendu disease, is an autosomal-dominant disease. Up to one-third of patients have hepatic involvement and manifest as vascular malformations,2Chung D.Y. Federle M.P. Barrett J.P. et al.Hepatic hereditary hemorrhagic telangiectasia.Clin Gastroenterol Hepatol. 2006; 4 (xx)Abstract Full Text Full Text PDF Scopus (1) Google Scholar such as hepatic arteriovenous fistula (Figure D, rectangle). Martini3Martini G.A. The liver in hereditary haemorrhagic teleangiectasia: an inborn error of vascular structure with multiple manifestations: a reappraisal.Gut. 1978; 19: 531-537Crossref PubMed Scopus (95) Google Scholar classified patients with hepatic disease due to HHT into 3 subgroups: patients who had telangiectases with fibrosis or cirrhosis (as in our case), those who had cirrhosis without telangiectases, and those who had telangiectases without fibrosis or cirrhosis. Treatment is mostly supportive, but severe patients may require hepatic artery embolization or liver transplantation.2Chung D.Y. Federle M.P. Barrett J.P. et al.Hepatic hereditary hemorrhagic telangiectasia.Clin Gastroenterol Hepatol. 2006; 4 (xx)Abstract Full Text Full Text PDF Scopus (1) Google Scholar During the period of waiting for liver transplantation, the patient developed hepatic and renal insufficiency and respiratory failure. On day 11 of hospitalization, the patient's family asked to be transferred back to the local hospital for treatment. The patient died of multiple organ failure on the third day after transfer.

Serum angiopoietin-2 levels in dogs with splenic haemangiosarcoma, haemangioma, and splenitis

Haemangioma (HA) and haemangiosarcoma (HSA) are among the most common splenic neoplasms in dogs. The survival time in splenic HSA is short, probably due to the lack of proper biological markers allowing early detection. We investigated the serum angiopoietin-2 (Ang-2) concentrations in 9 healthy dogs and 40 dogs with abnormal splenic masses. The Ang-2 concentration differences were further compared in healthy dogs, dogs with splenitis, splenic HA and HSA. The results showed that the Ang-2 level in healthy dogs was significantly lower than in the splenitis and splenic HA cases. Moreover, the Ang-2 level was significantly higher in splenic HA than in splenic HSA. Conversely, no significant differences in Ang-2 level were recorded between healthy and splenic HSA dogs, and between splenitis and splenic neoplasms (HA and HSA). No significant correlations were observed between the Ang-2 level and (i) the clinical stage, (ii) histological growth pattern, and (iii) median survival time of splenic HSA dogs. In conclusion, serum Ang-2 concentration is a potentially useful biological marker for the discrimination of dogs with splenitis and splenic HA, as well as for the differentiation of splenic HA from its malignant form, HSA.

The first case report of a solitary metastasis of the transitional cell carcinoma of the ovary to the spleen

Background. Primary transitional cell carcinoma (TCC) of the ovary is characterized by the presence of papillary projections of malignant transitional epithelial cells or their aggregates in the fibrous stroma. This type of tumor represents nearly 1% of all ovarian surface epithelium carcinomas. We presented the first report of a solitary splenic metastasis of primary ovarian TCC. Case report. A 60-year-old female patient was admitted because of an asymptomatic splenic tumor in December 2018. Two years prior, she underwent a total abdominal hysterectomy, bilateral adnexectomy, and infracolic omentectomy for the primary TCC of the ovary. Control abdominal ultrasonography, computed tomography, and magnetic resonance imaging performed two years after primary surgery showed a splenic tumor. An open splenectomy was performed, with the intraoperative finding of a hilar splenic tumor and the absence of other pathological lesions in the abdomen. Frozen section analysis showed a TCC metastasis, which was subsequently confirmed by definitive histopathological examination. During the one-year follow-up, there was no relapse of the disease. Conclusion. This is the first report of a solitary splenic metastasis of primary ovarian TCC based on the literature review. This case may serve as an example of the diagnostic and therapeutical role of splenectomy in isolated splenic metastases of ovarian cancer.

