Splenic hydatidosis

This report is concerned with ten patients treated surgically for a splenic hydatidosis. Splenic echinococcosis represents 3.5% of abdominal hydatid cysts treated in our Service. When splenic hydatidosis was diagnosed, the spleen was the first and only localization of hydatid disease in three cases. One of these patients underwent surgery for a pulmonary cyst four years later. Splenic cysts were asymptomatic in six patients. The most frequent clinical sign of splenic hydatidosis was a painful mass in the left upper abdominal quadrant. Ultrasonography and axial computed tomography (axial C.T.) were the most useful diagnostic tools. The complications arising from splenic hydatidic cysts were infection, rupture in the abdominal cavity and fistulization to the colon. A splenectomy was performed in every case. There was no mortality and morbidity was principally related to the hepatic-associated hydatidosis. It is concluded that splenic involvement is a rare manifestation of hydatid disease but should be looked for in a systematic way in patients with this diagnosis.     

Hepatic angiomyolipoma associated with splenic hamartoma

A 52-year-old woman was admitted to our hospital with thrombophlebitis of the internal jugular vein. Abdominal ultrasonography demonstrated a high echogenic mass measuring 4.5 cm in diameter in the liver, and abdominal CT revealed another liver tumor and an isodensity mass in the spleen. Abdominal MRI and angiography were performed and we presumed the tumors to be two hepatic angiomyolipoma and a splenic hamartoma. As an abdominal CT 21 months later revealed that all tumors were growing, these tomors were surgically resected. The histological diagnoses were hepatic angiomyolipoma and splenic hamartoma.     

Asymptomatic lymphangioma involving the spleen and retroperitoneum in adults

Lymphangioma, a benign neoplasm of the lymphatic system, is common in children but rare in adults. Its clinical manifestations include abdominal pain, nausea,vomiting and a palpable mass. However, abdominal sonography or abdominal computed tomography (CT) scan can also incidentally reveal lymphangioma. A larger or symptomatic lymphangioma is treated with total resection to prevent recurrence, infection, torsionand enlargement. Although lymphangioma rarely becomes malignant, its prognosis is generally good.We report a cystic lymphangioma of the spleen and retroperitoneum, which was incidentally found in a 56-year-old man who was hospitalized due to a colon mass. Physical examination showed no specific findings.Abdominal CT revealed a 5.7 cm, non-enhanced multilobulated cystic mass with multiple septa in the spleen and a 10 cm lobulated cystic mass in the paraaorticarea. Splenectomy and retroperitoneal resectionof the cystic mass were conducted. The endothelium of splenic and retroperitoneal cyst was immunohistochemically stained with D2-40 antibody. The patient was finally diagnosed with splenic cystic and retroperitoneal cavernous lymphangioma.     

Localized giant pseudopolyposis of the colon in ulcerative colitis

Recently a patient with ulcerative colitis developed abdominal pain and a left upper quadrant mass. A⁶⁷Ga-citrate scintiscan showed increased activity over the mass. A barium enema demonstrated retrograde obstruction at the splenic flexure and intraluminal multilobulated tissue masses. The total abdominal colectomy specimen showed localized giant pseudopolyposis at the splenic flexure. This condition is a rare local complication of both ulcerative and granulomatous colitis. It resembles a villous adenoma on barium enema and, although inflammatory, may simulate a colonic carcinoma. When symptomatic, local resection may be sufficient treatment.     

Splenic Abscess—Clinical Symptoms and Diagnostic Possibilities

A 71-yr-old female patient was admitted for investigation of a massive leukocytosis and loss of weight. Physical examination revealed a reduction in the respiratory excursion of the left lung, a left pleural friction rub located ventrobasally and tension of the upper abdominal wall. Additional diagnostic procedure excluded extrasplenic disease. Ultrasound-guided puncture demonstrated the presence of pus in the splenic bed, and splenic abscess was diagnosed. Subsequent surgery confirmed this diagnosis. Histological findings revealed extensive splenic infarction. Since bacteriological investigation revealed the identical pathogens in the pus obtained with the puncture needle, in the intraoperative swab and in the midstream urine, the splenic abscess was most likely caused by hematogenous spread of a urinary tract infection into the splenic infarction. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day, free of symptoms. The clinical picture, radiological diagnosis, origin, therapy and course f splenic abscess are discussed with reference to the literature.     

A case of splenic inflammatory pseudotumor]

A 74-year-old woman underwent abdominal echography at a local clinic and a splenic mass was found. She was hospitalized for detailed examinations and treatment. Splenectomy was performed to make a definite diagnosis and for treatment because a definitive diagnosis could not be made, despite various examinations. Histopathological examination revealed that the lesion was infiltrated by polyclonal lymphoid cells and contained proliferating spindle-shaped fibroblasts without any atypical cells, so the splenic mass was diagnosed as an inflammatory pseudotumor. Because some cases of inflammatory pseudotumor can be diagnosed from the clinical course and imaging findings, this possibility should also be considered in the differential diagnosis of a splenic mass.     

