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Splenosis is a rare disease, which is often discovered incidentally years after surgical procedures on the spleen or traumatic splenic lesions. Through injury of the splenic capsule, splenic cells are able to spread and autoimplant in a fashion similar to the process of metastatic cancer. Here we present the case of a 62-year-old female patient with a palpable tumor of the lower abdomen. Her medical history was unremarkable, except for splenectomy after traumatic splenic lesion in her childhood. Clinical examination and diagnostic imaging raised the suspicion of advanced ovarian cancer, which was further substantiated by the typical presentation of adnexal masses and disseminated peritoneal metastases during the following staging laparotomy. Surprisingly, we also found peritoneal implants macroscopically similar to splenic tissue. Microscopic examination of tissue specimens by intrasurgical frozen section confirmed the diagnosis of intra-abdominal splenosis. The patient then underwent cytoreductive surgery with complete resection of all cancer manifestations, sparing the remaining foci of splenosis to avoid further morbidity. This case demonstrates the rare coincidence of intra-abdominal carcinoma and splenosis, which could lead to intraoperative difficulties by misinterpreting benign splenic tissue. Therefore, splenosis should be considered in patients with medical history of splenic lesions and further diagnostic imaging like Tc-99m-tagged heat-damaged RBC scan could be used for presurgical distinguishing between tumor spread in the abdominal cavity and disseminated splenosis. The presented case report should not only raise awareness for the rare disease splenosis, but also emphasize the need to consider the possibility of simultaneous incidence of benign and malignant intra-abdominal lesions, as to our knowledge this is the first published case of simultaneous peritoneal carcinomatosis and splenosis.

Purpose. To demonstrate capabilities and features in spleen pathology diagnostics based on clinical experience of Botkin City Hospital.Materials and methods. The analysis of 89 patients with spleen abnormalities was performed in the term from 01/2014 till 08/2020. All the patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) with contrast enhancing. All cases verified surgically and/or clinically.Results. There were 37 cases of trauma (42%). Accuracy and precision of the method was 100%. In detection of active bleeding the highest diagnostic accuracy (100%) was shown with extravasation symptom – 7 cases. In non-traumatic group (n = 52, 58%) two biggest sub-groups were abscesses (n = 19, 36% in this group) and infarctions (n = 15, 29%). There were 8 cases of cysts (15%), 3 of them – hydatid, 5 cases of spleen hemangiomas. (9.6%), 3 cases of spleen metastases (6%). There was 1 case of angiosarcoma (2%) and 1 case cystic lymphangioma (2%).Conclusion. The most frequent condition in spleen pathology, diagnosed in radiology department is trauma. In non-traumatic cases two biggest groups are abscesses and infarctions. CT features of spleen infarction are pyramidal wedge of hypoperfused splenic tissue with the apex pointing towards the hilum, and the base on the splenic capsule. In all cases in our study cysts were incidental findings. Spleen metastases are rare due to organ hemodynamics. The most rare lesions of the spleen are primal tumors.

Highlights • Mature teratoma, also called a dermoid cyst. • Dermoid cysts have been observed in various anatomical positions. • Mature cystic teratoma with splenic location. • Splenic dermoid tumors., Introduction Teratomas are germ cell neoplasms that can be malignant or benign. Their occurrence is more prevalent in gonads, but there are rare extragonal reports, and splenic teratomas are exceptionally uncommon. Case report A 44-year-old woman with a report of abdominal pain on the left flank for 12 h, was evaluated with TC that visualized spleen showing an oval, intraparenchymal, hypodense image with dense areas, submitted to conventional splenectomy, what identified mature cystic teratoma. Discussion Dermoid cysts have nonspecific symptoms, usually related to extrinsic compression of other structures or rupture of the splenic capsule; the diagnosis is complex, since the alterations in imaging exams are not very specific. Thus, the confirmation is made through anatomopathological analysis. Conclusion Mature splenic cystic teratomas are rare and treatment should be evaluated according to the presence or absence of symptoms and diagnostic certainty.