Primary splenic anaplastic variant of diffuse large B-cell lymphoma: a case report\xa0

BackgroundPrimary splenic lymphoma represents a rare entity that constitutes less than 1% of non-Hodgkin lymphomas, and less than 2% of all lymphomas. Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype of primary splenic lymphomas. DLBCL encompasses a heterogeneous entity with distinct morphological variants. The anaplastic variant of DLBCL was first defined in the 2017 World Health Organization classification as a rare histological subtype that constitutes less than 3.4% of DLBCL cases.Case presentation A 65-year-old Syrian man presented to our hospital with constant dull localized left upper quadrant abdominal pain for about 20 days accompanied by general weakness, loss of appetite, and rapid weight loss. Clinical examination revealed isolated splenomegaly and left upper abdominal tenderness. Following physical, laboratory, and radiologic examinations, the patient underwent splenectomy. Interestingly, pathological and immunohistochemical examinations of the resected spleen confirmed the diagnosis of a primary anaplastic variant of DLBCL.ConclusionsHerein, we aimed to present an unusual combination of a rare splenic neoplasm and a unique lymphoma subtype. Furthermore, we aimed to highlight the difficulties in differential diagnosis and the importance of histological and immunohistochemical examinations with clinical correlation.

Splenic Mast Cell Tumors in Two Cats

Splenic Mast Cell Tumors in Two Cats

Pathomorphological features and mast cell count in canine visceral hemangiosarcomas

Visceral hemangiosarcoma were analyzed at the Department of Veterinary Pathology of the Faculty of Veterinary Medicine, University of Zagreb, over a 5-year period. From a total of 52 tumor masses in a total of 31 dogs, histological growth patterns (cavernous, capillary or solid) and the amount of tumor supporting stroma were evaluated. Additionally, sections were stained with toluidine blue for the purpose of mast cell detection and their number was determined in the tumor parenchyma, tumor stroma and edges. The average age of the affected animals was 10 years, males predominated, and the tumors occurred most frequently in cross breeds, German Shepherd dogs and Labrador Retrievers. The highest number of visceral hemangiosarcoma was found in the spleen (27/52). The most common growth pattern of visceral hemangiosarcoma was solely cavernous with a mixture of cavernous and solid patterns in different proportions. Mast cells were found in 44/52 (84.6%) of the visceral hemangiosarcomas. A smaller number of mast cells were found in the tumor parenchyma, and higher number were found in the stroma and tumor edges. The number of mast cells in tumors was not significantly associated with the tumor growth pattern, but there was a positive correlation between MCC - tumor parenchyma and stroma (rs = 0.28, P&lt;0.05), MCC - tumor stroma + edges (rs = 0.74, P&lt;0.05) and MCC - tumor parenchyma and MCC- tumor stroma+edges (rs = 0.30, P&lt;0.05) in all the examined tumors. In splenic tumors, there was only a significant positive correlation between MCC - stroma+edges (rs P = 0.68 P&lt;0.05). These results suggest a higher mast cell count in tumors with more developed stromal components in canine visceral hemangiosarcomas, and certainly indicate the need for further research on their role and the factors they release in the development and progression of hemangiosarcomas.

Onion leaf and synthetic additives in broiler diet: impact on splenic cytokines, serum immunoglobulins, cecal bacterial population, and muscle antioxidant status.

