562279
research-article2014
IJSXXX10.1177/1066896914562279International Journal of Surgical PathologyJahanshir et al
Images in Pathology International Journal of Surgical Pathology 2015, Vol. 23(2) 123–124 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066896914562279 ijs.sagepub.com
Intraabdominal Splenosis Amirhossein Jahanshir, MD1, Maryam Bahreini, MD1, Hadi Mirfazaelian, MD1, Azita Aledavood, MD2, Shahrzad Negahban, MD2, and Yahya Daneshbod, MD2
A 34-year-old man presented to the emergency department with new onset “rashes and bruising” on his limbs and trunk. He had a history of motor-vehicle accident and splenectomy 10 years ago. On physical examination, in addition to the splenectomy scar, there were petechiae and ecchymoses scattered all over his body. The patient had normal vital signs. The laboratory study was significant for anemia and thrombocytopenia. Abdominopelvic computed tomography scan found multiple rounded masses (1-4 cm in diameter) in the abdominal cavity. With regard to past splenectomy, the patient underwent technetium99m sulfur colloid scan. The increased uptake confirmed the diagnosis of hypersplenism due to splenosis or accessory spleen. Later on, due to resistance to treatment, the patient underwent laparotomy, and multiple splenic implants were detected on the greater omentum and parietal peritoneum (Figure 1). Splenosis and accessory spleen are 2 types of ectopic splenic tissue. Splenosis is the auto-implantation of splenic tissue after splenic rupture, usually in the abdominal, pelvic, or thoracic cavities and is mainly due to direct seeding with splenic tissue after splenic rupture due to trauma or surgical splenectomy (auto-implantation) or hematogenous spread of splenic tissue due to trauma or after surgery.1,2 An accessory spleen is a small splenic tissue apart from the spleen, but along the splenic vessels, that may be formed during embryonic development or less frequently after trauma.3 Table 1 presents some of their differentiating characteristics. Although most patients with these conditions are asymptomatic, abdominal pain or mass are the most common presentations of these patients. Radiological modalities may reveal some clues showing these nodules, but they are usually diagnosed as malignancy or lymphadenopathy, which are more prevalent.5 The diagnostic modality of choice for splenosis is technetium-99m heat-damaged erythrocytes scintigraphy.6 Symptomatic patients will benefit from surgical removal of splenosis nodules. In our patient, the masses had no true hilum and microscopically were composed of normal splenic tissue,
Figure 1. Splenosis on the greater omentum. Table 1. Characteristics of Splenosis and Accessory Spleens. Splenosis Prevalence4 Mechanism Pathophysiology Number of splenic nodules Histology Blood supply Location
Accessory Spleens
Unknown Trauma or surgery Autoimplantation >100
40% Congenital
Distorted, no hilum Surrounding tissues Intraperitoneal
Normal
Developmental ≤6
Branch of the splenic artery Intraperitoneal and extraperitoneal
1
Tehran University of Medical Sciences, Tehran, Iran Dr Daneshbod Pathology Laboratory, Shiraz, Iran
2
Corresponding Author: Hadi Mirfazaelian, Department Emergency Medicine, Tehran University of Medical Sciences, Keshavarz St, Tehran 15686, Iran. Email: [email protected]
124 confirming the diagnosis of splenosis. The patient’s anemia and thrombocytopenia resolved after surgery. References 1. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 29-1995. A 65-year-old man with mediastinal Hodgkin’s disease and a pelvic mass. N Engl J Med. 1995;333:784-791. 2. Rickert CH, Maasjosthusmann U, Probst-Cousin S, August C, Gullotta F. A unique case of cerebral spleen. Am J Surg Pathol. 1998;22:894-896.
International Journal of Surgical Pathology 23(2) 3. Gayer G, Zissin R, Apter S, Atar E, Portnoy O, Itzchak Y. CT findings in congenital anomalies of the spleen. Br J Radiol. 2001;74:767-772. 4. Ahmadi A, Faber LP, Milloy F, Jensik RJ. Intrathoracic splenosis. J Thorac Cardiovasc Surg. 1968;55:677-681. 5. Fleming CR, Dickson ER, Harrison EG Jr. Splenosis: autotransplantation of splenic tissue. Am J Med. 1976;61: 414-419. 6. Crivellaro C, Cabrini G, Gay E, Sara R, Rossetti C. Intrathoracic splenosis: evaluation by 99mTc-labelled heatdenatured erythrocyte SPECT/CT. Eur J Nucl Med Mol Imaging. 2011;38:412.
