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Tomihara H, Murakami M, Kitagawa A, Yasuhara Y, Nakamura M, Yoshihara T, Ohara N, Takeoka T, Hara H, Naito A, Kawabata R, Noura S, Miyamoto A. Sclerosing angiomatoid nodular transformation mimicking a splenic metastasis from rectal cancer: A case report. Exp Ther Med 2025; 29:78. [PMID: 40012921 PMCID: PMC11863181 DOI: 10.3892/etm.2025.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 01/23/2025] [Indexed: 02/28/2025] Open
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a rare, benign lesion of the spleen. Preoperative diagnosis of SANT without pathological examination poses significant challenges, particularly in patients with a previous history of malignancy. The present study describes the case of a 53-year-old woman that presented to our institution with general fatigue and anemia. Based on a diagnosis of rectal cancer, the patient underwent curative surgery. Postoperatively, with minor leakage and the need for endoluminal drainage, the patient was monitored without adjuvant chemotherapy. A total of 1 year post-operation, enhanced computed tomography (CT) revealed a low-density lesion measuring 7 mm in the spleen. While metachronous metastasis was considered, there was no accumulation of 18F-fluorodeoxyglucose, and the levels of tumor markers, such as carcinoembryonic antigen and carbohydrate antigen 19-9, remained unremarkable. Regular surveillance through contrast-enhanced CT was performed. Over a period of 3 years, the tumor gradually increased to 25 mm. After a diagnosis of metachronous metastasis from rectal cancer, the patient opted for surgery, and laparoscopic splenectomy was performed successfully. Histopathological examination of multiple angiomatoid nodules in the fibrosclerotic stroma confirmed the diagnosis of SANT. The postoperative course of the patient was uneventful. In cases of SANT following a prior malignancy, splenectomy should be considered for both diagnostic and therapeutic purposes.
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Affiliation(s)
- Hideo Tomihara
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Masahiro Murakami
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Akihiro Kitagawa
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Yumiko Yasuhara
- Department of Pathology, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Masahisa Nakamura
- Department of Radiology, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Terukazu Yoshihara
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Nobuyoshi Ohara
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Tomohira Takeoka
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Hisashi Hara
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Atsushi Naito
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Ryohei Kawabata
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Shingo Noura
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
| | - Atsushi Miyamoto
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-1199, Japan
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García Barquín P, Lángara García-Echave E, Pérez Arroyuelos I, Ingunza Loizaga E, Berastegi Santamaría C, Irigoyen G. The role of contrast-enhanced ultrasound in the evaluation of focal splenic lesions. RADIOLOGIA 2025; 67:61-73. [PMID: 39978881 DOI: 10.1016/j.rxeng.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/02/2023] [Indexed: 02/22/2025]
Abstract
The purpose of this article is to evaluate the role of contrast-enhanced ultrasound in the characterization of non-traumatic focal splenic lesions. Focal splenic lesions are less common than in other abdominal organs like the liver. Conventional ultrasound and Doppler ultrasound have a limited role in the characterization of splenic lesions, resulting in many of them unspecified. Contrast ultrasound is an accessible, cheap, and safe technique which can help in the immediate characterization of lesions incidentally detected in the ultrasound examination, being a good alternative to others imaging techniques. We review in detail the technique and the main indications. We also analyze imaging findings and enhancement pattern by using representative case of the main splenic lesions for both benign (epithelial cyst, cystic lymphangioma, hemangioma, hamartoma, infarction, sclerosing angiomatous nodular transformation, abscesses, sarcoidosis), and malignant (lymphoma, metastasis) and its pathological correlation in some cases.
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Affiliation(s)
- P García Barquín
- Departamento de Radiología, Hospital Galdakao Usansolo, Galdakao, Bizkaia, Spain.
| | | | - I Pérez Arroyuelos
- Departamento de Radiología, Hospital Galdakao Usansolo, Galdakao, Bizkaia, Spain
| | - E Ingunza Loizaga
- Departamento de Radiología, Hospital Galdakao Usansolo, Galdakao, Bizkaia, Spain
| | | | - G Irigoyen
- Departamento de Anatomía Patológica, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
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Wang C, Lu R. Chronic splenic hematoma simulating splenic hamartoma: A case report. Asian J Surg 2024:S1015-9584(24)02520-X. [PMID: 39537487 DOI: 10.1016/j.asjsur.2024.10.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 10/10/2024] [Indexed: 11/16/2024] Open
Affiliation(s)
- Chengcheng Wang
- Department of Radiology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Rong Lu
- Department of Radiology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.
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Oh YJ, Lee JE, You SK, Ohm JY, Han HY, Kim JM, Shin KS. Multimodality Imaging Features of Various Splenic Lesions: Clinical and Histopathologic Correlation. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:1099-1125. [PMID: 39660321 PMCID: PMC11625836 DOI: 10.3348/jksr.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/02/2024] [Accepted: 04/24/2024] [Indexed: 12/12/2024]
Abstract
The spleen is occasionally referred to as the 'forgotten organ' because splenic lesions are less common and encountered rarely compared to pathologies of other abdominal solid organs. Therefore, although well-demonstrated using various abdominal imaging modalities, radiologists tend to be less familiar with splenic diseases, making interpretation challenging. This study aimed to review common and uncommon splenic diseases and illustrate the multimodal imaging (including ultrasonography, CT, MRI, and PET/CT) features of these lesions in correlation with their histopathology. Recognizing the radiological findings of various splenic lesions helps narrow down the differential diagnosis and guide appropriate clinical decision-making for radiologists.
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Denolf M, Rappaport A, Delvaux S. Epithelioid Hemangioendothelioma of Spleen and Bone: A Case Report. J Belg Soc Radiol 2024; 108:64. [PMID: 38948496 PMCID: PMC11212771 DOI: 10.5334/jbsr.3600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/05/2024] [Indexed: 07/02/2024] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that can originate in various parenchymatous organs, soft tissue, and bone. Extrahepatic involvement is exceedingly rare. In this case, multifocal disease in the spleen and bone was present. Bone lesions showed a target appearance. Splenic lesions showed delayed enhancement of solid components with persistent rim enhancement. A bone biopsy with CAMTA1 staining confirmed the diagnosis. Teaching point: The presence of multifocal bone and splenic lesions can raise suspicion of EHE when other multifocal diseases are excluded.
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Affiliation(s)
- Melvin Denolf
- Department of Radiology, Sint Trudo Hospital, Sint-Truiden, Belgium
| | | | - Sigrun Delvaux
- Department of Pathology, Sint-Trudo Hospital, Sint-Truiden, Belgium
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Krähling H, Seidensticker M, Heindel WL, Gerwing M. Diagnostic approach to splenic lesions. ROFO-FORTSCHR RONTG 2024; 196:573-581. [PMID: 37967822 DOI: 10.1055/a-2193-2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Splenic lesions are rare and mostly incidental findings on cross-sectional imaging. Most lesions are of benign nature and can be correctly identified based on imaging characteristics. Further, invasive evaluation is only necessary in cases of splenic lesions with uncertain or potentially malignant etiology. METHOD While in most cases a correct diagnosis can be made from computed tomography (CT), (additional) magnetic resonance imaging (MRI) can aid in the identification of lesions. As these lesions are rare, only a few of the differential diagnoses are regularly diagnosed in the clinical routine. RESULT AND CONCLUSION This review presents the differential diagnoses of splenic lesions, including imaging characteristics and a flowchart to determine the right diagnosis. In conjunction with laboratory results and clinical symptoms, histological workup is necessary only in a few cases, especially in incidental findings. In these cases, image-guided biopsies should be preferred over splenectomy, if possible. KEY POINTS · Splenic lesions are rare and are usually incidental findings on abdominal imaging. · CT imaging and MRI imaging are the diagnostic tools of choice for the further workup of splenic lesions. · Based on their image morphological characteristics, a large number of splenic lesions can be assigned to one entity and do not need histological analysis. CITATION FORMAT · Krähling H, Seidensticker M, Heindel WL et al. Diagnostic approach to splenic lesions. Fortschr Röntgenstr 2024; 196: 573 - 581.
