Assuntos
Neoplasias do Endométrio , Esplenose , Humanos , Esplenose/diagnóstico , Esplenose/diagnóstico por imagem , Esplenose/patologia , Feminino , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/diagnóstico , Diagnóstico Diferencial , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Pelve , EsplenectomiaRESUMO
A 54-year-old man presented with abdominal pain and a history of post-traumatic splenectomy 33 years prior, imaging revealed an incidental hepatic mass.
Assuntos
Neoplasias , Esplenose , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Diagnóstico Diferencial , Diagnóstico por Imagem , Humanos , Masculino , Pessoa de Meia-Idade , Esplenectomia , Esplenose/diagnóstico por imagem , Esplenose/patologiaRESUMO
We report the case of a 62-year-old Caucasian male patient who presented with epigastric pain to our outpatient clinic. On abdominal ultrasound we detected a 26âmm oval hypoechoic lesion in segment 2 of the left liver lobe. Performing contrast-enhanced ultrasound this lesion showed an arterial hypervascularization with centripetal filling and a spoke wheel pattern. Due to a hyperenhancement during the portal and late phase this lesion led to the diagnosis of a benign liver tumor, probably a hepatocellular adenoma (HCA). As focal nodular hyperplasia (FNH) was still another possible diagnosis, we decided to perform an MRI, which could not differentiate between HCA and hepatocellular carcinoma (HCC). Therefore, we performed liver biopsy of this lesion. Histology and immunohistochemistry led to the final diagnosis of intrahepatic splenosis. Reassessment of patient history revealed an abdominal trauma with splenic rupture 5 years ago. Intrahepatic splenosis should be considered as an important differential diagnosis in patients with unknown liver tumor and a history of splenic trauma.
Assuntos
Imageamento por Ressonância Magnética , Esplenose/patologia , Abdome/diagnóstico por imagem , Adenoma de Células Hepáticas , Carcinoma Hepatocelular , Meios de Contraste , Diagnóstico Diferencial , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ultrassonografia/métodosRESUMO
OBJECTIVE: Leiomyosarcoma and ovarian cancer are often diagnosed late due to the absence of initial symptoms. Patients seek help when abdominal distension occurs; this is associated with pelvic tumor and carcinomatosis. Initial imaging often reveals pelvic tumors with diffuse abdominal nodules; however, this imaging could be misleading, such as in the cases of splenosis. CASE REPORT: A female presented with vaginal bleeding at our outpatient department. Serum CA125 level was elevated. Abdominal and pelvic CT showed multiple uterine masses and left adnexal cysts with peritoneal nodules. Leiomyosarcoma or ovarian cancer with carcinomatosis was suspected. Exploratory laparotomy was performed. Multiple purple spots spreading over peritoneal cavity were noted during the surgery. Pathological examination revealed adenomyosis with multiple uterine myomas and left ovarian endometrioma. Splenic tissues peritoneal implants were observed. CONCLUSION: In patients with a history of spleen rupture or splenectomy, splenosis should be considered in the differential diagnosis, especially in young patients.
Assuntos
Esplenose/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Histerectomia , Leiomiossarcoma/diagnóstico , Neoplasias Ovarianas/diagnóstico , Neoplasias Peritoneais/diagnóstico , Salpingo-Ooforectomia , Esplenose/patologia , Esplenose/cirurgiaRESUMO
Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.
