Pelvic splenosis: A systematic review of the literature.

Background: Splenosis is the presence of ectopic autotransplantation of splenic tissue in various compartments of the human body, occurring after rupture of the splenic parenchyma. Methods: A systematic PubMed and Scopus search was conducted. Results: The mean age of the patients was 51.7 years. The majority of patients were of female gender. An emergency presentation was noted in 30 out of 85 patients, having abdominal pain as main symptom. The principal reason for splenectomy were traffic accidents. The time span between splenectomy and the initial symptoms ranged between 1 and 57 years. The most frequent symptom at presentation of pelvic splenosis was abdominal pain. Almost a quarter of the included patients were without any symptom. Presence of extrapelvic splenosis was de-scripted in almost half of the included patients. With regards to the type of treatment provided, exploratory laparotomy, laparoscopic surgical exploration / laparoscopy, robotic removal of splenium and watchful waiting, were performed in 35 (41.2%), 32 (37.6%), 3 (3.5%) and 15 (16.3%) patients, respectively. No fatality was reported. Conclusion: Pelvic splenosis is a rare clinical condition. It may mimic several clinical conditions and mislead diagnosis. The clinical history of splenectomy for trauma or different other reasons may es-tablish diagnosis and exclude other morbidities. Excision and complete removal of pelvic splenosis nodules is not always necessary and it depends on the clinical symptomatology. Careful imaging and precise assessment with the assistance of nuclear medicine may lead to correct diagnosis and avoid unnecessary surgical interventions.

Splenosis as an incidental finding in a patient with multifactorial anemia.

A clinical case of a patient from our institution under study for anemia of multifactorial origin in whom splenosis was detected as an incidental finding.

Post-traumatic multifocal abdominal splenosis. The role of the clinical history. Case report and review of literature.

BACKGROUND: Splenosis is a benign clinical condition caused by the heterotopic autotransplantation of spleen's tissue tipically occurring after spleen rupture. Splenosis may be asymptomatic and found accidentally. When signs and symptoms occur they are due to mass effect or bleeding of the splenic nodules. CASE REPORT: 74-years-old male presenting with intestinal sub-occlusion and past medical history of post-traumatic splenectomy at 18-years-old. Based on TC findings of multiple hyperenhanced solid lesions located in greater omentum, mesentery and parietal peritoneum of right pelvic walls, the presumptive diagnosis was peritoneal carcinomatosis of unknown primary site. Stenosis of a ileum loop in the right pelvis, with dilatation and faecal stasis of the upstream loops proximal, required surgical procedure. At the opening of the peritoneal cavity the multifocal lesions varied in size, were reddish blu color, sessile, lobulate and with strong adhesions to the visceral peritoneum. Omentectomy and the blunt exicision of 3 extraparietal solid nodules, which had tenacious adhesions with stenotic ileum loop serosa for the lenght of 8 cm, were performed. Histopathological examination of surgical specimens showed splenic tissue with red pulp. CONCLUSION: CT scan usually do not allow to make a certain diagnosis of splenosis, so the clinical history of splenic trauma or splenectomy, positive in all cases reported in literature, represent the key in the diagnostic pathway of splenosis. Management should be conservative as much as possible nonetheless in abdominal splenosis the surgical approach should be chosen for the symptomatic patients who present abdominal pain, occlusion or bleeding. KEY WORDS: Abdominal, Splenosis, Spleen, Surgery.

Pelvic mass causing hematospermia: splenosis.