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Affiliation(s)
| | - Max Seidensticker
- Department of Radiology, Ludwig-Maximilians-Universität München, Germany
| | | | - Mirjam Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany
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Murshid MY, AlHawsah AO, AlSayed KT, Ansari FA. Isolated splenic lymphangioma in adulthood. J Surg Case Rep 2024; 2024:rjae411. [PMID: 38863957 PMCID: PMC11165307 DOI: 10.1093/jscr/rjae411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024] Open
Abstract
Isolated splenic lymphangiomas are rare benign lesions mostly seen in children are exceptionally rare in adults, often discovered incidentally due to their typically asymptomatic nature. This case report elaborates on the surgical excision of a rare splenic cystic lymphangioma in a 33-year-old woman, underscoring the diagnostic and therapeutic challenges these tumors pose. The patient's symptoms, abdominal pain and a palpable mass led to imaging through ultrasound and CT, which revealed a cystic splenic lesion. Total splenectomy was performed, revealing a large cystic mass, with pathological examination confirming a cystic lymphangioma. This case emphasizes the necessity of considering splenic lymphangiomas in adult patients presenting with splenic lesions. It also highlights the critical role of surgical interventions for definitive diagnosis and to prevent complications such as rupture and hemorrhage, thereby emphasizing on the complexity of managing rare splenic tumors.
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Affiliation(s)
- Mohsin Yahya Murshid
- Department of General Surgery, International Medical Center, P.O. Box 2172, Jeddah 21451, Saudi Arabia
| | - Atif Omar AlHawsah
- Department of General Surgery, Hera General Hospital, Al Madinah Al Munawarah Rd, Makkah 24227, Saudi Arabia
| | - Kadi T AlSayed
- Department of General Surgery, Hera General Hospital, Al Madinah Al Munawarah Rd, Makkah 24227, Saudi Arabia
| | - Farrukh Alim Ansari
- Department of General Surgery, Hera General Hospital, Al Madinah Al Munawarah Rd, Makkah 24227, Saudi Arabia
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Bazeboso JA, Mbuyi Mukendi D, Mbongo CL, Mbombo W, Lelo Tshikwela M, Molua A, Longo B, Tshilolo L, Bilbao JI. Partial Splenic Embolization in Paediatric Sickle Cell Disease Patients with Hypersplenism. Cardiovasc Intervent Radiol 2024; 47:652-660. [PMID: 38578371 DOI: 10.1007/s00270-024-03701-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To assess the safety and efficacy of partial splenic embolization (PSE) to reduce the need of transfusions and improve hematologic parameters in patients with hypersplenism and sickle cell disease (SCD). MATERIAL AND METHODS This prospective study includes 35 homozygous hemoglobin S patients with SCD and hypersplenism who underwent PSE from 2015 until 2021 in Kinshasa. Patients were evaluated, before and after PSE (1, 3 and 6 months), using clinical, laboratory and ultrasonographic methods. PSE was performed with the administration of gelatin sponge particles embolizing 60-70% of the splenic parenchyma. RESULTS The mean age was 10 (± 4) years and (21/35, 60%) were male. After PSE Leucocytes decreased at 3 months (16 692.94 vs 13 582.86, p = 0.02) and at six months Erythrocytes increased 2 004 000 vs. 2 804 142 (p < 0.001), Platelets increased (168 147 vs. 308 445, p < 0.001) and Hemoglobin increased (5.05 g/dL vs. 6.31 g/dL, p < 0.001) There was a significant dicrease in the need of transfusions from 6 (2-20) before PSE to 0.06 (0-1) after PSE (p < 0.001). The most frequent complication was splenic rupture (4/35, 11.4%), seen only and in all patients with hypoechogenic nodules at baseline. CONCLUSION PSE is a safe procedure in patients with SCD and hypersplenism, that do not have hypoechogenic nodules in the spleen. PSE improves the hematological parameters and reduces the frequency of blood transfusions.
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Affiliation(s)
- Jacques A Bazeboso
- Department of Radiology (Cliniques Universitaires de Kinshasa), Kinshasa, Institut de Recherche Biomédicale (IRB), Centre de Formation Et d'Appui Sanitaire (CEFA-Monkole), Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Didier Mbuyi Mukendi
- Department of Mathematics, Statistics and Computer Science, Faculty of Sciences and Technology), Institut de Recherche Biomédicale (IRB), Centre de Formation Et d'Appui Sanitaire (CEFA-Monkole), University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Cissé-Luc Mbongo
- Department of Anesthesiology (Clinica Universidad de Navarra), Universidad de Navarra, Pamplona, Spain
| | - Wilfrid Mbombo
- Department of Anesthesiology (Cliniques Universitaires de Kinshasa), Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Michel Lelo Tshikwela
- Department of Radiology (Cliniques Universitaires of Kinshasa), Kinshasa, Democratic Republic of the Congo
| | - Antoine Molua
- Department of Radiology (Cliniques Universitaires of Kinshasa), Kinshasa, Democratic Republic of the Congo
| | - Benjamin Longo
- Department of Internal Medicine-Cardiology, Cliniques Universitaires de Kinshasa), Kinshasa, Democratic Republic of the Congo
| | - Léon Tshilolo
- Institut de Recherche Biomédicale (IRB), Centre de Formation Et d'Appui Sanitaire (CEFA-Monkole), Kinshasa Université Officielle de Mbuji Mayi (UOM), Kinshasa, Democratic Republic of the Congo
| | - José I Bilbao
- Department of Radiology (Clínica Universidad de Navarra), Universidad de Navarra, Pamplona, Spain.
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Trigui A, Toumi N, Bouzid A, Saumtally MS, Akrout A, Trabelsi J, Bouzidi L, Mzali R, Dziri C, Frikha MF, Rejab H, Boujelbene S. Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Systematic Review. CURRENT SURGERY REPORTS 2024; 12:161-172. [DOI: 10.1007/s40137-024-00402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 09/27/2024]
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Blichárová A, Benetinová Z, Mátyás T, Labaj P, Verbóová Ľ, Tancoš V, Nedoroščík A. Peliosis of the spleen as an unusual cause of splenic rupture: A case report and a review of literature. J Forensic Leg Med 2024; 103:102659. [PMID: 38431990 DOI: 10.1016/j.jflm.2024.102659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/01/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
Isolated splenic peliosis is an extremely rare condition characterized by the presence of multiple blood-filled cavities, occasionally resulting in non-traumatic splenic rupture with fatal bleeding. In our case, a 64-year-old man was brought by ambulance due to weakness and abdominal pain without nausea or febrility. On clinical examination, the patient was sensitive to palpation with significant tenderness over the abdomen but no associated features of peritonitis. He collapsed during the imaging examination and became unconscious and asystolic. Cardiopulmonary resuscitation was not successful. The patient died approximately within 2 hours of admission to the hospital. Postmortal examination showed 2800 ml of intraperitoneal blood with clots and a laceration of the lower pole of the spleen. Macroscopic examination of the spleen revealed huge nodular splenomegaly, measuring 21 cm x 19 cm x 5 cm, weighing 755 g. On the cut surfaces, multiple randomly distributed blood-filled cavities ranging from 0,5 to 2 cm in diameter were seen. At microscopic examination, the specimens showed multiple irregular haemorrhagic cyst-like lesions that were not lined by any epithelium or sinusoidal endothelium, consistent with the diagnosis of peliosis lienis. Although the condition is often clinically silent, the forensic pathological significance arises from the differential diagnosis of resultant intraperitoneal haemorrhage and sudden death, mimicking a violent death.
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Affiliation(s)
- Alžbeta Blichárová
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
| | - Zuzana Benetinová
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
| | - Tibor Mátyás
- Forensic Medicine and Pathological Anatomy Workplace in Košice of Health Care Surveillance Authority, Ipeľská 1, 043 74, Košice, Slovakia.
| | - Peter Labaj
- Forensic Medicine and Pathological Anatomy Workplace in Košice of Health Care Surveillance Authority, Ipeľská 1, 043 74, Košice, Slovakia.
| | - Ľudmila Verbóová
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
| | - Vladimír Tancoš
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
| | - Adam Nedoroščík
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
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Xiao M, Liang J, Ren J, Zheng R, Wu L. The imaging features of ectopic spleen: which modality is more consistent? A cases series report and literature reviews. Front Oncol 2024; 14:1310394. [PMID: 38529386 PMCID: PMC10961413 DOI: 10.3389/fonc.2024.1310394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/20/2024] [Indexed: 03/27/2024] Open
Abstract
Ectopic spleen (ES) is a rare condition. It is difficult to diagnose with conventional imaging modalities. In this case series, we presented the imaging features of three misdiagnosed ES cases in our hospital and previously reported cases to compare the consistency of enhancement patterns among different imaging modalities with varied phases. Finally, 22 cases were reviewed. We determined that variable arterial phase enhancement and persistent enhancement throughout the portal and delayed phases are present in contrast-enhanced ultrasound (CEUS) imaging of the ES and found the arterial phase of CEUS had the highest consistency compared with computerized tomography (CT) and magnetic resonance imaging (MRI).