Ectopic spleen mimicking an intrinsic fundal lesion of the stomach

Summary This report describes the case of an elderly man with severe pulmonary disease, who had radiographic evidence of a mass involving the fundus of the stomach, which was thought to be a neoplasm that was growing slowly. Abdominal exploratory operation was obviated when a combination of newer technics for study of the upper gastrointestinal tract revealed that the defect was was produced by the impingement of the patient's spleen, which was normal except for its ectopic position. Selective abdominal angiography revealed that the blood supply to the mass was provided by the splenic artery and vein. Scintillation scanning demonstrated that injured red blood cells were sequestered in the mass, a normal function of the spleen. A flexible fiberoptic gastroscope permitted visualization of the mucosa in the fundic and cardioesophageal regions of the stomach and demonstrated that there was no neoplasm of the gastric mucosa in the region of the defect demonstrated in the fundus of the stomach.     

A case of splenic artery aneurysm simulating a pancreas tumor

A 46-year-old man was admitted to our hospital for further evaluation of a hypoechogenic mass in the pancreatic body. He had no history of hypertension, pancreatitis, abdominal trauma, or portal hypertension. He had no abdominal symptoms. A contrast-enhanced CT scan demonstrated a hypodense, round shaped mass. EUS and MRI also showed it to be a pancreatic mass. Because of the tumor size of more than 30mm and the possibility of malignancy, distal pancreatectomy was performed. Microscopic findings showed the mass was the dissection of the proximal splenic artery. The true lumen of the dissecting aneurysm was occluded and the false lumen developed fusiform dilatation. Moreover, microscopic findings revealed the rupture of the false lumen complicated by pseudoaneurysm. We finally diagnosed the lesion simulating a pancreatic tumor as the pseudoaneurysm of the splenic artery.     

The 'true' splenic wanderer.

Wandering spleen is an unusual entity and remains an elusive clinical diagnosis. Among the modern imaging modalities including computed tomography, magnetic resonance imaging, nuclear scans and ultrasonography, the latter appears to be the least invasive and the most effective in reaching a definitive diagnosis. A patient with 'true' wandering spleen who presented with chronic, intermittent abdominal pain, weight loss and a right lower quadrant mass that was interpreted as a pelvic lymphoma or a primary pelvic malignancy on computed abdominal tomography (CAT) scan is presented. Abdominal ultrasonography conducted a few weeks before the CAT scan showed a normal splenic shadow in the left upper abdomen.     

Splenomegaly with sea-blue histiocytosis, dyslipidemia, and nephropathy in a patient with lecithin-cholesterol acyltransferase deficiency: a clinicopathologic correlation

A 31-year-old man with no significant medical history presented with a 5-day history of progressive left upper quadrant abdominal pain. Physical examination revealed a tender guarded abdomen, no icterus, and bilateral corneal “arcus senilis”-like changes. Laboratory workup showed a mild normocytic, normochromic anemia; and target cells were seen in the peripheral blood smear. Serum was turbid; and the lipid profile showed elevated total cholesterol, low high-density lipoprotein cholesterol, and elevated triglycerides. Urinalysis revealed nephrotic range proteinuria with microhematuria. An abdominal computed tomographic scan demonstrated a homogeneously enlarged spleen. The patient was discharged after symptomatic treatment to be followed as an ambulatory patient. Several days later, he returned with severe left upper quadrant pain and was admitted to the surgical service for further evaluation. A splenectomy was performed for a suspected splenic lymphoma. Upon gross examination, spleen was moderately enlarged, weighing 780 g. Sectioning revealed a beefy red cut surface without gross lesions. Wright-Giemsa-stained touch imprints showed many sea-blue histiocytes. A renal biopsy was also performed, demonstrating focal segmental glomerular sclerosis and mesangial expansion with extramembranous and intramembranous deposition of lipids. In the absence of hematologic malignancy and in light of the abnormal lipid profile, a disorder of lipid metabolism was suspected. Histologic and ultrastructural findings in the kidney and spleen raised the likelihood of lecithin-cholesterol acyltransferase (LCAT) deficiency, which was confirmed by the markedly decreased serum LCAT activity and serum LCAT mass. We describe a case with the triad of splenomegaly with sea-blue histiocytes, nephropathy, and dyslipidemia in a patient with LCAT deficiency.     