Assuntos
Traumatismos Abdominais/complicações , Doenças Assintomáticas , Baço/lesões , Esplenose/diagnóstico , Esplenose/etiologia , Doenças Torácicas/diagnóstico , Doenças Torácicas/etiologia , Traumatismos Torácicos/complicações , Procedimentos Desnecessários , Adulto , Humanos , Masculino , Esplenectomia , Esplenose/patologia , Esplenose/cirurgia , Doenças Torácicas/patologia , Doenças Torácicas/cirurgia , ToracotomiaRESUMO
A 40-year-old woman presented with abdominal pain and jaundice. Past medical history was significant only for splenectomy following a motor vehicle accident. Owing to presence of multiple peritoneal nodules on computerized tomography (CT) and elevated serum CA-125, ovarian peritoneal carcinomatosis was suspected. Ultrasound-guided fine-needle aspiration (FNA) revealed presence of abundant hemosiderin, leukocytes, endothelial cells, and fungal hypha-like structures. No evidence of neoplasia was found. Findings were consistent with Gamna-Gandy bodies (GGBS) within splenic tissue. Based on history of splenectomy and FNA findings, a diagnosis of abdominal splenosis with presence of GGBS was made. Workup for hepatic cirrhosis and portal hypertension was recommended. Liver biopsy confirmed presence of cirrhosis. To our knowledge, this is the first report of GGBS identified within abdominal splenosis. It is important for pathologists to be able to recognize GGBS and to be aware of their relationship to portal hypertension and other conditions associated with severe vascular congestion or hemorrhage. History and pathogenesis of GGBS, their diagnostic morphologic features and a review of cases of GGBS diagnosed via cytology are given.
Assuntos
Biópsia por Agulha Fina/métodos , Hipertensão Portal/diagnóstico , Esplenose/complicações , Esplenose/diagnóstico , Esplenose/patologia , Adulto , Feminino , Humanos , Hipertensão Portal/complicações , Esplenectomia/efeitos adversosRESUMO
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the most common primary liver malignancies. HCC and ICC have characteristic imaging findings, but a number of benign entities can appear similar and can cause diagnostic dilemma. Ideally, accurate and timely diagnosis of these conditions can help the patient to avoid a needle biopsy or even unnecessary treatment. In this article, we present various benign liver lesions that display imaging characteristics that are similar to HCC and ICC on magnetic resonance imaging (MRI) and discuss salient features that may assist in accurate diagnosis.
Assuntos
Adenoma de Células Hepáticas/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Adenoma de Ducto Biliar/diagnóstico por imagem , Adenoma de Ducto Biliar/patologia , Adenoma de Células Hepáticas/patologia , Adulto , Idoso , Angiomiolipoma/diagnóstico por imagem , Angiomiolipoma/patologia , Neoplasias dos Ductos Biliares/patologia , Meios de Contraste , Cistos/diagnóstico por imagem , Cistos/patologia , Diagnóstico Diferencial , Feminino , Granuloma de Células Plasmáticas/diagnóstico por imagem , Granuloma de Células Plasmáticas/patologia , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Histiocitoma Fibroso Benigno/diagnóstico por imagem , Histiocitoma Fibroso Benigno/patologia , Humanos , Abscesso Hepático/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Derivação Portossistêmica Cirúrgica/estatística & dados numéricos , Esplenose/diagnóstico por imagem , Esplenose/patologiaRESUMO
Splenosis refers to ectopic splenic implants that are often found incidentally years after splenic rupture/splenectomy, and the nodules of splenosis are usually small, less than 3 cm for the majority. We report a case of splenosis with a 5-centimeter large mass in the anterior abdomen in a 79 year-old male with a remote history of splenic rupture/splenectomy. Unexpectedly, needle core biopsy of the abdominal mass demonstrated splenic tissue with a mononucleated cell infiltrate blurring the splenic architecture that was highlighted only by CD8 stain. This finding prompted a bone marrow examination resulting in the diagnosis of acute myeloid leukemia in the patient. Retrospectively, enlargement of this ectopic spleen may have been caused by this leukemic infiltrate. This case underscores the importance of being aware of this rare pathological condition and its retained vulnerability for involvement by hematolymphoid neoplasms, as well as significance of identifying splenic architecture highlighted by CD8 stain to reach a correct diagnosis.