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Affiliation(s)
| | | | | | | | - Lili Wu
- Department of Ultrasound, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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12
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Bakhsh A, Ghandourah H, Alakrawi K, Alsahafi E, Saklou R. Splenic Peliosis as a Rare Cause of Spontaneous Splenic Rupture: A Case Report. Cureus 2024; 16:e55839. [PMID: 38463409 PMCID: PMC10924470 DOI: 10.7759/cureus.55839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 03/12/2024] Open
Abstract
Atraumatic splenic rupture is a serious intraabdominal emergency that requires emergent intervention. This can be due to a number of causes. In this case report, we introduce a rare cause of atraumatic splenic rupture, which is an otherwise benign asymptomatic disease that only manifests clinically upon rupture, namely splenic peliosis. There is limited existing knowledge concerning the disease's etiology and diagnosis; however, this study presents the possible etiological explanations, associated risk factors, and possible radiologic diagnostic modalities.
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Affiliation(s)
- Amal Bakhsh
- Department of Diagnostic Radiology, King Fahad General Hospital, Jeddah, SAU
| | - Hussain Ghandourah
- Department of Diagnostic Radiology, King Fahad General Hospital, Jeddah, SAU
| | - Khatoon Alakrawi
- Department of General Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Eman Alsahafi
- Department of Diagnostic Radiology, King Fahad General Hospital, Jeddah, SAU
| | - Rana Saklou
- Department of Diagnostic Radiology, King Fahad General Hospital, Jeddah, SAU
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13
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Jia G, Dong A, Cheng C, Zuo C. Intense 18 F-PSMA-1007 Uptake of Splenic Hemangioma. Clin Nucl Med 2024; 49:e90-e92. [PMID: 38048527 DOI: 10.1097/rlu.0000000000004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
ABSTRACT A 77-year-old man was referred for 18 F-PSMA-1007 PET/CT scan for initial staging of biopsy-proved prostate adenocarcinoma. 18 F-PSMA-1007 PET/CT showed focal intense 18 F-PSMA-1007 of the prostate adenocarcinoma and a focal intense activity (SUV max , 27) in the spleen. The 18 F-PSMA-1007-avid splenic lesion corresponded to a splenic hemangioma, which was initially detected on contrast-enhanced CT 7 months ago and unchanged in size and enhancement pattern on follow-up contrast-enhanced CT. This case indicates that splenic hemangioma should be included in the differential diagnosis of PSMA-avid splenic lesions.
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Affiliation(s)
- Guorong Jia
- From the Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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14
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Wu Q, Wang M, Zhou M, Miao F, Ni J, Yin Q. Sclerosing Angiomatoid Nodular Transformation of the Spleen: Radiological Findings and Radiological-pathological Correlation. Curr Med Imaging 2024; 20:e260423216201. [PMID: 37170973 DOI: 10.2174/1573405620666230426122828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 05/13/2023]
Abstract
Introduction The objective of this study was to describe the CT and MRI features of sclerosing angiomatoid nodular transformation (SANT) of the spleen with pathologic correlation. Materials and Methods Ten patients with surgically resected and pathologically confirmed SANTs were included. Clinical history was reviewed, and gross pathologic, histologic, and immunohistochemical findings were recorded. CT and MRI examinations were evaluated by two radiologists. Results Patients included seven men and three women, with a mean age of 42.9±16.7 years. Pathologic features of SANTs involved multiple angiomatous nodules in a radiating pattern with a central stellate fibrous scar and evidence of hemosiderin deposition. 9 cases showed a lobulated demarcated margin, 8 cases a slight hypoattenuating, 1 isoattenuating, and 1 case with two lesions demonstrated a slight hyperattenuating margin, respectively. Multiple scattered punctate calcifications were involved in 2 cases. 5 cases manifested hypointensity on in-phase imaging, 1 iso-intensity, and 4 iso-hypointensity on out-of-phase imaging. Progressive and centripetal enhancement were exhibited in 10 cases, spoke-wheel pattern in 3 cases, and nodular enhancement in 4 cases, respectively. The central fibrous scar was identified in 8 cases during delayed enhancement. Conclusion Characteristics of SANTs on CT/MRI reflected the underlying pathology. Hypointensity on DWI and T2WI, and change of signal on T1 chemicalshift imaging were found to be due to hemosiderin deposition and fibrous tissue. Typical feature was a solitary, round, lobulated mass with a fibrous scar. Progressive and centripetal enhancement, spoke-wheel pattern, nodular enhancement, and delayed enhancement of central fibrous scar were observed.
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Affiliation(s)
- Qingyang Wu
- Department of Radiology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Mingliang Wang
- Department of Radiology, ZhongShan Hospital, Fudan University, Shanghai, China
| | - Ming Zhou
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Fei Miao
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianming Ni
- Department of Radiology, The Affiliated Second Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Qihua Yin
- Department of Radiology, Shanghai Pudong New Area People's Hospital, Shanghai, China
- Department of Radiology, The Affiliated Second Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
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15
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Lew C, Dhadlie S, Hussey D, Mayavel N, Skinner S, Wilson K. The first case of a littoral spleen-preserving resection: a case report. J Surg Case Rep 2023; 2023:rjad563. [PMID: 37867921 PMCID: PMC10589073 DOI: 10.1093/jscr/rjad563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023] Open
Abstract
Littoral cell angiomas are uncommon primary splenic haemangiomas with rare malignant potential. We report a case of a 76-year-old male with an incidental solitary littoral cell angioma found within an accessory spleen. We provide an overview of the literature of littoral cell angiomas and highlight the diagnostic challenge and treatment of this important differential for general surgeons caring for patients with splenic masses. This is the first case to describe primary resection of a littoral cell angioma with splenic preservation.
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Affiliation(s)
- Chen Lew
- Department of General Surgery, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Sunny Dhadlie
- Department of General Surgery, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Daniel Hussey
- Department of Anatomical Pathology, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Naveen Mayavel
- Department of General Surgery, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Stewart Skinner
- Department of General Surgery, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Kasmira Wilson
- Department of General Surgery, The Alfred Hospital, Melbourne, VIC 3004, Australia
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16
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Raja F, Kumar V, Moll E, Hammad A, Ayub S. Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Report of Rare Case and Literature Review. Cureus 2023; 15:e45422. [PMID: 37854759 PMCID: PMC10581663 DOI: 10.7759/cureus.45422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a benign vascular lesion of the spleen with uncertain etiology. It predominantly affects women between the ages of 30 and 60 years. Clinically, it is asymptomatic or can cause abdominal pain, but usually discovered incidentally on imaging, which can identify a mass but may not provide a definitive diagnosis. In uncertain vascular lesions, there is always a risk of spontaneous rupture of large vessels and the potential for spreading malignancy. Hence, the final diagnosis is rendered on microscopy after splenectomy. A middle-aged female came to the clinic complaining of abdominal pain. Radiology showed a solid splenic mass and the patient underwent splenectomy. Gross examination showed a 3 cm white firm mass with focal hemorrhage. Microscopy revealed multiple nodules of variable sizes surrounded by fibrosclerotic stroma. The nodules showed round to slit-like vascular spaces with numerous red blood cells. The internodular stroma consisted of dense fibrous tissue with scattered plump myofibroblasts and lymphoplasmacytic inflammatory cells. These distinctive features lead to the diagnosis of SANT. SANT possesses characteristic histologic features with distinctive immunohistochemistry (IHC). IHC reveals three different types of vessels within the nodules as follows: (1) small veins (CD34-, CD31+, CD8-), (2) sinusoids (CD34-, CD31+, CD8+), and (3) capillaries (CD34+, CD31+, CD8-). All three types of vessels are negative for CD21/CD35 and CD68. Hemangioma and littoral cell angioma are two frequent vascular tumors in the spleen that should be considered differential diagnoses. Both lesions lack the microscopic features of SANT and have only a single type of vessel. The vessels in hemangioma are (CD31+, CD34+, CD8-), while in littoral cell angioma they are (CD31+, CD34-, CD8-, CD21+, CD68+). There are no specific clinical or radiologic findings for SANT. It is important to recognize these characteristic features and to differentiate them from other benign and malignant lesions, such as angiosarcoma. A thorough histopathologic examination and IHC are helpful in making the correct diagnosis.
