Search

Aims and Background Splenic metastases associated with mucinous intraabdominal tumors have been an enigma in the radiologic and oncology literature. These focal parenchymal defects from a non-metastasizing malignancy within an organ that rarely develops metastatic foci, even with high-grade cancer, were studied. Methods Information on 9 patients who underwent splenectomy with intraparenchymal splenic masses associated with appendiceal or colorectal mucinous tumors with peritoneal dissemination was collected. The CT scan, the histopathology and the clinical parameters of these patients were studied. A literature review searching for prior reports of this subject was performed. Results Eight of these patients had mucinous appendiceal tumors and 1 a mucinous sigmoid colon cancer. All patients had mucinous carcinomatosis at some time in their clinical course. These splenic tumor masses had a CT image compatible with metastases and not compatible with mucinous tumor layered out of the splenic capsule. None of the patients had evidence of metastases to other sites such as liver or lymph nodes. All patients had a mucinous histopathology. Splenectomy may be associated with prolonged survival. Conclusions From our review of the clinical information available on these 9 patients, these splenic lesions were thought to be an entrapment of mucinous tumor within splenic surface trabeculae, which expand into the splenic parenchyma resembling metastatic disease. These CT findings may be more accurately referred to as splenic pseudometastases.

A 14-year-old Thoroughbred gelding with a history of acute onset of hematuria was presented for necropsy. Transitional cell carcinoma of the urinary bladder with intra-abdominal dissemination was diagnosed. Tumor masses were observed on the splenic capsule and surrounding the distal abdominal aorta. Tumor cells showed diffuse cytoplasmic reactivity for cytokeratin but were negative for epithelial membrane antigen, carcinoembryonic antigen, tumor-associated glycoprotein 72, and vimentin.

pedicle. The condition is associated with other congenital abnormalities including the prune-belly syndrome, in which dilatation of the genitourinary tract interferes with gut rotation and fusion of the dorsal mesogastrium7. Some have suggested that it is the abnormal laxity of the splenic ligaments that is the primary aetiology8. An excess incidence in child-bearing years and in the multiparous has raised the possibility of ligamentous lengthening as a cause. Increased splenic mass has also been proposed as a possible aetiology but data regarding malarial and lymphomatous splenomegaly are conflicting; in most patients with a wandering spleen there is nothing wrong with the spleen itself9. Many patients with a wandering spleen are symptomfree, the condition being discovered incidentally on abdominal examination. Intermittent abdominal pains are a common mode of presentationl. Severe and persistent abdominal pain suggests splenic torsion which may vary from 90 to 160 degrees. Delay in diagnosis risks not only splenic infarction but also pancreatic necrosis10. How should a symptomatic wandering spleen be managed? At one time the favoured treatment was splenectomy, but this operation is now avoided when possible because of the spleen's important role in the reticuloendothelial system; therefore there is renewed interest in splenopexy. Torsion of the spleen and consequent infarction still necessitates splenectomy. All patients undergoing elective splenopexy should undergo pneumococcal vaccination in case the need for splenectomy should arise during splenopexy. Of the splenopexy techniques describedll, suturing of the spleen is said not to be complicated by haemorrhage though some feel this applies only to paediatric splenopexy where a thicker splenic capsule is more forgiving12. Our approach, whereby a Prolene pouch is fashioned and secured in the left upper quadrant, is novel. The spleen can then be easily placed within and the pouch closed thus securing the spleen in its correct anatomical position.