Epidermoid Splenic Cyst Presented as Huge Splenic Abscess: a Case Report

Epidermoid splenic cysts are very rare. Symptoms emerge because of enlargement, infection, haemorrhage or rupture. Although splenectomy is indicated for large cysts, minimally invasive and preservation procedures, such as partial splenectomy or total cystectomy with splenorrhaphy, have been increasingly used during the last decade. We report herein the case of a 16-year old female presented with left upper abdominal quadrant pain, fever and abdominal distention treated in our department.     

Videolaparoscopic Approach of the Splenic Cyst: A Case Report

The authors report a case of an asymptomatic 30-year-old female patient with an extensive cystic lesion continuous with the splenic parenchyma. A review of the literature and use of a videolaparoscopic approach to the treatment of these lesions is presented.     

Solitary Splenic Metastasis from Ovarian Cancer Successfully Treated by Hand-Assisted Laparoscopic Splenectomy: Report of a Case

Solitary splenic metastasis is an extremely rare phenomenon for which splenectomy is generally indicated because a good prognosis can be achieved if chemotherapy is given postoperatively. We report herein a case of solitary splenic metastasis from ovarian cancer, which was completely removed by hand-assisted laparoscopic surgery. Received: June 25, 2001 / Accepted: January 8, 2002     

Conservative laparoscopic treatment of a posttraumatic splenic cyst

Laparoscopy has recently been demonstrated to be a useful alternative to open surgery for the surgical treatment of spleen disorders, and it can also facilitate a conservative approach for treatment of selected spleen lesions. We present the laparoscopic spleen-preserving treatment of a post-traumatic spleen cyst. A 28-year-old female presented a mass in the left hypochondrium immediately after an uneventful pregnancy. CT revealed a splenic cyst of 10×8 cm. Laparoscopic exploration showed a cyst located in the lower pole of the spleen. All the cyst wall not covered by spleen tissue (70%) was excised, and the fragment of cyst wall was recovered through a bag. The patient recovered uneventfully and was discharged 72 hours later. The laparoscopic approach should be considered for evaluation and treatment of selected benign cystic lesions of liver, retroperitoneum or spleen origin.     

Hyperfunctioning Parathyroid Cysts: a Case Report

Parathyroid cysts are infrequent lesions of which most are non-functional. They are often misdiagnosed as thyroid cysts. Pre-operative diagnosis and differentiation from thyroid cysts is generally difficult. We hereby report a case that was admitted to the emergency room and was diagnosed as hypercalcemic crisis. The mass found during the neck examination was thought to be a thyroid nodule. A right total and left subtotal thyroidectomy was performed. Palpable thyroid nodule was diagnosed as cystic parathyroid adenoma postoperatively. When a cystic lesion is found in the neck of a patient, a pararthyroid cyst should be considered.     

Partial Splenectomy in the Management of Nonparasitic Splenic Cysts

Background  Recognition of the importance of the spleen in immunological function and the potential threat of severe postsplenectomy complications have led to the development of parenchyma-preserving surgical procedures. The aim of the present study was to assess the impact of open splenic partial resection on the management of splenic cysts. Patients and methods  From April 2003 to June 2007, 11 patients with splenic cysts were evaluated. All patients fulfilled the criteria for surgical resection. Ten of the patients (6 women and 4 men) 15–42 years of age (mean: 26.4 years) were subjected to open partial splenectomy. In one patient, a centrally located splenic cyst was considered unsuitable for partial splenectomy, and the patient therefore underwent total spleen excision. Patients with splenic cysts constituted 3.8% of all 290 patients subjected to splenectomy during the study period. Spleen parenchyma was cut with the aid of a LigaSure instrument. Bleeding from the transected splenic parenchyma was secured with argon plasma coagulation and absorbable tape sutures or oxidized cellulose. Results  Nine of the ten patients underwent successful partial splenectomy. In one patient, insufficient arterial supply to the preserved splenic remnant after excision of the upper cyst-containing splenic pole led to total splenectomy. The mean operative time was 98 min (range: 85–160 min), and mean blood loss was 106 ml (55–200 ml). The mean cyst diameter was 9.1 cm (range: 7–17 cm) and weight was 738 g (range: 230–2,420 g). The postoperative course was uneventful in all cases. Pathological examination showed an epithelial cyst in 8 patients and a pseudocyst in 2. After a mean follow-up of 26.4 months, the size of the splenic remnant constituted, on average, 71% of preoperative spleen size. Moreover, normal splenic vein flow was observed. Platelet counts remained within the normal range, and no cyst recurrence was observed. There were no infections documented during the follow-up period. Conclusions  Open partial splenectomy is a safe and effective method in the management of nonparasitic splenic cysts. It ensures complete cyst removal, lack of cyst recurrence, and preservation of the spleen functions.     