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Affiliation(s)
- Fnu Raja
- Pathology, MetroHealth Medical Center, Cleveland, USA
| | - Vinesh Kumar
- Pathology, MetroHealth Medical Center, Cleveland, USA
| | - Eric Moll
- Pathology, MetroHealth Medical Center, Cleveland, USA
| | - Azzam Hammad
- Pathology, MetroHealth Medical Center, Cleveland, USA
| | - Salman Ayub
- Pathology, Metrohealth Medical Center, Cleveland, USA
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17
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Slack JC, Putra J, Callahan MJ, Church AJ, Teot LA, Eng W, Perez-Atayde AR. Splenic Lymphatic Malformation With Papillary Endothelial Proliferation: A Rare Histologic Variant or a Unique Entity? Am J Surg Pathol 2023; 47:915-925. [PMID: 37334821 DOI: 10.1097/pas.0000000000002070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Lymphatic malformations (LMs) are congenital anomalies of the lymphatic system due to abnormalities that occur during the development of the lymphovascular system. Also known as lymphangiomas, they are usually multifocal, affect multiple organ systems, and are seen in a variety of developmental or overgrowth syndromes. Splenic lymphangiomas are uncommon and usually occur in the context of multiorgan lymphangiomatosis. Within the spleen, 7 prior cases have been reported of LMs with unusual papillary endothelial proliferations (PEPs), which can mimic more aggressive splenic lymphovascular tumors. It is not currently known if splenic LM-PEP represents a unique entity, or is simply an unusual, site-specific, morphologic variant of LM. To address this question, we conducted a retrospective, single-institutional review of this rare entity and systematically evaluated its clinical, histologic, radiologic, electron microscopical, and molecular features. In all 3 splenic LM-PEPs, the clinical course was benign, imaging demonstrated subcapsular lesions with characteristic "spoke-and-wheel" appearance, histology showed distinctive PEPs within lymphatic microcysts, immunohistochemistry confirmed a lymphatic endothelial phenotype and electron microscopy demonstrated lesional endothelial cells, rich in mitochondria and intermediate filaments with prominent cytoplasmic lumina and vacuoles and lacking Weibel-Palade granules. Occasional lymphothelial cells were situated within the cytoplasm of another lesional cell, appearing to be engulfed. Next-generation sequencing identified a PIK3CA mutation in 1 patient, while in 2 others no molecular alterations were identified. We conclude with a summary of all prior published cases and discuss key diagnostic elements that distinguish this benign entity from its more aggressive mimickers.
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Affiliation(s)
| | | | | | | | | | - Whitney Eng
- Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
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18
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Soleimani N, Pouraminaee F, Anbardar MH, Bahador A, Rahimi B, Mohammadzadeh S, Aghakhaninejad F, Farahmand M, Hasani M. Splenic Lymphangioma Mimicking Lymphomatous Involvement: A Case Report with Review of the Literature. Case Rep Med 2023; 2023:9969213. [PMID: 37383046 PMCID: PMC10299890 DOI: 10.1155/2023/9969213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023] Open
Abstract
Lymphangioma is a benign malformation of lymphatic vessels usually found in the head and neck areas or axilla. They may involve visceral organs with a lower percentage. Splenic lymphangioma is a rare tumor. This disease is often seen in children but may be diagnosed incidentally in adults. Most patients are asymptomatic, but in large and multifocal lesions, the patient may have some nonspecific symptoms such as abdominal pain, abdominal distention, nausea, vomiting, and loss of appetite. Physical examination may show no specific findings or detect palpable masses. The preoperative diagnosis of splenic lymphangioma is challenging. Histopathological evaluation and sometimes immunohistochemistry tests can result in a definitive diagnosis. In this study, we present an 18-year-old man, with Burkitt's lymphoma who underwent laparotomy and total splenectomy as a result of cystic lesions discovered accidentally during imaging with the final diagnosis of splenic lymphangioma after histopathological evaluation.
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Affiliation(s)
- Neda Soleimani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Pouraminaee
- Pathology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Anbardar
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Bahador
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Benyamin Rahimi
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahand Mohammadzadeh
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Aghakhaninejad
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Farahmand
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Hasani
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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19
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Gourtsoyianni S, Laniado M, Ros-Mendoza L, Mansueto G, Zamboni GA. The Spectrum of Solitary Benign Splenic Lesions-Imaging Clues for a Noninvasive Diagnosis. Diagnostics (Basel) 2023; 13:2120. [PMID: 37371015 DOI: 10.3390/diagnostics13122120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/03/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Cross-sectional imaging of the upper abdomen, especially if intravenous contrast has been administered, will most likely reveal any acute or chronic disease harbored in the spleen. Unless imaging is performed with the specific purpose of evaluating the spleen or characterizing a known splenic lesion, incidentally discovered splenic lesions pose a small challenge. Solitary benign splenic lesions include cysts, hemangiomas, sclerosing angiomatous nodular transformation (SANT), hamartomas, and abscesses, among others. Sarcoidosis and tuberculosis, although predominantly diffuse micronodular disease processes, may also present as a solitary splenic mass lesion. In addition, infarction and rupture, both traumatic and spontaneous, may take place in the spleen. This review aims to describe the imaging features of the most common benign focal splenic lesions, with emphasis on the imaging findings as these are encountered on routine cross-sectional imaging from a multicenter pool of cases that, coupled with clinical information, can allow a definite diagnosis.
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Affiliation(s)
- Sofia Gourtsoyianni
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Ave., 11528 Athens, Greece
| | - Michael Laniado
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Luis Ros-Mendoza
- Department of Radiology, Miguel Servet University Hospital, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - Giancarlo Mansueto
- Istituto di Radiologia, DAI Patologia e Diagnostica, Policlinico GB Rossi, AOUI Verona, 37134 Verona, Italy
| | - Giulia A Zamboni
- Istituto di Radiologia, DAI Patologia e Diagnostica, Policlinico GB Rossi, AOUI Verona, 37134 Verona, Italy
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20
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Zhu B, Yoon E, Mahajan S, Kranz AO. False-Positive Uptake in Splenic Hemangioma on 68 Ga-DOTATATE PET/CT. Clin Nucl Med 2023; 48:518-519. [PMID: 37075248 DOI: 10.1097/rlu.0000000000004626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
ABSTRACT Somatostatin receptor imaging using 68 Ga-DOTATATE PET is widely popular for evaluation of neuroendocrine tumors. 68 Ga-DOTATATE PET/CT shows highest physiologic uptake in spleen followed by other organs such as kidneys, adrenal glands, and liver. Hemangiomas, although rare, are the most common primary benign neoplasm of the spleen, composed of endothelial-lined vascular channels. We present a case of 77-year-old man who underwent 68 Ga-DOTATATE PET/CT scan for evaluation of pancreatic neuroendocrine tumor and incidentally demonstrated intense radiotracer uptake in splenic hemangiomata.
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Affiliation(s)
- Brian Zhu
- From the Department of Radiology, New York University Long Island School of Medicine, Mineola
| | - Emily Yoon
- From the Department of Radiology, New York University Long Island School of Medicine, Mineola
| | - Sonia Mahajan
- Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Anca-Oana Kranz
- From the Department of Radiology, New York University Long Island School of Medicine, Mineola
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21
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Jang YS, Kim SS, Shin HC, Choi SY, Park CH, Lee HN, Kim SY, Park H, Kim YT. Various congenital anomalies and anatomical variations of the spleen: a multimodality pictorial review. Abdom Radiol (NY) 2023; 48:1505-1513. [PMID: 36790453 DOI: 10.1007/s00261-023-03826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/16/2023]
Abstract
There are various congenital anomalies and anatomical variations of the spleen (CAAVS). CAAVS are common and are often associated with systemic anomalies. Widespread use of computed tomography and magnetic resonance imaging in a variety of clinical situations has increased the detection of CAAVS. However, CAAVS are frequently overlooked and are occasionally misdiagnosed as pathologic disease entities. This article aimed to review the various manifestations of CAAVS with radiologic findings.
