Sclerosing angiomatoid nodular transformation of the spleen: A case report and literature review

BACKGROUNDSclerosing angiomatoid nodular transformation (SANT) is a rare disease of the spleen. It has unique pathological features and mimics splenic tumor on radiological imaging.CASE SUMMARYA 47-year-old woman was incidentally found to have a splenic mass on abdominal ultrasound. She had a 10-cm postoperative scar in the lower abdomen due to previous cesarean sections. The patient had a past history of anemia of unknown etiology for 20 years. The patient underwent laparoscopic splenectomy. The postoperative course was uneventful, with a hospital stay of 7 d. The histopathological examination of the spleen revealed SANT. At the 6-mo follow-up, the patient remained disease-free.CONCLUSIONSANT is a rare benign disease mimicking a malignant tumor. A definitive diagnosis can be made only on histopathology.     

Nonsurgical diagnosis and management of an inflammatory pseudotumor of the spleen in a child

Primary splenic tumors in children are rare and usually benign. We report the case of a 7-year-old boy with a splenic mass that initially resembled an infectious process. Histopathologic examination of a specimen obtained using sonographically guided Tru-cut needle biopsy, performed after angiography, revealed an inflammatory pseudotumor of the spleen, an extremely rare benign lesion. The lesion has been managed conservatively with clinical and sonographic follow-up. This case shows that benign lesions of the spleen can easily be diagnosed using current radiologic and histopathologic techniques without the need for surgery, thus allowing total or even partial splenectomy to be reserved for patients in whom a mass cannot be diagnosed or in whom clinical progression is evident.     

Incidentally discovered asymptomatic splenic hamartoma misdiagnosed as an aneurysm: A case report

BACKGROUNDSplenic hamartoma (SH) is a rare, benign vascular proliferation that is often found incidentally. It may be misdiagnosed as a splenic aneurysm or splenic malignancy.CASE SUMMARYA 21-year-old male patient was admitted to our hospital with a complaint of an incidentally discovered asymptomatic splenic space-occupying lesion for 2 wk. Abdominal computed tomography (CT) scan showed a circular low-density shadow in the hilum of the spleen. Contrast-enhanced CT revealed an aneurysm located in the hilum of the spleen before operation. Laparoscopic splenectomy was performed and postoperative pathology revealed the presence of SH.CONCLUSIONImaging studies are insufficient for the differential diagnosis of SH from other diseases, and laparoscopic splenectomy is a less invasive procedure and useful for the diagnostic purpose as well.     

Isolated splenic Mycobacterium tuberculosis complex infection in an immunocompetent individual with FDG-PET positive mass

Tuberculosis, caused by Mycobacterium tuberculosis complex, is a leading cause of mortality in the world, and 15% of the patients may present with extrapulmonary diseases, including splenic lesion. However, isolated splenic infection with M. tuberculosis complex is very rare. A 19-year-old otherwise healthy woman presented with left flank pain, revealing FDG-avid nodules in the spleen. She did not have pulmonary lesions. Histopathology of splenectomized sample showed granuloma, and subsequent PCR revealed amplification of IS6110, a genetic sequence exclusively detected in M. tuberculosis complex. A wide range of differential diagnosis of isolated splenic lesion should include M. tuberculosis infection regardless of pulmonary involvement. An elective splenectomy may be mandatory in timely manner.     

Littoral cell angioma: A case report

Primary splenic lesions are rare entities among which littoral cell angioma(LCA) is a recently described, uncommon vascular lesion that is unique to the spleen. It has heretofore been described primarily in pathologic series and has been found mostly to behave as a benign entity. A few reports of malignant variants have been reported. We present a case report of a solitary LCA discovered after splenectomy for an incidentally discovered splenic lesion, along with a literature review.     

Postsplenectomy abscess leading to acute gastric hemorrhage

A case is presented of a 14-year-old boy with massive gastric bleeding 8 months after a splenectomy. A linear gastric ulcer was found associated with perforation leading to an abscess in the former splenic site. The vulnerability of proximal greater curvature to perforation after splenectomy, and the possibility of extrinsic erosion causing gastric or duodenal ulceration are emphasized.     