Assuntos
Leucemia Mieloide Aguda/diagnóstico , Esplenose/patologia , Idoso , Humanos , Achados Incidentais , MasculinoAssuntos
Esplenose/diagnóstico , Adulto , Humanos , Masculino , Baço/patologia , Baço/fisiopatologia , Esplenose/patologia , Esplenose/fisiopatologiaAssuntos
Eritrócitos/fisiologia , Cirrose Hepática , Fígado , Cintilografia/métodos , Esplenose , Idoso , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Cirrose Hepática/cirurgia , Transplante de Fígado , Masculino , Esplenose/complicações , Esplenose/diagnóstico por imagem , Esplenose/patologiaAssuntos
Hepatopatias/diagnóstico por imagem , Esplenose/diagnóstico por imagem , Idoso , Carcinoma Hepatocelular/diagnóstico , Diagnóstico Diferencial , Humanos , Hepatopatias/patologia , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Masculino , Esplenectomia , Esplenose/patologiaAssuntos
Neoplasias Hepáticas/patologia , Fígado/patologia , Esplenose/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Humanos , Achados Incidentais , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Esplenectomia/efeitos adversos , Esplenose/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
RATIONALE: Ectopic splenic autotransplantation refers to the heterotopic autotransplantation of splenic tissue and no treatment is necessary for it when patient is asymptomatic. Its incidence rate is reported up to 67% among patients with a history of splenic trauma and splenic surgery. The diagnosis of it before operation is really difficult, and it is easy to mimic as other tumors. PATIENT CONCERNS: We reported a 42-year-old man with hepatic splenosis, with history of splenectomy for traumatic splenic rupture 16 years ago and hepatitis B&C. The patient was enrolled with recurrent low back pain for more than 1 month without any treatment. DIAGNOSES: Radiological imaging revealed a subcapsular hepatic nodule, showing "fast-in and fast-out" enhancement. Surgery was performed, and the result of histological diagnosis was hepatic splenosis. INTERVENTIONS: No intervention before segmentectomy of the liver. LESSONS: When imaging of a patient with history of traumatic splenic rupture or splenectomy shows1 or few well circumscribed hepatic nodules with enhancement in dynamic study, we should suspect hepatic splenosis, for the purpose of avoiding unnecessary surgery.
Assuntos
Hepatite B/complicações , Hepatite C/complicações , Fígado/patologia , Esplenose/diagnóstico , Adulto , Carcinoma Hepatocelular/diagnóstico , Diagnóstico Diferencial , Fígado Gorduroso/complicações , Fígado Gorduroso/patologia , Hepatite B/diagnóstico por imagem , Hepatite B/patologia , Hepatite C/diagnóstico por imagem , Hepatite C/patologia , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Esplenose/complicações , Esplenose/patologia , Esplenose/cirurgiaRESUMO
Splenosis is a pathology resulting from a rupture of the spleen due to a trauma or a surgery. We report the case of a patient presenting with a splenosis, initially diagnosed as endometriosis-related pelvic nodules, the most frequent cause of pelvic nodules in women. We will describe the imaging strategy that led to the final diagnosis of splenosis.
Assuntos
Endometriose/diagnóstico , Distúrbios do Assoalho Pélvico/diagnóstico , Pelve/patologia , Esplenose/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pelve/diagnóstico por imagem , Esplenose/patologia , Tomografia Computadorizada por Raios XRESUMO
Renal mass biopsy is increasingly used to guide conservative tumor management, placing increasing importance on pathologists' ability to diagnose small tumor samples. A 66-year-old man with a history of prior splenectomy for trauma presented for urologic evaluation after identification of a left 5.8 cm renal mass. Partial envelopment of the mass by renal parenchyma and equivocal enhancement on computed tomography raised concern for renal cell carcinoma. Needle-core biopsy revealed blood, subtle vasculature, few aggregates of lymphocytes, and rare renal tubules. Immunohistochemical staining revealed CD8-positive sinusoids but negative reactivity for epithelial antigens (PAX8, keratin, epithelial membrane antigen, carbonic anhydrase IX), supporting diagnosis of renal splenosis. Renal splenosis is a rare phenomenon that can form a sizeable intrarenal mass, mimicking renal cell carcinoma. Pathologists' awareness of this uncommon occurrence may avoid unnecessary surgery. CD8-positive sinusoids and negative epithelial markers are helpful confirmatory features in the biopsy setting.