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Affiliation(s)
- Young Sil Jang
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Seung Soo Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea.
| | - Hyeong Cheol Shin
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon-si, Republic of Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Shin Young Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Hyerim Park
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Young Tong Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
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22
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Damouny M, Mansour S, Khuri S. Primary Angiosarcoma of the Spleen: An Aggressive Neoplasm. World J Oncol 2022; 13:337-342. [PMID: 36660212 PMCID: PMC9822683 DOI: 10.14740/wjon1542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 12/25/2022] Open
Abstract
Primary tumors of the spleen are rare, with an incidence rate of about 0.1%. These tumors could be benign, usually asymptomatic, or malignant which are usually symptomatic with abdominal pain being the most common symptom. Lymphoid neoplasms are the most common primary splenic tumors. Primary angiosarcoma is one of the extremely rare malignant vascular neoplasms of the spleen, which carries a dismal prognosis. It constitutes almost 7.4% of all primary malignant splenic neoplasms and is well known as an aggressive tumor with high local recurrence and distant metastasis rates. Overall survival is up to 12 months following diagnosis, regardless of management strategy. Due to the broad differential diagnosis of splenic tumors, this tumor is often forgotten, and is very challenging to diagnose early. Less than 300 cases of primary splenic angiosarcoma have been reported in the English literature. The main issue of this article is to review the current English literature to figure out the characteristic demographic features, clinical presentation, imaging findings and management of such tumors, in order to increase awareness of the treating physicians to improve diagnosis, management, as well as overall survival.
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Affiliation(s)
- Mira Damouny
- General Surgery Department, Rambam Medical Center, Haifa, Israel
| | - Subhi Mansour
- General Surgery Department, Rambam Medical Center, Haifa, Israel
| | - Safi Khuri
- General Surgery Department, Rambam Medical Center, Haifa, Israel
- HPB and Surgical Oncology Unit, Rambam Medical Center, Haifa, Israel
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23
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Arcuri PP, Taglianetti S, Vavalà B, Battaglia C, Laganà D, Manti F. Incidental littoral cell angioma of the spleen: cross-sectional imaging findings and review of the literature. Radiol Case Rep 2022; 17:3545-3550. [PMID: 35923330 PMCID: PMC9340147 DOI: 10.1016/j.radcr.2022.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Littoral cell angioma (LCA) is a primary splenic hemangioma found mostly in normal red sinus shore cells of the reticuloendothelial cell system of the spleen. In most cases is benign, but sometimes malignancies have been reported. This tumor displayed epithelial and histiocytic properties based on its cell of origin, splenic littoral cells. In this case report, we will describe a case of a 21-year-male presenting with an incidentally discovered LCA illustrated by cross-sectional imaging techniques, highlighting how the diffusional sequence and the positron emission tomography study, thanks to their greater specificity, have contributed to reaching a correct diagnostic orientation more than dynamic studies with contrast agent in both computed tomography and magnetic resonance.
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24
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Lymphangiomatosis of spleen, fallopian tube and abdominal wall associated with mucinous cystadenoma of the right ovary. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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25
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Xu SY, Zhou B, Wei SM, Zhao YN, Yan S. Successful treatment of pancreatic accessory splenic hamartoma by laparoscopic spleen-preserving distal pancreatectomy: A case report. World J Gastrointest Oncol 2022; 14:1057-1064. [PMID: 35646283 PMCID: PMC9124993 DOI: 10.4251/wjgo.v14.i5.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/26/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic accessory spleen (PAS) is an uncommon congenital abnormality of the spleen. Spleen hamartoma (SH) is also rare. Moreover, hamartoma in the PAS has not been reported thus far. We report the first case here.
CASE SUMMARY A 26-year-old male presented with a one-month history of left upper quadrant abdominal pain, and computerized tomography (CT) examination suggested a mass in the pancreas tail. The patient then attended our hospital for diagnosis and treatment. Ultrasonography, CT, and magnetic resonance imaging revealed a solid mass with cystic degeneration growing from the tail of the pancreas. The tumor marker carbohydrate antigen 19-9 (CA19-9) increased to 96.7 U/mL (normal range 0-37 U/mL). An epidermoid cyst in a PAS was considered preoperatively. However, a malignant tumor cannot be ruled out. We performed laparoscopic surgery, and two pancreatic masses were found growing from the pancreatic tail. The two masses were so closely connected that preoperative imaging examinations suggested only one mass. We carefully isolated the masses from the splenic artery and vein. A laparoscopic spleen-preserving distal pancreatectomy was successfully performed. On pathological examination, the masses were well-defined, homogeneous red-tan, 4 × 3, and 4.5 × 1.5 in size, respectively. One of them was cystically degenerated. On microscopical examination, the mass contained unorganized small slit-like vascular channels enclosing red blood cells and lined with plump endothelial cells. No area of cytologic atypia was identified. Focal lymphoid aggregates were found in the intravascular areas. White pulp or fibrosis was not observed. The final diagnosis was pancreatic accessory SH with cystic degeneration. After the operation, CA19-9 was reduced to normal. The patient recovered well, and the 34-mo follow-up period was uneventful.
CONCLUSION Here, we report the first case of pancreatic accessory SH. A laparoscopic spleen-preserving distal pancreatectomy was successfully performed. The patient recovered well and had a good prognosis.
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Affiliation(s)
- Shao-Yan Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Bo Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Shu-Mei Wei
- Department of Pathology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Ya-Nan Zhao
- Department of Ultrasound, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Sheng Yan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
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26
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Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Diagnostic Conundrum. J Belg Soc Radiol 2022; 106:12. [PMID: 35480339 PMCID: PMC8992766 DOI: 10.5334/jbsr.2689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
A splenic lesion often represents a diagnostic challenge due to relative scarcity and the broad differential diagnosis. Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen is usually encountered only incidentally. Although benign, patients with SANT often receive splenectomy, due to its rarity, diagnostic uncertainty and sometimes intimidating imaging morphology and size. Imaging features on computed tomography, magnetic resonance and positron emission tomography have a high diagnostic value for SANT and help differentiate this entity from other splenic lesions. When the imaging parameters are matched with core needle biopsy tissue analysis, further watchful waiting can be recommended in order to avoid splenectomy.
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27
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Hiyama K, Kirino I, Fukui Y, Terashima H. Two cases of splenic neoplasms with differing imaging findings that required laparoscopic resection for a definitive diagnosis. Int J Surg Case Rep 2022; 93:107023. [PMID: 35477212 PMCID: PMC9052252 DOI: 10.1016/j.ijscr.2022.107023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Splenic tumors are rare and are sometimes found incidentally. In such cases, laboratory tests and imaging studies should be performed based on the diagnostic algorithm to determine whether the tumor is benign or malignant. However, we clinicians sometimes encounter challenging cases. Herein we experienced two challenging cases of splenic tumor which we could not correctly diagnosis preoperatively. Case presentation Case 1: A female in her 80s presented to our surgical department to undergo follow-up examinations for Stage IIIa ascending colon cancer. A follow-up CT scan showed marked enlargement of the splenic tumor which suggested metastatic cancer. We performed laparoscopic splenectomy. Case 2: A healthy female in her 50s presented to our internal medicine department to undergo a workup after multiple splenic tumors. A follow-up CT scan showed that the tumors had grown slightly. We could not completely rule out a malignant tumor. She rejected further follow-up study and chose splenectomy. Clinical discussion We experienced two cases of splenic hemangioma with different clinical presentations and imaging findings. Although some studies have reported that biopsying a splenic tumor is a safe and effective way of distinguishing among splenic tumors, in our country splenic biopsies are seldom performed due to fears of causing intraabdominal bleeding or tumor dissemination. Clinicians should consider whether it would be better to perform follow up with a biopsy or splenectomy as a definitive treatment on a case-by-case basis. Conclusion Laparoscopic splenectomy can be used for definitive management in cases involving malignancy or an uncertain etiology.
Splenic tumors are sometimes challenging to be correctly diagnosed. We should recognize a diagnostic algorithm, but not always applicable. Clinicians should choose follow-up or splenectomy on a case-by-case basis. Splenectomy is the definitive management of malignancy or an uncertain etiology.
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Affiliation(s)
| | - Izumi Kirino
- Department of Surgery, Atago Hospital, Kochi, Japan
| | - Yasuo Fukui
- Department of Surgery, Atago Hospital, Kochi, Japan
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28
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Choi G, Kim KA, Lee J, Park YS, Lee J, Choi JW, Lee CH. Ultrasonographic atlas of splenic lesions. Ultrasonography 2022; 41:416-429. [PMID: 35045593 PMCID: PMC8942726 DOI: 10.14366/usg.21189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/02/2021] [Indexed: 11/03/2022] Open
Abstract
Ultrasonography (US) is widely used for abdominal imaging. Its noninvasiveness, extensive range of application, and low cost make US a useful and valuable tool for the detection, diagnosis, and follow-up of splenic abnormalities. Concomitantly with the increasing frequency of imaging, more splenic lesions are being discovered and the requirements for the differential diagnosis are rising. In this pictorial essay, we introduce the representative US findings of many different splenic lesions, including normal sonographic findings, normal variants and congenital anomalies, infectious conditions, benign and malignant neoplasms, and non-neoplastic lesions. Knowledge of the US features of various splenic lesions will help narrow the differential diagnosis and guide clinical decision-making.