Splenosis--important differential diagnosis in splenectomized patients presenting with abdominal masses of unknown origin

A 40-year-old female patient was admitted for work-up of multiple abdominal masses. The lymphoma-mimicking tumors were detected accidentally during an ultrasound course. The past medical history was unremarkable besides a status post-traumatic splenic rupture and splenectomy. The patient was asymptomatic, especially there were no complaints of fever, night sweats or weight loss. Laboratory tests did not show pathological results. Ultrasound of the abdomen revealed multiple hypoechoic mesenterial and peritoneal enlarged tumors as well as a subhepatic mass (30 x 20 mm). Transmission computed tomography (CT) showed a normal chest, excluded abnormal thoracal masses and confirmed the multiple abdominal nodules. Microparticles were trapped only by tissue with phagocytosis function as cells of the reticulohistiocytary system in liver and spleen. Uptake of (99 m)Tc-labeled microparticles is specific for splenic tissue. All abdominal masses were detectable by single photon emission computed tomography (SPECT) after intravenous administration of this radiotracer. Ultrasound-guided biopsy proved the presence of spleen tissue with follicular hyperplasia. In conclusion, we report a case of post-traumatic splenosis. In 16 - 67 % of patients who experienced traumatic splenic rupture autotransplanted spleen tissue can be detected. Splenosis therefore is an important differential diagnosis of abdominal masses in splenectomized patients.     

A case of splenic pseudocyst difficult to differentiate from splenic lymphangioma]

Splenic pseudocyst is a rare complication of abdominal trauma. Although it is rare, splenic pseudocyst is well-documented in the literature. According to the current classification, approximately 30% of all splenic cysts or pseudocysts result from direct abdominal trauma. In addition, chronic pancreatitis leads to change of nearby organs with possible acute and chronic complications including splenic lesions. This unusual complication can occur in both emergent and non-emergent conditions. The useful diagnostic procedures to assess intrasplenic pseudocyst are sonogram, CT scan, splenic scan, and occasionally angiography. However, definite diagnosis of pseudocyst is possible only after splenectomy when the absence of epithelial lining is confirmed histologically. Splenic pseudocyst requires surgical resection. We experienced a 31-year-old man who confirmed of warmness in the left side of back with left upper quadrant abdominal pain for several months. First impression was splenic lymphangioma based on CT scan and sonogram finding. Splenectomy was performed. Microscopic examination revealed splenic pseudocyst with fibrous capsule without epithelial lining.     

Spontaneous rupture of intrahepatic artery aneurysm with complicated vascular anomalies

An 18-year-old man developed a sudden onset of upper abdominal pain with vomiting. Ultrasound and computed tomographic (CT) scans revealed the spontaneous rupture of an intrahepatic artery aneurysm with subcapsular hematoma. A celiac arteriogram demonstrated a ruptured intrahepatic artery aneurysm in the right lobe of the liver, right extrahepatic artery aneurysm, obliteration of gastroduodenal artery, and abnormal flow pattern of the splenic artery. Portal vein phase, using superior mesenteric arteriography, showed portal vein varices and obliteration of the portal trunk. A right hepatic lobectomy was performed. The cut surface of the resected liver revealed a ruptured intrahepatic artery aneurysm with massive hematoma.     

Isolated gastric varices: splenic vein obstruction or portal hypertension?

The presence of isolated gastric varices without esophageal varices is thought to be highly suggestive of splenic vein obstruction. A review of our radiologic files revealed 14 patients with isolated gastric varices on barium studies performed during the past 10 years. Eight of the 14 patients had adequate clinical and/or radiologic follow-up to suggest the pathophysiology of the varices. Seven had evidence of portal hypertension, and the remaining patient had evidence of splenic vein obstruction. Six patients had signs of upper gastrointestinal (GI) bleeding. Double-contrast upper GI examinations revealed thickened, tortuous fundal folds in 6 patients and a lobulated fundal mass in 2. Thus, most patients with isolated gastric varices have portal hypertension rather than splenic vein obstruction as the underlying cause.     

Non hypoxia-related splenic infarct in a patient with sickle cell trait and infectious mononucleosis

Splenic infarction in patients with sickle cell trait is usually related to hypoxic conditions, while non-hypoxia-related infarcts are extremely rare. We report on a case of a 17-year-old male patient, living at sea level, who developed a severe left upper quadrant abdominal pain during the course of a febrile episode. On physical examination he had a mildly palpable but extremely painful spleen. A spleen scan revealed 2 areas of impaired radionucleide distribution. Hepatic enzymes were moderately increased and the IgM anti-EBV antibodies positive. Hemoglobin electrophoresis revealed the presence of 42% of hemoglobin S. A probable diagnosis of splenic infarction was established in a patient with sickle cell trait, during the course of infectious mononucleosis. The patient was treated symptomatically. The conditions of splenic congestion induced by the EBV infection and the high-grade fever may have contributed to splenic sequestration and subsequent infarcts.     