Splenic hamartoma: A case report and review of the literature

Splenic hamartoma is a rare benign malformation, composed of an anomalous mixture of normal splenic elements, often found incidentally while working up other complaints or at autopsy. A splenic mass was incidentally found while evaluating the effects of a traffic accident in a 63-year-old woman. Abdominal computed tomography revealed a well-defined splenic mass with rim enhancement. The patient underwent splenectomy. The resected spleen contained a well-defined mass lesion measuring 3.5 cm × 3.0 cm. Microscopic examination revealed disorganized slit-like vascular channels lined by plump endothelial cells without atypia. The cells lining the vascular channels were positive for CD8, CD31, CD34 and vimentin. Endothelial cells that are positive for CD8 are a key feature that differentiates hamartoma from other vascular lesions of the spleen. Although this tumor is very rare, it must be included in the differential diagnosis of splenic mass-forming lesions.     

Extensive abdominal splenosis: imaging features

We present the case of a 22-year-old patient who had splenectomy in childhood after trauma and had a known chronic active infection with hepatitis C. Imaging procedures in different radiologic modalities diagnosed diffuse intraabdominal splenosis. Splenosis is a rare, severe complication of splenic trauma or surgery, but the pathogenesis is not clear. Imaging features play a key role in the diagnosis of ectopic splenic tissue, which must be differentiated from malignancies, especially from lymphoma. Splenosis itself may induce relapse of hematologic diseases, mainly autoimmune thrombocytopenia.     

Adenosquamous carcinoma of the pancreas: report of two cases

Adenosquamous carcinoma (ASqC) of the pancreas is a rare tumor. We analyzed the radiologic findings and clinical manifestations in two such cases. In both cases (a 51-year-old woman and a 67-year-old man), the portal system was selectively and largely invaded, the superior mesenteric vein in one and the splenic vein in the other, without arterial invasion. Thus, peripancreatic vessels should be carefully observed in patients with ASqC of the pancreas. One case showed an unusual mode of spread. Only a huge metastatic lesion was initially detected, leading to the misdiagnosis of primary malignant mesenteric tumor. Such an unusual growth pattern is also worth noting.     

脾硬化性血管瘤样结节性转化临床病理观察

目的探讨脾硬化性血管瘤样结节性转化(SANT)的临床病理特征、鉴别诊断、治疗及预后。方法分析1例SANT患者的临床病理特征及免疫组化表达,并复习相关文献。结果镜下病变呈多个硬化性血管瘤样结节,结节中央为裂隙样及不规则的富含红细胞的血管样腔隙,边缘间质内见数量不等的淋巴细胞、浆细胞及组织细胞浸润。免疫组化示vimentin弥漫(+),血管瘤样结节CD31和CD34(+),CD8(-);多结节CD235α及CD 61(+);结节中靶环状排列的梭形细胞及卵圆形细胞SMA、actin、CD 68、S-100、lysozyme、EMA及CD1α不同程度(+);CK-pan、ALK、CD21、CD23均(-)。随访6个月无复发及转移。结论SANT是一种罕见具有独特的临床病理改变的良性病变,确诊需依据其特征性的病理学形态及免疫组化结果,脾切除术可以治愈。     

Sclerosing angiomatoid nodular transformation (SANT) of the spleen: Sonographic finding

Sclerosing angiomatoid nodular transformation (SANT) is a recently recognized benign vascular lesion of the spleen. There is limited information regarding its imaging findings of this condition. Until now, the diagnosis was based on histopathologic examination of splenectomy specimens. We report the sonographic findings in a case of SANT of the spleen confirmed by ultrasound‐guided core needle biopsy. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009     

Splenic lymphoma with massive splenomegaly: Case report with review of literature

As per strict criteria of Das Gupta et al, primary splenic lymphoma is very rare. Herein, we are reporting an unusual case of primary large cell splenic lymphoma of B lineage in a middle aged female presenting with massive splenomegaly (3.8 kg) and hypersplenism. After performing therapeutic splenectomy for hypersplenism, a precise diagnosis of diffuse large B cell lymphoma was made on histopathology and confirmed by immunohistochemistry. The patient responded well to standard (Cyclophosphamide, Hydroxydaunorubicin, Oncovin (vincristine), Prednisone or prednisolone) regimen last year and is now in full remission. The splenectomy thereby has prevented the potential grave complications related to hypersplenism and splenic rupture. Our aim behind highlighting the topic is to specify that emergency splenectomy followed by anticoagulation therapy is an effective plan of management to prevent untoward complications related to disease and treatment.     

Acute Splenic Syndrome in an African-American Male with Sickle Cell Trait on a Commercial Airplane Flight

Background

Patients with sickle cell trait (SCT) generally suffer few effects of sickle cell disease. Acute splenic syndrome is a rare but well-documented complication of SCT that can present in the setting of low oxygen tension that occurs with major changes in altitude, either by unpressurized air flight or ground travel such as mountain climbing.