Author(s): Wang, Jason; Choi, Heesun; Ashurst, John | Abstract: Introduction: Colonoscopy is a commonly performed outpatient procedure with a low risk of complications. The most common complications seen in the postoperative period include hemorrhage and perforation. Infrequently, splenic injury can occur.Case Report: A 72-year-old male presented with a one-day history of left upper quadrant pain following colonoscopy. During the procedure he had two polyps removed along the transverse colon near the splenic flexure. There were no complications during the procedure or in the immediate post-operative period. On presentation to the emergency department, abdominal tenderness was present in the left upper quadrant without rebound, rigidity, or guarding. Point-of-care ultrasound of the abdomen demonstrated mixed hypoechoic densities confined to the splenic capsule, and computed tomography of the abdomen and pelvis with intravenous contrast noted a grade II/III splenic laceration without active extravasation. The patient was admitted for serial abdominal examination and labs.Conclusion: Splenic injury following colonoscopy is a rare complication of colonoscopy. Emergency providers should be aware of this possible complication, and acute management should include basic trauma care and consultation for possible intervention, if warranted.

Splenic injuries during laparoscopic gastrectomy include splenic vascular injury, splenic parenchymal injury and splenic capsule injury. Sometimes, it can lead to lethal hemorrhage. The avoidance of splenic injuries in the laparoscopic radical gastrectomy for gastric cancer is important, especially for the obese patients. Establishing a safe method to avoid splenic injuries in laparoscopic total gastrectomy (LTG) is an urgent issue in the surgical procedure. We developed a novel approach by extended separation of the superficial plane of the posterior gastric fascia to avoid the splenic injury effectively.

Toxoplasma gondii infection induces parasite infiltration and apoptosis in the spleen. However, dose-dependent parasite infiltration, apoptosis, body weight alternations and survival in mice remain largely unknown. In this study, mice were intraperitoneally infected with 10, 30 or 100 tachyzoites of T. gondii, respectively. Parasite infiltration and apoptosis in the spleen were analyzed on days 3, 7, and 9 post-infection by immunohistochemistry and flow cytometry. Significantly higher levels of T. gondii infiltration and apoptosis in the spleen were found in 30 and 100 tachyzoites infected mice compared to 10 tachyzoites infected mice on days 7 and 9 post-infection. Although 30 and 100 tachyzoites infected mice showed significant body weight loss compared to 10 tachyzoites infected mice, all of the 100, 30, and 10 tachyzoites infected mice died by days 12, 15, and 17, each respectively. Interestingly, T. gondii infiltration in 10 tachyzoites infected mice were limited to capsule area of the spleen on day 9 post-infection. Several areas of parasite infiltrations were found in the 30 tachyzoites infected mice, where noticeable levels of splenic capsule de-adhesion occurred. These results indicated that parasite infiltration and apoptosis in the spleen, as well as body weight loss (survival) are closely correlated with infection dosage. The level of T. gondii infiltration and apoptosis in the spleen and splenic de-adhesion were dependent on the parasite dose.

We report findings from an autopsy case who died from massive bleeding because of splenic peliosis. The case subject was an 80-year-old man who had diabetes mellitus and who was receiving hemodialysis and anticoagulant therapy. Postmortem computed tomography demonstrated massive intra-abdominal hemorrhage especially seen around the spleen. At autopsy, we found abundant hemorrhagic ascites, including a large number of clots, in the abdominal cavity. The spleen had several distinct dark red areas ranging in size from 1.5 to 2.5 cm and showed spontaneous rupture along with hematoma formation on the outside of the splenic capsule on the anterior side. From these findings, we concluded that the cause of death in this case was massive hemorrhage owing to spontaneous rupture of splenic peliosis. Although peliosis itself rarely causes death, but when it is destroyed, massive bleeding leads to death. Thus, it is necessary to know the histopathological characteristics of peliosis, in forensics.