Copyright of International Journal of Surgical Pathology is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
research-article2014
IJSXXX10.1177/1066896914562279International Journal of Surgical PathologyJahanshir et al
Images in Pathology International Journal of Surgical Pathology 2015, Vol. 23(2) 123–124 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066896914562279 ijs.sagepub.com
Intraabdominal Splenosis Amirhossein Jahanshir, MD1, Maryam Bahreini, MD1, Hadi Mirfazaelian, MD1, Azita Aledavood, MD2, Shahrzad Negahban, MD2, and Yahya Daneshbod, MD2
A 34-year-old man presented to the emergency department with new onset “rashes and bruising” on his limbs and trunk. He had a history of motor-vehicle accident and splenectomy 10 years ago. On physical examination, in addition to the splenectomy scar, there were petechiae and ecchymoses scattered all over his body. The patient had normal vital signs. The laboratory study was significant for anemia and thrombocytopenia. Abdominopelvic computed tomography scan found multiple rounded masses (1-4 cm in diameter) in the abdominal cavity. With regard to past splenectomy, the patient underwent technetium99m sulfur colloid scan. The increased uptake confirmed the diagnosis of hypersplenism due to splenosis or accessory spleen. Later on, due to resistance to treatment, the patient underwent laparotomy, and multiple splenic implants were detected on the greater omentum and parietal peritoneum (Figure 1). Splenosis and accessory spleen are 2 types of ectopic splenic tissue. Splenosis is the auto-implantation of splenic tissue after splenic rupture, usually in the abdominal, pelvic, or thoracic cavities and is mainly due to direct seeding with splenic tissue after splenic rupture due to trauma or surgical splenectomy (auto-implantation) or hematogenous spread of splenic tissue due to trauma or after surgery.1,2 An accessory spleen is a small splenic tissue apart from the spleen, but along the splenic vessels, that may be formed during embryonic development or less frequently after trauma.3 Table 1 presents some of their differentiating characteristics. Although most patients with these conditions are asymptomatic, abdominal pain or mass are the most common presentations of these patients. Radiological modalities may reveal some clues showing these nodules, but they are usually diagnosed as malignancy or lymphadenopathy, which are more prevalent.5 The diagnostic modality of choice for splenosis is technetium-99m heat-damaged erythrocytes scintigraphy.6 Symptomatic patients will benefit from surgical removal of splenosis nodules. In our patient, the masses had no true hilum and microscopically were composed of normal splenic tissue,
Figure 1. Splenosis on the greater omentum. Table 1. Characteristics of Splenosis and Accessory Spleens. Splenosis Prevalence4 Mechanism Pathophysiology Number of splenic nodules Histology Blood supply Location
Accessory Spleens
Unknown Trauma or surgery Autoimplantation >100
40% Congenital
Distorted, no hilum Surrounding tissues Intraperitoneal
Normal
Developmental ≤6
Branch of the splenic artery Intraperitoneal and extraperitoneal
1
Tehran University of Medical Sciences, Tehran, Iran Dr Daneshbod Pathology Laboratory, Shiraz, Iran
2
Corresponding Author: Hadi Mirfazaelian, Department Emergency Medicine, Tehran University of Medical Sciences, Keshavarz St, Tehran 15686, Iran. Email: [email protected]
124 confirming the diagnosis of splenosis. The patient’s anemia and thrombocytopenia resolved after surgery. References 1. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 29-1995. A 65-year-old man with mediastinal Hodgkin’s disease and a pelvic mass. N Engl J Med. 1995;333:784-791. 2. Rickert CH, Maasjosthusmann U, Probst-Cousin S, August C, Gullotta F. A unique case of cerebral spleen. Am J Surg Pathol. 1998;22:894-896.
International Journal of Surgical Pathology 23(2) 3. Gayer G, Zissin R, Apter S, Atar E, Portnoy O, Itzchak Y. CT findings in congenital anomalies of the spleen. Br J Radiol. 2001;74:767-772. 4. Ahmadi A, Faber LP, Milloy F, Jensik RJ. Intrathoracic splenosis. J Thorac Cardiovasc Surg. 1968;55:677-681. 5. Fleming CR, Dickson ER, Harrison EG Jr. Splenosis: autotransplantation of splenic tissue. Am J Med. 1976;61: 414-419. 6. Crivellaro C, Cabrini G, Gay E, Sara R, Rossetti C. Intrathoracic splenosis: evaluation by 99mTc-labelled heatdenatured erythrocyte SPECT/CT. Eur J Nucl Med Mol Imaging. 2011;38:412.
Copyright of International Journal of Surgical Pathology is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