The disadvantages associated with the use of synthetic additives in animal production could threaten human and animal health, and the safety of animal-derived foods. This study assessed the growth performance, blood chemistry, immune indices, selected caeca bacterial population, muscle antioxidant enzyme activities, and meat quality in broiler chickens fed diet supplemented with antibiotic (70% oxytetracycline +30% neomycin), tert-butylhydroxytoluene or onion leaf powder (OLP). One day old Ross 308 chicks (n=240) were assigned randomly to either D-1, control diet (CD) without additives; D-2, CD +0.3g kg-1 antibiotic +0.15 g kg-1 tert-butylhydroxytoluene; D-3, CD +2.5g kg-1 OLP; or D-4, CD +5g kg-1 OLP for 42 days. The D-2 and D-4 diets improved (P <0.05) bodyweight gain and feed efficiency in broilers. Platelet and cecal Lactobacillus spp. counts were higher (P <0.05) whereas muscle cholesterol was lower (P< 0.05) in the OLP-supplemented birds. Supplemented birds had higher (P <0.01) splenic interleukin-10 and lower (P <0.01) splenic tumor necrosis factor-α, immunoglobulin A, cecal E. coli and C. perfringens counts compared with the D-1 birds. The D-4 birds had the least (P <0.05) splenic interleukin-1β. Dietary supplements increased (P <0.05) catalase, glutathione peroxidase, and total antioxidant capacity, and lowered (P <0.05) drip loss, malondialdehyde and carbonyl content in breast meat. Dietary supplementation of 5g kg-1 OLP exerted antimicrobial, immunomodulatory, and antioxidant effects that were comparable to those of antibiotics and tert-butylhydroxytoluene in broiler chickens. © 2021 Society of Chemical Industry.

A focal extramedullary hematopoiesis of the spleen in a patient with essential thrombocythemia presenting with a complicated postoperative course: a case report

BackgroundExtramedullary hematopoiesis is a compensatory response occurring secondary to inadequate bone marrow function and is occasionally observed in essential thrombocythemia (ET). This disease usually presents as multifocal masses in the paravertebral or intra-abdominal region; however, formation of a focal mass in the liver or spleen is rare. In addition, ET is characterized by increased platelet count and shows a tendency toward thrombosis and, occasionally, bleeding. Serious bleeding is common in ET patients, caused by the decrease in or abnormalities of von Willebrand factor (vWF) as a consequence of the precipitous rise in platelets. Therefore, strict management of platelet count using medication is crucial in patients with ET who require invasive procedures, especially splenectomy.Case presentationA 68-year-old man with ET was found to have an enlargement of a focal splenic tumor. Imaging findings revealed that the tumor was likely a hemangioma or hamartoma; however, the possibility of malignant disease could not be completely ruled out because of short-term tumor enlargement, and we conducted a splenectomy. The surgery was uneventful, but the patient presented with severe polycythemia and vWF abnormalities postoperatively, which resulted in bleeding from the drain insertion site and wound, epistaxis, and hemorrhoidal bleeding. Three months after discharge, polycythemia still persisted and the level of vWF gradually decreased. With a decrease in vWF, the patient suffered from an increased bleeding tendency. Therefore, the patient has been referred for bone marrow transplantation and is currently awaiting a suitable donor.ConclusionsExtramedullary hematopoiesis should be listed as a differential diagnosis of focal enlarged splenic tumors, especially in patients with myeloproliferative disorders. Additionally, in splenectomy for ET patients, careful perioperative management taking into consideration the conflicting features of a tendency toward thrombus formation and bleeding is necessary.

Tumor Necrosis Factor-α Blockade Corrects Monocyte/Macrophage Imbalance in Primary Immune Thrombocytopenia.