Splenic Metastasis from Esophageal Cancer: Report of a Case

The spleen is an unusual site of metastasis from an esophageal malignancy. We herein report the case of a 25-year-old woman who underwent a transhiatal esophagectomy and adjuvant radiotherapy and chemotherapy for squamous cell carcinoma of the lower third of the esophagus with pN1 lymph node metastasis. Fifteen months following surgery she was found to have splenic metastasis infiltrating the tail of the pancreas at the hilum. A splenectomy, distal pancreatectomy, and resection of the splenic flexure with colocolic anastomosis were performed. A histological examination of the resected specimen showed squamous cell carcinoma.     

Laparoscopic Splenectomy for Isolated Splenic Sarcoidosis

Introduction:

Sarcoidosis is an inflammatory disease with an unknown etiology. The pulmonary interstitium is mainly involved, with noncaseating granulomas and lymphadenopathy. It is a multisystemic disease, and the differential diagnosis should include infectious, neoplastic, and autoimmune diseases to prevent inappropriate treatment and unnecessary surgery. Abdominal disease without evidence of pulmonary abnormalities on chest radiography in sarcoidosis can be found in approximately 25% to 38% of cases.The approach to isolated splenic nodules in a patient with nonspecific abdominal symptoms should be focused on exclusion of malignancies and infections, and may require computed tomography, magnetic resonance imaging, and positron emission tomography–computed tomography imaging; scintigraphy; bone marrow biopsy; breast and genital examinations; and endoscopies.This report documents a rare case of isolated granulomatous disease of the spleen that was diagnosed and treated laparoscopically.

Case:

A 29-year-old woman presented with nonspecific complaints such as nausea, vomiting, and epigastric discomfort. Further laboratory test results were normal. Abdominal ultrasonography, computed tomography, and magnetic resonance imaging revealed multiple splenic lesions. Additional examination findings were negative for occult neoplasia or infectious disease. Laparoscopic splenectomy was performed as a diagnostic procedure, without complications, and the final diagnosis was sarcoidosis.

Conclusion:

Isolated splenic sarcoidosis is a rare manifestation of extrapulmonary disease. The final diagnosis may be achieved only by histology, requiring biopsy or splenectomy. Minimally invasive surgery is a safe and efficient method for diseases of the spleen and should be the first option when feasible. The patient did well; however, further monitoring is required to diagnose recurrence.     

Isolated Splenic Metastasis from Colorectal Cancer: Report of a Case

The authors report a case of a patient with splenic metastasis with previous history of colorectal cancer. A 69-year-old woman underwent a left hemicolectomy for sigmoid colon cancer. The tumor was staged T3N0M0. Two years after the operation, there was an elevation of CEA and computed tomography (CT) scan revealed a mass in the spleen, considered as an isolated metastasis. The patient underwent splenectomy. Histological diagnosis confirmed a metastatic adenocarcinoma from colorectal carcinoma. Patient was alive without neoplasic recurrence 5 years after splenectomy. Generally, splenic metastasis is uncommon. However, with the case of colorectal cancers, metastasis to the spleen is particularly rare. As with splenic metastasis of all primary tumors, the literature recommends that the treatment, where possible, is surgical.     

脾囊肿(附9例报告)

本文回顾了9例脾囊肿的诊断与治疗,临床表现主要为上腹不适和脾肿大。诊断主要依靠B超声和CT等影像学检查方法。传统的治疗方法是脾切除术,近年来随着对脾在免疫学中作用的认识,已经开始应用单纯切除或囊肿开窗引流的方法。对于脾囊肿的分类,认为应当增加肿瘤性、胰源性起源。临床上应注意囊肿亦有恶变。     

Giant Aneurysm of the Splenic Artery Adherent to the Pancreas with Splenic Infarct: Report of a Case

Giant aneurysms of the splenic artery are extremely rare clinical entities. The size of splenic aneurysms rarely exceeds 3 cm. The treatment includes surgical procedures that sometimes require pancreatectomy. We present a case of a 9 cm giant splenic artery aneurysm tightly adherent to the pancreas which was treated surgically.     

Partial Splenectomy for Benign Splenic Cysts with the Aid of a Lin Clamp: Technical Note

Background Spleen-preserving procedures deserve every effort by surgeons to reduce the risk of overwhelming postsplenectomy infection. Partial splenectomy at hospitals with restricted sources remains technically demanding. We describe our method of partial splenectomy for benign splenic cysts with the aid of a Lin clamp. Patients and Methods Since April 2003 to August 2004, we have performed partial splenectomy with the aid of a Lin clamp on 5 suitable patients with symptomatic cysts. Detailed patient characteristics, operative variables, and outcomes were collected. Following surgery, they were regularly followed up every 6 months. Results All five partial splenectomies were successfully executed without any complications. The mean operating time was 75 minutes, and a mean operative blood loss of 68 ml could be achieved. With a mean follow-up of 34.4 months, no cyst recurrences were detected to date. Postoperative laboratory data, imaging studies, and clinical situations proved that the preserved splenic parenchyma maintained adequate function. Conclusions Partial splenectomy with the aid of a Lin clamp for benign splenic cysts is a practical method with the advantages of easy application, rapid parenchymal dissection, secure hemostasis, and cost-effectiveness. With encouraging preliminary results, further application of this method to bleeding eccentric parenchymal injuries of the spleen may be warranted.     