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Affiliation(s)
- Gayoung Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.,Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jinhwan Lee
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang-Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Pan D, Li TP, Xiong JH, Wang SB, Chen YX, Li JF, Xiao Q. Treatment with sorafenib plus camrelizumab after splenectomy for primary splenic angiosarcoma with liver metastasis: A case report and literature review. World J Clin Cases 2022; 10:2818-2828. [PMID: 35434106 PMCID: PMC8968800 DOI: 10.12998/wjcc.v10.i9.2818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/04/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary splenic angiosarcoma (PSA) is an extremely rare and aggressive mesenchymal malignancy with high metastatic potential and a poor prognosis. There are no established treatment guidelines for PSA, even for adjuvant therapy. This rare case may provide a reliable therapeutic regime for a better prognosis.
CASE SUMMARY A 49-year-old female who complained of right-upper quadrant abdominal pain was diagnosed as having PSA with splenic rupture and liver metastasis. After splenectomy and liver tumor resection, she received sorafenib and camrelizumab therapy. After 15 mo of follow-up, she is in good condition, without recurrence or any identified metastasis.
CONCLUSION Immunotherapy combined with targeted therapy could be a potential option for the adjuvant therapy of PSA.
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Affiliation(s)
- Dan Pan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Tai-Ping Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jian-Hui Xiong
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Shu-Bo Wang
- The Medical Department, 3D Medicines Inc., Shanghai 201114, Shanghai Province, China
| | - Yao-Xu Chen
- The Medical Department, 3D Medicines Inc., Shanghai 201114, Shanghai Province, China
| | - Jian-Feng Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Qi Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Malgras B, Najah H, Dohan A, Barat M, Soyer P. Diagnosis and treatment of focal splenic lesions. J Visc Surg 2022; 159:121-135. [DOI: 10.1016/j.jviscsurg.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sabra TA, Maher A, AlRashidi R, Ibrahim H. A splenic hamartoma: Adding a new case to the literature: A case report. Int J Surg Case Rep 2022; 90:106647. [PMID: 34979425 PMCID: PMC8732791 DOI: 10.1016/j.ijscr.2021.106647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/21/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Splenic tumours are relatively rare and include malignancies such as lymphomas, angiosarcomas, plasmacytomas, primary malignant fibrous histiocytomas, and splenic metastases. Benign tumours of the spleen such as hemangiomas, cysts, and inflammatory pseudotumours are very rare (Kaza et al., 2010, PisaniCeretti et al., 2012) [1], [2]. There are fewer than 160 cases of splenic hamartoma or splenomas having been reported in the literature (Basso et al., 2012) [3]. Only 20% of the cases were detected in children (Abramowsky et al., 2004) [4]. Although multi-modality imaging findings were described preoperatively, the final diagnosis was splenic hamartoma based on histology and immunohistochemistry. Case report Here, we report a case of a14 year old child left upper quadrant abdominal pain and worsening sickness. Multi-modality imaging detected a solid lesion of the spleen, who required splenectomy and was pathologically diagnosed as a splenic hamartoma. The postoperative course was uneventful. Discussion Splenic hamartoma is very rare. Only 20% of hamartomas occur in children. They are commonly found incidentally on imaging with no symptoms. Conclusion Splenic hamartoma is a benign vascular proliferative lesion that requires a multi-modality imaging studies for diagnosis and confirmed by histopathology. It must be included in the differential diagnosis of splenic mass forming lesions.
There are fewer than 160 cases of splenic hamartoma having been reported in the literature. Only 20% of the cases were detected in children. Although imaging findings were described preoperatively, the final diagnosis was splenic hamartoma based on histology. We report a case of solid lesion of the spleen, who required splenectomy and was pathologically diagnosed as splenic hamartomas.
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Affiliation(s)
| | - Ahmed Maher
- Pediatric surgery unit, Assiut university children hospital, Assiut, Egypt
| | | | - Hussein Ibrahim
- Pediatric surgery unit, Assiut university children hospital, Assiut, Egypt
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Wang MX, Segaran N, Bhalla S, Pickhardt PJ, Lubner MG, Katabathina VS, Ganeshan D. Tuberous Sclerosis: Current Update. Radiographics 2021; 41:1992-2010. [PMID: 34534018 DOI: 10.1148/rg.2021210103] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tuberous sclerosis complex (TSC) is a relatively rare autosomal dominant neurocutaneous disorder secondary to mutations in the TSC1 or TSC2 tumor suppressor genes. Although manifestation of the classic triad of seizures, intellectual disability, and facial angiofibromas may facilitate timely diagnosis of TSC, the multisystem features that may indicate TSC in the absence of these manifestations remain highly variable. In addition, patients with TSC are at risk of developing multiple benign and malignant tumors in various organ systems, resulting in increased morbidity and mortality. Thus, imaging plays a critical role in diagnosis, surveillance, and management of patients with TSC. It is crucial that radiologists be familiar with TSC and the various associated imaging features to avoid a delayed or incorrect diagnosis. Key manifestations include cortical dysplasias, subependymal nodules, subependymal giant cell astrocytomas, cardiac rhabdomyomas, lymphangioleiomyomatosis, and angiomyolipomas. Renal angiomyolipomas in particular can manifest with imaging features that mimic renal malignancy and pose a diagnostic dilemma. Other manifestations include dermatologic and ophthalmic manifestations, renal cysts, renal cell carcinomas, multifocal micronodular pneumocyte hyperplasia, splenic hamartomas, and other rare tumors such as perivascular epithelioid tumors. In addition to using imaging and clinical features to confirm the diagnosis, genetic testing can be performed. In this article, the molecular pathogenesis, clinical manifestations, and imaging features of TSC are reviewed. Current recommendations for management and surveillance of TSC are discussed as well. ©RSNA, 2021.
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Affiliation(s)
- Mindy X Wang
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Nicole Segaran
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Sanjeev Bhalla
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Perry J Pickhardt
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Meghan G Lubner
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Venkata S Katabathina
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Dhakshinamoorthy Ganeshan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
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Franke D, Anupindi SA, Barnewolt CE, Green TG, Greer MLC, Harkanyi Z, Lorenz N, McCarville MB, Mentzel HJ, Ntoulia A, Squires JH. Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children. Pediatr Radiol 2021; 51:2229-2252. [PMID: 34431006 DOI: 10.1007/s00247-021-05131-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
Gray-scale and color/power Doppler ultrasound (US) are the first-line imaging modalities to evaluate the spleen, gallbladder and pancreas in children. The increasing use of contrast-enhanced ultrasound (CEUS) as a reliable and safe method to evaluate liver lesions in the pediatric population promises potential for imaging other internal organs. Although CEUS applications of the spleen, gallbladder and pancreas have been well described in adults, they have not been fully explored in children. In this manuscript, we present an overview of the applications of CEUS for normal variants and diseases affecting the spleen, gallbladder and pancreas. We highlight a variety of cases as examples of how CEUS can serve in the diagnosis and follow-up for such diseases in children. Our discussion includes specific examination techniques; presentation of the main imaging findings in various benign and malignant lesions of the spleen, gallbladder and pancreas in children; and acknowledgment of the limitations of CEUS for these organs.