Primary immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder. Monocytes and macrophages are the major cells involved in autoantibody-mediated platelet clearance in ITP. In the present study, we found increased percentages of peripheral blood proinflammatory CD16+ monocytes and elevated frequencies of splenic tumor necrosis factor-α (TNF-α)-expressing macrophages in ITP patients compared with healthy controls. Concurrently, we observed elevated TNF-α secretion in plasma as well as higher TNF-α mRNA expression in total peripheral blood mononuclear cells and CD14+ monocytes of ITP patients. Of note, in vitro TNF-α blockade with neutralizing antibody remarkably reduced polarization to M1 macrophages by inhibiting the nuclear factor kappa B (NF-κB) signaling pathway. Moreover, TNF-α blockade dampened macrophage phagocytosis and T cell stimulatory capacity. Finally, in passive and active murine models of ITP, anti-TNF-α therapy reduced the number of nonclassical monocytes and M1 macrophages, ameliorated the retention of platelets in spleen and liver, and increased the platelet count of ITP mice. Taken together, TNF-α blockade decreased the number and function of proinflammatory subsets of monocytes and macrophages by inhibiting the NF-κB signaling pathway, leading to remarkable attenuation of antibody-mediated platelet destruction. Thus, TNF-α blockade may be a promising therapeutic strategy for the management of ITP.

Follicular Dendritic Cell Sarcomas: CT and MRI Findings in 20 Patients.

OBJECTIVE. The objective of this study was to assess the imaging features of follicular dendritic cell sarcoma (FDCS) on CT and MRI. MATERIALS AND METHODS. The clinical data and pretreatment findings of 20 patients with pathologically proven FDCS on CT (n = 15), MRI (n = 7), or both (n = 2) were analyzed retrospectively. Tumor location, number, size, morphology, attenuation or signal intensity, margin, presence of metastases, and contrast enhancement were evaluated. RESULTS. FDCS originated from lymph nodes (n = 6) or a variety of extranodal sites (n = 14). The tumors were typically solitary and well-circumscribed. Extranodal lesions (mostly in the abdomen or mediastinum with mean diameter, 11.8 cm) were larger than nodal lesions (mean diameter, 6.5 cm). Nodal-type cases presented with homogeneous masses on CT and MRI. However, on CT, all extranodal tumors (n = 12) showed heterogeneous attenuation, of which 91.7% (11/12) contained areas of lower attenuation because of internal necrosis and 50.0% (6/12) showed calcifications. On MRI, primary hepatic or splenic tumors (n = 3) also appeared as large heterogeneous masses. Seven patients (35.0%) had advanced-stage disease, and intraabdominal extranodal cases were more likely to have regional lymphadenopathy (n = 4) and distant metastases (n = 5). Hypervascularity was seen in 90.0% (18/20) of patients and progressive enhancement was seen in 11 (78.6%) of 14 tumors with multiphase imaging. CONCLUSION. FDCS is a rare, mostly solitary, well-delineated malignancy. A nodal-type FDCS typically presents as a small homogeneous mass, whereas an extranodal FDCS in the mediastinum or abdomen manifests as a large heterogeneous mass with internal necrosis and calcifications accompanied by regional lymphadenopathy. Hypervascularity and progressive enhancement can be seen in the majority of tumors.