Splenic and Pulmonary Metastases from Renal Cell Carcinoma: Report of a Case

We report herein the case of a patient in whom pulmonary and splenic metastases from renal cell carcinoma (RCC) were successfully treated by surgical excision. A 69-year-old man who underwent left nephrectomy for RCC 17 months before was suspected to have a pulmonary metastasis based on computed tomography (CT) findings. Partial resection of the left lower lobe was performed with thoracoscopic assistance. However, 4 months later, a splenic tumor, 6 cm in diameter, was detected by CT and ultrasonography, and a splenectomy was performed. Histologically, both resected specimens were diagnosed as metastasis from RCC. A second pulmonary metastasis of the left upper lobe was resected 4 years 8 months later. The patient was in good health when last seen 11 months after his last operation. Malignant neoplasms rarely metastasize to the spleen and most cases are found at autopsy, or feature multiple distant metastases. Only four other cases of splenic metastases from RCC have been reported. The prognosis associated with splenic metastasis is favorable when only a solitary lesion exists. Received: February 4, 2000 / Accepted: November 20, 2000     

Splenic Autotransplantation for a Congested and Enlarged Wandering Spleen with Torsion: Report of a Case

In children with diseases of the spleen, every effort should be made to preserve the organ, to prevent severe infections postsplenectomy. We report the case of a 7-year-old girl with torsion of a wandering spleen who we treated by autotransplantation of splenic tissues following splenectomy, when fixation of the enlarged spleen seemed impossible. Spleen scintigraphy showed uptake in the regenerating splenic tissues 9 months after surgery, and evidence of an increase in the size of the tissues 23 months after surgery. Howell–Jolly bodies had disappeared by 16 months after surgery. These findings suggested that the transplanted splenic tissues were resuming splenic functions. Based on our experience with this case, we conclude that autotransplantation after splenectomy is a treatment option for wandering spleen with torsion when fixation seems difficult because of splenic congestion and enlargement.     

Removal of a Splenic Artery with a Large Aneurysm Adhered to the Pancreas Without Pancreatectomy: Report of a Case

Splenic artery aneurysms account for about 60% of all visceral aneurysms. The treatment include surgical procedures that sometimes require pancreatectomy. This report describes the case of a 64-year-old woman who had multiple splenic artery aneurysms with various visceral artery dilatations. Because there was no obvious cause for the splenic artery aneurysms and other arterial abnormalities, we suspected an anomaly of the connective tissue, which was subsequently confirmed by a postoperative histopathologic examination. Thus, we decided to remove the whole splenic artery, to eliminate the formation of any further aneurysms, as well as a splenectomy. During the operation, the largest splenic artery aneurysm was found to be adhered to the pancreas too tightly to ablate. It initially appeared that pancreatectomy would be necessary, but considering the associated risk of postoperative complications, we tried to avoid this. Thus, we cut open the aneurysm and excised it, leaving the anterior wall which was adhered to the pancreas. Our procedure proved the best way to preserve the pancreas and eliminate further aneurysmal formation. Received: July 12, 2001 / Accepted: January 8, 2002     

Isolated Gastric Varices Resulting from Iatrogenic Splenic Vein Occlusion: Report of a Case

Iatrogenic splenic vein occlusion is known to be a rare cause of left-sided portal hypertension. We herein describe the clinical course of a 43-year-old woman with isolated gastric varices, which proved to be attributable to a segmental splenic vein resection during an operation for a benign pancreatic tumor 11 years previously. Seven years after the initial operation, prominent gastric varices due to left-sided portal hypertension were first noted. During the follow-up period of 4 years, she had no episodes of gastrointestinal hemorrhaging. Although the size of the gastric varices did not change, she decided to have a splenectomy considering the potential risk of variceal hemorrhaging. It may be reasonable to perform a splenectomy concomitantly when the splenic vein is to be resected or ligated during pancreatic surgery to avoid the future development of left-sided portal hypertension. However, the role of prophylactic surgery in asymptomatic patients with iatrogenic splenic vein occlusion remains to be determined. Received: June 3, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: Y. Ku     

Multiple Orthokeratinized Odontogenic Cysts: A Case Report

The purpose of this report is to document the clinical, radiographic, pathological and molecular findings of the first case of multiple orthokeratinized odontogenic cysts (OOCs). Multiple odontogenic keratocysts are one of the major features of nevoid basal cell carcinoma syndrome (NBCCS), and loss of heterozygosity in the PTCH gene, the culprit gene for NBCCS, has recently been found in sporadic OOC cases. Therefore, in this presenting case, we also investigated the possibility that this patient might also have NBCCS, by comparing the available clinical information and the molecular findings of this case to the diagnostic criteria for NBCCS (as proposed by the First International Colloquium on NBCCS in 2011). However, this patient with multiple OOCs showed no evidence of having NBCCS. This conclusion supports the findings from previous case series based on sporadic cases that OOC does not appear to be associated with NBCCS.