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Affiliation(s)
- Doris Franke
- Department of Pediatric Kidney, Liver and Metabolic Diseases, MHH, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Thomas G Green
- Department of Radiology, Crouse Hospital, Syracuse, NY, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Norbert Lorenz
- Children's Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy H Squires
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Karaosmanoglu AD, Uysal A, Onder O, Hahn PF, Akata D, Ozmen MN, Karcaaltıncaba M. Cross-sectional imaging findings of splenic infections: is differential diagnosis possible? Abdom Radiol (NY) 2021; 46:4828-4852. [PMID: 34047800 PMCID: PMC8160561 DOI: 10.1007/s00261-021-03130-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 01/31/2023]
Abstract
The spleen plays an important role in the immunological homeostasis of the body. Several neoplastic and non-neoplastic diseases may affect this organ, and imaging is of fundamental importance for diagnosis. Infectious diseases of the spleen can be encountered in daily radiology practice, and differential diagnosis may sometimes be challenging. Infectious involvement of the spleen can be primary or secondary to a different source outside the spleen. Despite the fact that different infectious diseases may cause similar imaging findings, we believe that differential diagnosis between different causes may also be possible in certain patients with imaging. Early diagnosis may potentially enhance patients’ treatment and outcome. In this review, we aimed to increase imaging specialists’ awareness of splenic infections by describing the multimodality imaging features of common and atypical infections of the spleen with their differential diagnoses.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, Ankara, 06010, Turkey
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
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35
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Trenker C, Görg C, Freeman S, Jenssen C, Dong Y, Caraiani C, Ioanițescu ES, Dietrich CF. WFUMB Position Paper-Incidental Findings, How to Manage: Spleen. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2017-2032. [PMID: 34052061 DOI: 10.1016/j.ultrasmedbio.2021.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.
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Affiliation(s)
- Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse, Marburg, Germany
| | - Christian Görg
- Department of gastroenterology, Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstrasse Marburg, Germany
| | - Simon Freeman
- University Hospitals Plymouth, Imaging Directorate, Derriford Hospital, Plymouth, United Kingdom
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH Strausberg/Wriezen, Akademisches Lehrkrankenhaus Medizinische Hochschule Brandenburg "Theodor Fontane", Germany; Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena Simona Ioanițescu
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Center of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
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Ozkale Yavuz O, Ozcan HN, Oguz B, Ayaz E, Ekinci S, Ciftci TT, Haliloglu M. Imaging findings of benign and malignant pediatric splenic lesions. Abdom Radiol (NY) 2021; 46:3245-3252. [PMID: 33661318 DOI: 10.1007/s00261-021-03004-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 02/06/2023]
Abstract
Splenic lesions in children have a wide histological spectrum. The majority of pediatric splenic lesions are benign and detected incidentally, and the most common benign lesions are cysts, followed by hemangiomas and lymphatic malformations. Most of the splenic malignancies in children are secondary to leukemia or lymphoma. The purpose of this article is to describe the ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) features of benign and malignant splenic lesions in the pediatric age group.
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Affiliation(s)
- Ozlem Ozkale Yavuz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey.
- Division of Pediatric Radiology, Department of Radiology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Hatice Nursun Ozcan
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
| | - Berna Oguz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
| | - Ercan Ayaz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
- Department of Radiology, Diyarbakır Children Hospital, Diyarbakır, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
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Incidental Splenic Findings on Cross-Sectional Imaging. Radiol Clin North Am 2021; 59:603-616. [PMID: 34053608 DOI: 10.1016/j.rcl.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Incidental splenic focal findings are commonly encountered in clinical practice and frequently represent a diagnostic dilemma due to nonspecific imaging features. Most are benign, particularly in patients without a history of malignancy and without symptoms of fever, weight loss, or left upper quadrant or epigastric pain. Incidental malignant splenic processes are exceedingly rare. This article reviews imaging characteristics of incidental focal splenic findings, and proposes a practical approach for management of such findings, which can prevent unnecessary workup and its related drawbacks in clinical practice.
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Mirali H, Kamaoui I, Aichouni N, Nasri S, Skiker I. Diffuse Capillary Spleen Hemangiomatosis: A Rare Cause of Hepatic Dysmorphia. Cureus 2021; 13:e15320. [PMID: 34221769 PMCID: PMC8238496 DOI: 10.7759/cureus.15320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Spleen hemangiomatosis is the most common type of benign vascular tumor, and it is usually associated with other visceral localizations such as the liver, lymph nodes, skin, and bone marrow. The diffuse form of this condition is defined by the number of locations in one organ. We report the case of a 48-year-old female who sought consultation for left hypochondrium chronic pain. Physical examination subsequently revealed splenomegaly. Imaging showed a diffuse capillary spleen hemangiomatosis, hepatic dysmorphia, and several signs of portal hypertension.
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Affiliation(s)
- Houda Mirali
- Radiology, University Hospital Mohammed VI, Oujda, MAR
| | - Imane Kamaoui
- Radiology, University Hospital Mohammed VI, Oujda, MAR
| | | | - Siham Nasri
- Radiology, Centre Hospitalier Universitaire Mohammed VI, Oujda, MAR
| | - Imane Skiker
- Radiology, University Hospital Mohammed VI, Oujda, MAR
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Li WW, Liang P, Zhao HP, Zhang YX, Liu YY, Gao JB. Composite hemangioendothelioma of the spleen with multiple metastases: CT findings and review of the literature. Medicine (Baltimore) 2021; 100:e25846. [PMID: 34032697 PMCID: PMC8154451 DOI: 10.1097/md.0000000000025846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 04/18/2021] [Indexed: 01/04/2023] Open
Abstract
Composite hemangioendothelioma (CHE) is a rare vascular neoplasm of intermediate malignant potential. Only 52 cases have been reported in the English literature, and one case previously reported occurred in the spleen. The purpose of our study was to report a 65-year-old man diagnosed as CHE primary arising from the spleen with multiple metastases.Clinical and imaging features, laboratory tests, and pathological results about CHE were described in detail in this study.The patient presented with multiple lesions in bilateral lungs and spleen that had been incidentally detected by computed tomography (CT). Except for thrombocytopenia, other laboratory tests were not significant. The CT scan of the abdomen revealed multiple round-like and irregularly mixed density masses with unclear borders in enlarged spleen. And contrast enhancement showed mild heterogeneous enhancement. CT scan also showed widespread liver, ribs, lungs, and vertebral bodies metastases. This diagnosis was confirmed by histopathological examination. The patient underwent splenectomy and still survives with tumors after six months followed-up.Due to the lack of specificity of clinical features and laboratory tests, it is necessary to combine imaging features and pathological findings to make a correct diagnosis.
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Affiliation(s)
- Wei wei Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Hui ping Zhao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Yan xing Zhang
- Department of Cardiology, The People's Hospital of HEBI, Hebi, Henan Province, China
| | - Yi yang Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Jian bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
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Barat M, Hoeffel C, Aissaoui M, Dohan A, Oudjit A, Dautry R, Paisant A, Malgras B, Cottereau AS, Soyer P. Focal splenic lesions: Imaging spectrum of diseases on CT, MRI and PET/CT. Diagn Interv Imaging 2021; 102:501-513. [PMID: 33965354 DOI: 10.1016/j.diii.2021.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/12/2022]
Abstract
The spleen can be affected by a variety of diseases. Some of them are readily identified as variations of normal or benign diseases on imaging. However, for a substantial number of focal splenic abnormalities, the diagnosis can be difficult so that histopathologic analysis may be required for a definite diagnosis. In this review, the typical splenic abnormalities that can be diagnosed with imaging with a high degree of confidence are illustrated. The complementary role of computed tomography (CT), magnetic resonance imaging and positron emission tomography/CT that helps make a diagnostic approach is discussed. Finally, current applications and future trends of radiomics and artificial intelligence for the diagnosis of splenic diseases are addressed.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France.