Splenic Stromal Sarcoma in a Labrador Dog

Background: Splenic stromal neoplasms are a heterogeneous group of tumors that shares the morphology of spindle cells, and are considered a primary mesenchymal neoplasm of the spleen. Among these neoplasms, some are as yet unclassified. Although stromal neoplasms represent 25 a 50% of dog splenic neoplasms in dogs, subtypes rarely occur alone. As these neoplasms are difficult to diagnose in the routine veterinary medical examination, the objective of this article was to report a case of splenic stromal sarcoma in a dog treated at a private veterinary hospital in Recife, Pernambuco, Brazil. Case: An 8-year-old male labrador dog was treated at a veterinary hospital for an initial clinical suspicion of gastroenteritis. Clinical examinations showed anemic ocular mucosa and a distended abdomen. Considering the animal’s condition, blood count, serum biochemistry, and abdominal ultrasonography (US) were requested. The laboratory tests revealed anemia, thrombocytopenia, leukocytosis with neutrophilia, and changes in the indices of alanine aminotransferase (ALT) and alkaline phosphatase (ALP), among other findings. Abdominal ultrasound showed hepatomegaly, diffuse splenomegaly, a neoformation in the spleen suggestive of splenic neoplasia, and mild cystic prostatic hyperplasia. The dog underwent exploratory laparotomy with splenectomy. During the procedure, a nodule was found attached to the spleen. It was removed, fixed in a 10% neutral buffered formalin solution, and sent for histopathological and immunohistochemical examinations (vimentin, S100, desmin, MyoD1, HHF35, CD31, and alpha smooth muscle actin). The histopathological diagnosis was poorly differentiated spindle cell splenic sarcoma, compatible with splenic stromal sarcoma. Immunohistochemistry showed neoplastic cells immunoreactive for vimentin and S100, and it was not reactive for other markers. Based on the immunohistochemical and morphological profile, the diagnosis of splenic stromal sarcoma was confirmed. Discussion: Dogs affected by splenic neoplasms are generally aged between three and 17 years, and clinically present withanorexia, emesis, lethargy, weight loss, and abdomen distension, which were observed in the present case. However, a purelyclinical diagnosis is disputable, since other diseases can present the same signs. Thus, complementary exams are essential for a correct diagnosis. Laboratory changes in blood count and serum biochemistry are considered nonspecific for splenic neoplasms, with neutrophilic leukocytosis and anemia being consistent with paraneoplastic syndromes frequently diagnosed in small animals. Microscopically, splenic stromal sarcomas are characterized by focal splenic nodules composed of cohesive polygonal to spindle-shaped cell layers. The cells usually exhibit anisokaryosis and often have large oval to round vesicular nuclei and, occasionally, multinucleated cells. They have large areas of necrosis, diffuse or nodular lymphoid aggregates, and foci of extramedullary hematopoiesis, consistent with the histopathological examination reported in the present case. The immunohistochemical analysis included evaluation of seven markers to elucidate the histogenesis of the neoplasm, with the anti-vimentin and anti-S100 markers demonstrating positive cytoplasmic immunoreactivity, revealing the mesenchymal origin of the neoplasm. Thus, the definitive diagnosis was splenic stromal sarcoma, a rare and aggressive neoplasm. Keywords: spleen, histopathology, immunohistochemistry, neoplasm. Descritores: baço, histopatologia, imunohistoquímica, neoplasia

A Case of Pancreatic Tail Carcinoma That Was Difficult to Differentiate from a Splenic Tumor with Penetration of the Colon

A Case of Pancreatic Tail Carcinoma That Was Difficult to Differentiate from a Splenic Tumor with Penetration of the Colon

Laparoscopic caudate lobectomy with irreveresible electroporation (IRE) for colorectal liver metastasis

Background: Surgical resection of resectable colorectal liver metastasis with adjuvant/neoadjuvant chemotherapy has become standard management. Minimally invasive surgery reduced morbidity and improves outcomes. Irreversible electroporation is a novel technology which uses short, strong electrical currents to create nanopores in cell membrane and induce apoptosis. This can be utilised in oncological resections, particularly with challenging margin clearance eg near to major vessels, to increase the rate of R0 resection and reduce to risk of local recurrence. Method: A 38-year-old male with T4N1M1 splenic flexure tumour and synchronous solitary liver metastasis in caudate lobe was treated with 4 cycles neoadjuvant chemotherapy. He had a good response and multidisciplinary plan was for colorectal liver metastasis (CRLM) first resection. The tumour lay close to inferior vena cava, therefor Laparoscopic 3D anatomical resection of segment 1 with IRE was performed. Results: Final histology showed CRLM moderately differentiated adenocarcinoma R0 resection. The patient made an uncomplicated recovery and was discharged on day 4, with subsequent Left hemicolectomy. He remains disease free at 3 years. Conclusion: Laparoscopic caudate lobectomy is a feasible and safe approach in selected cases. Retraction of the left lateral segment and use of hilar tape improves exposure and elective allows for control of inflow and outflow. Mobilisation of the right lobe may be necessary if the caudate lobe is wrapped on to the right of the IVC. IRE is a safe and effective therapy to improve R0 rate and reduce the risk of local recurrence.