Pancreatic splenosis mimicking neuroendocrine tumors: microhistological diagnosis by endoscopic ultrasound guided fine needle aspiration.

CONTEXT: Pancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm. OBJECTIVE: To describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic nodules suspicious for pancreatic splenosis. METHOD: From 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed. RESULTS: A total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6%) cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7), young (mean age: 42 years) and asymptomatic (8). Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis was found most commonly in the tail, was round, hypoechoic, with homogeneous pattern, regular borders, and with scintigraphy negative for somatostatin receptors. The average diameter of these nodules identified by endoscopic ultrasound was 2.15 cm. Microhistology obtained by EUS-FNA confirmed the diagnosis in 9/10 patients. CONCLUSION: Pancreatic splenosis can be diagnosed by EUS-FNA. Microhistology prevents unnecessary surgeries, and reassures asymptomatic patients with hypoechoic, homogeneous, and well circumscribed pancreatic nodules.

PANCREATIC SPLENOSIS MIMICKING NEUROENDOCRINE TUMORS: microhistological diagnosis by endoscopic ultrasound guided fine needle aspiration

Context Pancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm. Objective To describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic nodules suspicious for pancreatic splenosis. Method From 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed. Results A total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6%) cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7), young (mean age: 42 years) and asymptomatic (8). Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis was found most commonly in the tail, was round, hypoechoic, with homogeneous pattern, regular borders, and with scintigraphy negative for somatostatin receptors. The average diameter of these nodules identified by endoscopic ultrasound was 2.15 cm. Microhistology obtained by EUS-FNA confirmed the diagnosis in 9/10 patients. Conclusion Pancreatic splenosis can be diagnosed by EUS-FNA. Microhistology prevents unnecessary surgeries, and reassures asymptomatic patients with hypoechoic, homogeneous, and well circumscribed pancreatic nodules. .

Contexto A esplenose pancreática é uma afecção benigna que pode mimetizar uma neoplasia pancreática. Objetivo Descrever o papel da ecoendoscopia associada à punção aspirativa com agulha fina ecoguiada (EE-PAAF) dos nódulos de pâncreas suspeitos de esplenose pancreática. Método De 1997 a 2011, pacientes com tumores sólidos de pâncreas sugestivos de esplenose pancreática, conforme achados de exames de imagem por tomografia computadorizada e/ou ressonância magnética foram encaminhados para EE-PAAF. Os casos com esplenose pancreática confirmada pela ecoendoscopia ou pela cirurgia foram incluídos. Os achados endossonográficos e os aspectos clinicopatológicos foram analisados. Resultados Dois mil e sessenta pacientes com tumores sólidos do pâncreas foram submetidos a EE-PAAF. Quatorze (0,6%) casos com esplenose pancreática foram encontrados. Após emprego dos critérios de exclusão, 11 pacientes foram selecionados. A maioria dos pacientes era do sexo masculino (7), jovens (idade média: 42 anos) e assintomáticos (8). A imagem ecoendoscópica isolada suspeitou de esplenose pancreática em 6 casos, e tumores neuroendócrinos em outros 5 casos. A esplenose pancreática foi detectada mais comumente na cauda do pâncreas, era redonda, hipoecogênica, com padrão homogêneo, bordos regulares bem delimitados e com cintilografia negativa para os receptores de somatostatina. O diâmetro médio dos nódulos foi de 2,15 cm. A microhistologia obtida pela EE-PAAF confirmou o diagnóstico em 9/10 pacientes. Conclusão A esplenose pancreática pode ser diagnosticada pela punção aspirativa com agulha fina ecoguiada. A microhistologia evita cirurgias desnecessárias ...

Hemoperitoneum in a Dog with Hepatic Splenosis

Ectopic splenic tissue results from the autotransplantation and seeding of splenic tissue, often secondary to splenic trauma or splenectomy. Splenic implantations occur mostly as nodules within the peritoneal cavity and constitute an incidental finding at necropsy, surgery, or imaging investigations. This report addresses a case of hemoperitoneum associated with hepatic splenosis in a dog that became ill several years after splenic trauma.(AU)

Hemoperitoneum in a Dog with Hepatic Splenosis

Ectopic splenic tissue results from the autotransplantation and seeding of splenic tissue, often secondary to splenic trauma or splenectomy. Splenic implantations occur mostly as nodules within the peritoneal cavity and constitute an incidental finding at necropsy, surgery, or imaging investigations. This report addresses a case of hemoperitoneum associated with hepatic splenosis in a dog that became ill several years after splenic trauma.

Antibody response of autogenous splenic tissue implanted in the abdominal cavity of mice.

There is still controversy about the immunologic function of autotransplanted splenic tissue. In this study, splenic autotransplantation was performed in the abdominal cavity of mice, and the plaque-forming cell (PFC) assay was used to investigate the frequency of antibody-forming cells in response to sheep red blood cell (SRBC) immunization. BALB/c mice were divided into four groups according to the location of the autogenous graft: intraomental (IO), free peritoneal splenosis (FPS), retroperitoneal (RP), and nongrafted control (CT). Thirty days after surgery the mice were immunized intraperitoneally with SRBCs, and 4 days later splenic immunoglobulin M anti-SRBC-secreting cells were determined by counting the number of PFCs. All the immunized mice showed increased numbers of PFCs that were about 2 logs higher than those in the the nonimmunized controls (P < 0.005). The frequencies of anti-SRBC-producing cells in the tissues grafted in various sites of the abdominal cavity (IO, FPS, RP), in the normal spleen from nonoperated controls (CT), or in the sham-operated control group (SCT) were not notably different (5582 +/- 2475 PFC/10(7) cells for IO; 4849 +/- 1856 for FPS; 6604 +/- 2903 for RP; 5940 +/- 5029 for CT; and 6172 +/- 2203 for SCT). Similar histology with small architectural variations was observed in all implants; less white pulp was involved, and there was more congestion in the red pulp, with extensive sinusoids and reticular fiber proliferation. This study shows that the T cell-dependent antibody response in implanted splenic tissues is as efficient as in the intact spleen, with no difference between the graft sites studied. This immune response does not depend on the slight architectural variations observed in the splenic implants.