BACKGROUND: Most patients with splenosis have no clinical symptoms and do not need intervention. Hematospermia and testicular pain occurred in this patient, which was considered to be related to the huge pelvic implantation of the spleen, which was relatively rare in clinical practice, so we hereby report this case. CASE PRESENTATION: A 28-year-old male patient with a history of splenectomy was admitted to the Urology Department of the Second Affiliated Hospital of Anhui Medical University with the chief complaint of "Hematospermia for 1 month and testicular pain for 2 days". Preoperative imaging examination indicated pelvic mass. Combined with the patient's history of splenectomy for splenic rupture in childhood, the possibility of pelvic spleen implantation was considered. Laparoscopic pelvic exploration was performed. During the operation, multiple grayish-brown nodular tissues were observed in the space between the posterior bladder and rectum, and a lobulated grayish-brown mass with a diameter of about 9 cm was observed in the posterior upper part of the prostate gland and seminal vesicle at the pelvic floor. Two nodular tissues were removed intraoperatively and sent for quick frozen pathology, which was reported as spleen tissue. Further resection of the huge mass was performed, and the postoperative pathological results were consistent with the diagnosis of splenosis. CONCLUSION: We report a rare case of splenosis presenting with hemospermia and testicular pain.

Thoracic splenosis mimicking pleural tumor after firearm injury: A case report with long-term follow-up.

Splenosis describe a clinical entity of autotransplantation after removal of the spleen secon-dary to a traumatic rupture or surgery. A 39-year-old female was referred to thoracic surgery department with complaints of severe chest pain. She had left thoracic and abdominal gun-shot injury that occurred 19 years earlier. Thorax computed tomograhy and thorax magnetic resonance imaging revealed pleural lesions. A video thoracoscopic biopsy disclosed splenosis in the patient. Splenic implants did not change in 6 years. The patient has mild thoracic pain. Thoracic splenosis can occur in patients who underwent abdominothoracic gunshot injury. The implants did not seem to change in long-term follow-up. Thoracic splenosis may occur, persist for years and it mimics pleural tumor after abdominal gun-shot injury and does not seem to necessitate any surgical intervention including diaphragmatic repair.

[Post-traumatic thoracic splenosis]. / Klinicheskii sluchai posttravmaticheskogo grudnogo splenoza.

Splenosis is a rare disease and defined as spleen tissue autotransplantation following spleen rupture and subsequent splenectomy in most cases. The authors report ectopic splenic tissue in pleural cavity diagnosed in 31 years after blunt thoracoabdominal trauma.

Thoracic Splenosis, a Challenging Diagnosis / Esplenosis torácica, un diagnóstico complejo

No disponible

Intraperitoneal splenosis mimics peritoneal carcinomatosis of leiomyosarcoma and ovarian cancer.

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.

An Uncommon Focal Liver Lesion: Intrahepatic Splenosis.

Multiple focal liver lesions were incidentally detected in a patient screened by ultrasound for a recent diagnosis of lower limb deep vein thrombosis, for which anticoagulation had been initiated. Past medical history reported a post-traumatic splenectomy 15 years before. Magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) showed a subcapsular lesion in liver segment 5 consistent with focal nodular hyperplasia (FNH) and multiple other nodules, with a different pattern from the former, judged as probable hepatic adenomas by MRI but probable hemangiomas by CEUS (hyperenhancement in the late phase). Therefore, another MRI with gadoxetic acid was performed. The diagnosis of FNH was confirmed. The other lesions showed an hyperenhancing pattern in the arterial phase with progressive wash-out in the portal and late phase and marked hypointensity in the hepatobiliary phase. This pattern apparently confirmed the hypothesis of adenomas, with a potential risk of malignancy due to the hepatobiliary phase pattern and the recent occurrence of deep vein thrombosis. Due to the inherent risk of spontaneous bleeding from subcapsular adenomas increased by the ongoing anticoagulant therapy and the recommendation of international guidelines to resect adenomas in male subjects, the patient was directly offered surgery. Pathology of the resected specimens confirmed one FNH but demonstrated intrahepatic splenosis for all other lesions. This case suggests that in the setting of previous splenic trauma any discrepancy between MRI and CEUS findings should lead one to consider also the hypothesis of intrahepatic splenosis.

Thoracic splenosis: Case report of a symptomatic case.

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.