Splenic lymphangioma that manifested as a solid-cystic mass:A case report

Lymphangioma,a congenital malformation of the lymphatic system,is usually found in children,and generally occurs in the neck and mediastinum.It is rarely found in the spleen.The clinical features of splenic lymphangioma typically include abdominal pain,nausea,and abdominal distention.Frequently,however, this condition is asymptomatic and is incidentally detected by abdominal ultrasonography or by an abdominal computed tomography(CT)scan.In this paper,we retrospectively describe a case of incidentally detected splenic lymphangioma in a 30-year-old woman with special abdominal contrast material-enhanced CT findings,which was accurately diagnosed by histopathology.The clinical and physical examinations related to the mass were negative.A few cases of splenic lymphangioma have been reported previously;however,the presentation of the mass and the enhancement pattern in the contrast medium-enhanced CT images were quite extraordinary.These findings had misled our abdominal radiologists to consider it as other neoplastic diseases of the spleen.     

Spontaneous splenic rupture following the administration of intravenous heparin: case report and retrospective case review

We report the case of a 40-year-old African-American female who presented to the Emergency Department with unstable angina. The patient, who had multiple risk factors for coronary artery disease, was admitted to the coronary care unit for cardiac work-up and management. Shortly after the intravenous administration of unfractionated heparin, she suffered the acute onset of upper abdominal pain and shock. A CT scan of the abdomen revealed splenic rupture with hemoperitoneum. The patient, who was managed surgically, had complete recovery before discharge. A review of systems and medical records revealed no obvious risk factors or other potential etiology for this rupture. We herein provide the characteristics of this rarely documented causal relationship between heparin and spontaneous splenic rupture and retrospectively review similar cases in the literature.     

Tuberculosis of the pancreas

A 67-year-old woman was admitted to the hospital because of intermittent pain in the upper left quadrant of the abdomen. Ultrasound and computed tomography (CT) scan revealed a mass in the body of the pancreas, and angiography demonstrated encasement of the celiac trunk and splenic vein thrombosis. She was thought to have a pancreatic carcinoma and was surgically explored to obtain tissue for diagnosis. A hard and irregular tumor was found, and biopsies revealed granulomatous inflammation with caseous necrosis. The final diagnosis was tuberculosis, and treatment with rifampicin, isoniazid, and ethambutol was undertaken. One year later the patient is asymptomatic and new CT scan shows disappearance of the pancreatic mass.     

Multiple indexes of lipid availability are independently related to whole body insulin action in healthy humans

An increase in muscle lipid content has been postulated to relate closely to the evolution of insulin resistance. We aimed to test whether the multiple indexes of lipid supply within man [namely, circulating triglycerides, skeletal muscle triglycerides (SMT), total and central fat mass, and circulating leptin] were independent predictors of insulin resistance, or whether triglycerides from different sources are additive in their influence on whole body insulin sensitivity. Whole body insulin sensitivity, body composition, and SMT content were determined in 49 sedentary, nondiabetic males (age, 20-74 yr; body mass index, 20-38 kg/m(2)). Insulin sensitivity was inversely associated with central abdominal fat (r(2) = 0.38; P < 0.0001), total body fat (r(2) = 0.21; P = 0.0003), SMT content (r(2) = 0.16; P = 0.005), and fasting triglycerides (r(2) = 0.24; P = 0.0003), nonesterified free fatty acid (r(2) = 0.19; P = 0.002), and leptin (r(2) = 0.35; P < 0.0001) levels. However, only central abdominal fat was significantly related to SMT content (r(2) = 0.10; P = 0.03). SMT content, circulating triglycerides, and measurements of total or central adiposity were independent predictors of whole body insulin sensitivity.     

Spontaneous rupture of splenic hamartoma in a patient with hepatitis C virus-related cirrhosis and portal hypertension： A case report and review of the literature

Spontaneous rupture is a rare complication of splenic hamartoma. A review of the literature revealed only four such cases. To the best of our knowledge, this is the first report of spontaneous rupture of splenic hamartoma associated with liver cirrhosis and portal hypertension. A 53-year-old woman, who was followed up for aortic dissection and hepatitis C virus (HCV)-related liver cirrhosis, was referred with sudden left chest and shoulder pain. An abdominal ultrasound showed intraabdominal bleeding, and computed tomography indicated rupture of a splenic tumor. Emergent splenectomy was carried out. The postoperative course was uneventful, and the patient was discharged on the 13th postoperative day. Pathology revealed the tumor to be a ruptured splenic hamartoma. The non-tumorous splenic parenchyma revealed congestive changes. We consider that the presence of liver cirrhosis and portal hypertension are risk factors for spontaneous rupture of the splenic hamartoma.