| | - Christine Hoeffel
- Department of Radiology, Reims University Hospital, 51092 Reims, France; CRESTIC, University of Reims Champagne-Ardenne, 51100 Reims, France
| | | | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Amar Oudjit
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Raphael Dautry
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Anita Paisant
- Department of Radiology, University Hospital of Angers, 49100 Angers, France; Faculté de Médecine, Université d'Angers, 49045 Angers, France
| | - Brice Malgras
- Department of Digestive and Endocrine Surgery, Bégin Army Training hospital, 94160 Saint-Mandé, France; École du Val-de-Grâce, 75005 Paris, France
| | - Anne-Ségolène Cottereau
- Université de Paris, 75006 Paris, France; Department of Nuclear Medicine, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
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Yang R, Lu Q, Xu J, Huang J, Gao B, Zhang H, Zhou J, Du L, Yan F. Value of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Focal Splenic Lesions. Cancer Manag Res 2021; 13:2947-2958. [PMID: 33833578 PMCID: PMC8021137 DOI: 10.2147/cmar.s300601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/08/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To identify and validate contrast-enhanced ultrasound (CEUS) features for differentiating malignant from benign splenic lesions. PATIENTS AND METHODS Splenic lesions in 123 patients who underwent conventional ultrasound (B-mode US) and CEUS were included in this study. Two radiologists evaluated the sonograms of B-mode and CEUS. Statistical analysis was performed to identify significant imaging predictors for splenic malignant lesions. Two other radiologists independently reviewed B-mode and CEUS sonograms and diagnosed the lesions based on proposed criteria as 1) benign, 2) probably benign, 3) probably malignant or 4) malignant. The diagnostic efficiency between B-mode US and CEUS was compared. RESULTS Common imaging findings of malignant lesions included hypoechoic, ill-defined margin, absence of cystic/necrotic portion, presence of splenomegaly on B-mode US, and hypoenhancement, rapid washout and presence of intralesional vessels on CEUS (P < 0.05). Among them, three independent features were identified using multivariate logistic regression analysis: hypoechoic pattern, hypoenhancement pattern and intralesional vessels. When three of these findings were combined as a predictor for splenic malignant lesions, 22 (55.0%) of 40 malignant splenic lesions were identified with a specificity of 100%. The diagnostic performance of two readers using receiver operating characteristic curve analysis was 0.622 and 0.533, respectively, for B-mode US, which was significantly improved to 0.908 and 0.906 for CEUS (P < 0.001). The degree of other diagnostic efficiency and inter-reader agreement also increased with CEUS compared to B-mode US. CONCLUSION CEUS may provide more useful information than B-mode US and improve the diagnosis efficiency for distinguishing malignant from benign splenic lesions.
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Affiliation(s)
- Rui Yang
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Qiang Lu
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jinshun Xu
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jiayan Huang
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Binyang Gao
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Huan Zhang
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Jie Zhou
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Lanxin Du
- Ultrasound Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Feng Yan
- Laboratory of Ultrasound Imaging, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Nadeem M, Tiwari HA, Jambhekar K, Shah H, Ram R. Revisiting the Spleen—An Imaging Review of the Common and Uncommon Splenic Pathology. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1721626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractThe spleen is the largest lymphatic organ and is responsible for both hematological and immunological functions. Several common etiologies such as trauma, developmental variants, infectious/inflammatory conditions, and benign and malignant lesions can occur in the spleen. The role of imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) in diagnosing these conditions continues to evolve. The main objective of this review article is to illustrate the role of imaging in identifying the common and uncommon pathology of the spleen.
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Affiliation(s)
- Meshaal Nadeem
- Department of Diagnostic Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Hina Arif Tiwari
- Division of Radiology, Department of Medical Imaging, University of Arizona Health sciences, Tuscon, Arizona, United States
| | - Kedar Jambhekar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Hemendra Shah
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Roopa Ram
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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Consul N, Javed-Tayyab S, Morani AC, Menias CO, Lubner MG, Elsayes KM. Iron-containing pathologies of the spleen: magnetic resonance imaging features with pathologic correlation. Abdom Radiol (NY) 2021; 46:1016-1026. [PMID: 32915270 DOI: 10.1007/s00261-020-02709-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/17/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022]
Abstract
Systemic and non-systemic pathologies that involve iron deposition within the spleen have characteristic features on MRI due to the susceptibility properties of deposited iron, or hemosiderin. These lesions will have signal loss on longer echo sequences due to the T2* effect when evaluated with dual-echo gradient-echo sequences. The pathophysiology of systemic and localized iron sequestration disease processes can elucidate an underlying diagnosis based on these imaging features in conjunction with clinical information.
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Affiliation(s)
- Nikita Consul
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Sidra Javed-Tayyab
- Department of Radiology, Memorial-Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ajaykumar C Morani
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, 53726, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ, USA.
- Department of Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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Etchison A, Menias CO, Ganeshan DM, Consul N, Nada A, Shaaban AM, Gaballah AH, Javadi S, Elsayes KM. A review of anatomy, pathology, and disease spread in the perisplenic region. Abdom Radiol (NY) 2021; 46:805-817. [PMID: 32949273 DOI: 10.1007/s00261-020-02736-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
The perisplenic region is a complex anatomical area involving multiple peritoneal and subperitoneal structures, which influence the presentation and behavior of various pathologic processes. This review is a comprehensive resource for perisplenic anatomy and pathology with associated clinical presentations and imaging findings. Understanding the pathophysiologic intricacies of the perisplenic region assists the radiologist in building a helpful differential diagnosis and recognizing predictable disease patterns.
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Affiliation(s)
- Ashley Etchison
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | | | - Dhakshina M Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nikita Consul
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ayman Nada
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Akram M Shaaban
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Ayman H Gaballah
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Sanaz Javadi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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Zhong X, Yang L, Huang J, Deng L, Nie L, Lu Q. Contrast-enhanced ultrasonographic imaging of hepatic splenosis: A case report. Medicine (Baltimore) 2021; 100:e24243. [PMID: 33546044 PMCID: PMC7837972 DOI: 10.1097/md.0000000000024243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Hepatic splenosis or heterotopic auto-transplantation of spleen in the liver usually occurs after either spleen trauma or surgery. It is of great importance for the differential diagnosis of hepatic splenosis and other liver tumors because surgery is usually not needed if a diagnosis of splenosis is confirmed. PATIENT CONCERNS Multiple hepatic masses were revealed by grayscale ultrasound in a 55-year-old man complaining of persistent colic in the upper abdomen after greasy food. DIAGNOSIS Benign neoplasm with enlarged lymph node in the gastro-hepatic ligament was suspected by contrast enhanced US. The nature of the hepatic mass was undetermined by CECT. INTERVENTIONS The lesions were surgically removed. OUTCOMES Multiple splenic tissue implants in the liver and peritoneum were confirmed by pathology after surgery. The patient recovered well and was followed up for more than 1 year without recurrence. LESSONS Splenosis should be included in the differential diagnosis of focal liver lesion in patients with a history of spleen trauma or surgery. In spite of nonspecific findings on pre-contrast ultrasound, splenosis shows characteristic homogeneous hyperenhancement in arterial and portal phases, as well as prolonged hyperenhancement in the late phase for more than 5 minutes. Furthermore, the confidence of the diagnosis of splenosis may be enhanced by identifying multiple masses with similar enhancing patterns in other regions of the abdominal cavity.
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Affiliation(s)
| | | | | | | | - Ling Nie
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
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Duffy P, Castro-Aragon I, Tivnan P, Volberg FM, Kipervasser E, Harkanyi Z, Paltiel HJ. Spleen and Peritoneal Cavity. PEDIATRIC ULTRASOUND 2021:481-561. [DOI: 10.1007/978-3-030-56802-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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47
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Laparoscopic partial splenectomy for a splenic hamartoma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Zhang ZB, Li L. Splenic sclerosing angiomatoid nodular transformation in a patient with right renal carcinoma: A case report. Asian J Surg 2020; 44:396-397. [PMID: 33176967 DOI: 10.1016/j.asjsur.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Zhen-Bin Zhang
- Department of Gastrointestinal Surgery, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Ling Li
- Department of Intensive Care Unit, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
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Zhao S, Zhu L, Tong F, Tinzin L, Huang F, Zhou Y. Unexpected death due to spontaneous splenic rupture: A rare case in splenic angiosarcoma. Leg Med (Tokyo) 2020; 47:101785. [PMID: 32977197 DOI: 10.1016/j.legalmed.2020.101785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 12/27/2022]
Abstract
Splenic angiosarcoma (SA) is a rare disease that can cause spontaneous splenic rupture leading to unexpected death. The rare incidence and non-specific clinical presentations made the early correct diagnosis of SA impossible in clinical practice. Even with medical intervention, 80% of patients died within 6 months after diagnosis. Here, we report a man who had complained of abdominal distension for 2 weeks and succumbed to the disease nine hours after admission. Diagnosis of hepatic and splenic angiosarcomas was based on post-mortem histopathological examination and immunohistochemistry, and the cause of death was hemorrhagic shock caused by spontaneous splenic rupture secondary to SA. This present case was the first forensic autopsy of spontaneous splenic rupture secondary to SA, which can highlight the diagnosis of rare diseases in forensic practice, and forensic pathologists should bear in mind these rare diseases even in routine practice.
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Affiliation(s)
- Shuquan Zhao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Longlong Zhu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Fang Tong
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Lopsong Tinzin
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Fang Huang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China.
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50
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Farah BL, Madeline Chee YM, Ching SS, Tan CS. Primary splenic leiomyosarcoma as an exceptionally rare cause of ruptured splenomegaly – A case report and review of primary splenic sarcomas. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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