Objective

Our objective was to increase emergency physician awareness of the rare diagnosis of altitude-induced splenic infarction in patients with SCT by presenting and reviewing recorded literature.

Case Report

This is an unusual case of a man with SCT who suffered acute splenic syndrome while on a pressurized airplane flight subsequently requiring splenectomy.

Conclusions

Although it is a rare phenomenon, patients with SCT who are exposed to high altitudes can be subject to splenic syndrome. There are many patients who are unaware that they have SCT, which makes the diagnosis challenging for emergency physicians. In addition, because patients with SCT generally do not have complications related to their disease, diagnosing splenic syndrome might be delayed, potentially resulting in inadequate hydration, pain management, and other supportive treatment, which ultimately leads to worsening splenic syndrome and splenectomy.     

Splenic implant in the jejunum: Radiographic and pathologic findings

We report a patient in whom barium studies and computed tomography revealed an intramural mass in the jejunum that consisted pathologically of ectopic splenic tissue. Because the patient had a prior splenectomy, the lesion probably represented splenosis rather than an accessory spleen. When intramural lesions are detected on barium studies in patients who have had prior abdominal trauma or splenectomy,^99mTc-tagged, heated-red blood cell scintigraphy may be performed to confirm the diagnosis, thereby eliminating the need for surgery in these patients.     

Thrombocytopenia caused by splenic hamartoma: resolution after splenectomy

We report a rare case of isolated thrombocytopenia due to a large hamartoma of the pulposal type, which resolved with splenectomy in a 46-year-old man. Although hamartomas are usually found incidentally, they may cause hematologic disturbances such as thrombocytopenia, anemia, or splenic rupture. The diagnosis of splenic hamartoma is difficult to make preoperatively. Splenectomy is important in excluding malignant tumors from the diagnosis when the etiology of a splenic mass is unclear and ameliorating hematologic symptoms related to hamartomas.     

Ruptured splenic peliosis in a patient with no comorbidity: A case report

BACKGROUND Splenic peliosis is a disease characterized by widespread blood-filled cystic cavities within the parenchyma. Patients with this disease are usually asymptomatic;therefore, spontaneous or trauma-related rupture of the hemorrhagic cysts can occasionally cause life-threatening hemorrhagic shock.CASE SUMMARY A 51-year-old male patient with abdominal pain visited our emergency medical center two times with an interval of 2 mo. The patient was discharged from the hospital without treatment at his first visit;however, at the time of second admission, the hemoperitoneum with multiple cystic lesions of the spleen was found incidentally on the abdomen computed tomography scan. Since the patient was stable hemodynamically, a scheduled surgery was performed. The operative findings were consistent with splenic peliosis, and laparoscopic splenectomy was performed to prevent recurrent rupture of the hemorrhagic cysts.CONCLUSION Splenic peliosis is extremely rare, and we suggest splenectomy is necessarily required as a definite treatment for ruptured splenic peliosis to rescue patients with hemodynamic instability and to prevent recurrent rupture of hemorrhagic cysts in patients with stable hemodynamics.     

Torsion of Wandering Spleen: A Case Report

BackgroundWandering spleen is defined as the localization of the spleen in the lower parts of the abdomen or the pelvic region, rather than the left upper quadrant. The torsion of wandering spleen is a rare clinical condition.Case ReportWe evaluate a case diagnosed with torsion of wandering spleen and underwent splenectomy in our hospital and discuss it in light of the literature. A 26-year-old man presented to the emergency department with abdominal pain and abdominal distention. The patient was diagnosed with the torsion of wandering spleen based on computed tomography scan results.Why Should an Emergency Physician be Aware of This?The torsion of wandering spleen is rare in patients presenting with acute abdominal pain, but it is an important condition that should be considered in the differential diagnosis. The diagnosis of wandering spleen should be made before the development of potentially life-threatening complications. Emergency surgery should be undertaken in patients with splenic infarction.     

Intrahepatic splenosis mimicking a liver tumor

A rare case of ectopic splenic tissue in the liver is presented which mimicked a liver tumor. It is considered that some splenic tissue was seeded in the liver during the splenectomy that the patient underwent 23 years ago. Computed tomography (CT), magnetic resonance imaging (MRI), and angiographic features of this lesion were almost indistinguishable from those of other liver tumors.