The spleen is the largest secondary lymphoid organ with major roles in the removal of blood-borne antigens. The Eurasian moorhen is a wild aquatic bird that revealed the adaptation to harsh environmental conditions. Information regarding the structural features of moorhen's spleen is lacking. The present study aimed to describe the composition of moorhen's spleen using anatomical dissection, histology, histochemistry, immunohistochemistry, and transmission electron microscopy. The spleen appeared as a brownish red sickle-shaped organ close to the proventriculus and gizzard. The splenic capsule was very thin, and the trabeculae were poorly developed. The white pulp formed of the periarteriolar lymphoid sheath, lymphoid follicles, and periellipsoidal lymphatic sheath. The red pulp composed of sinusoids and cords and contained various types of blood cells. Blood vessels were observed within the splenic capsule and inside the parenchyma. Notably, penicillar capillaries (PCs) appeared branched and surrounded by well-developed ellipsoids. Direct connections were observed between PCs and splenic sinusoids suggesting a closed type of circulation. Ultrastructurally, intercellular spaces and vascular channels were evident in the wall of PCs. Ellipsoid-associated cells, lymphocytes, monocytes, and heterophils were observed within splenic ellipsoids. Ellipsoids were thus suggested as a crucial component of moorhen's spleen. Numerous MafB-immunoreactive (IR) macrophages were seen within the red pulp. Splenic cords contained the highest number of PHH3-IR cells, while CCASP3-IR cells were exclusive to follicles of the white pulp. In conclusion, the structure of moorhen's spleen revealed species-specific features. The findings of the present study could help to improve the immunity of domestic birds.

Splenic cysts are rare. Most true (congenital) splenic cysts are epithelial in origin and have embryonic inclusion of epithelial cells from adjacent structures. Congenital spleen cysts are also called epidermoid or epithelial cysts. They form when there is an invagination of the mesothelium-lined splenic capsule during development. The lining is pluripotential and may undergo metaplastic changes and fluid accumulation with resultant cyst expansion. We present our own clinical case of the true spleen cysts in twins. Both patients did’t have any complains. In one of the twins, the lesion was up to 85.0 mm in diameter, localized in the spleen gates and squeezed the spleen vascular pedicle, which necessitated the surgical treatment. In the second twin, the cyst also localized in the spleen gates, however, it was of minor dimensions and, there was no growth at dynamic monitoring at the present time.

Objective: To describe the findings of an unusual splenic tumor in a kitten. Methods: A grossly multinodular mass arising from the splenic capsule of a 7-month-old male Havana kitten was echographically detected and surgically removed by splenectomy, then analyzed microscopically and ultrastructurally. Results: The mass showed features of an inflammatory myofibroblastic tumor. Treatment and Outcome: Two months after surgical excision, the mass recurred in the same intra-abdominal area but disappeared after 2 months of anti-inflammatory therapy. Follow-up at 18 months after surgery revealed resolution of the disease. Clinical Relevance: Inflammatory myofibroblastic tumor in cats have been rarely reported and are usually in the orbital region. In the present report, an unusual multinodular gross presentation, a recurrence over time, and a favorable clinical course, are described.

A 50-year-old man was diagnosed with multiple myeloma complicating AL amyloidosis. Splenic rupture was complicated during autologous stem cell transplantation (auto-SCT). Granulocyte colony-stimulating factor (G-CSF) was not administered. A pathological examination of the spleen revealed that CD34-positive cells were concentrated in the ruptured part of the splenic capsule. Hematopoietic cells were engrafted in the small gap between the capsule and amyloid protein deposition area of the spleen, which might have caused the splenic rupture in the absence of G-CSF administration. Special attention is thus required for amyloidosis patients undergoing auto-SCT, even when G-CSF is not administered.

Background Research describing the splenic capsule and its effect on non-operative management of splenic injuries is limited. The aim of this study is to identify the current beliefs about the splenic capsule thickness and investigate changes in the splenic capsule with age. Methods Trauma Medical Directors were surveyed on their beliefs regarding splenic capsule thickness changes with age. Thicknesses of cadaveric splenic capsule samples were measured. Results The majority of trauma medical directors (59%) believe the capsule thickness decreases with age. There were 94 splenic specimens obtained. The splenic capsules of infants were thin and had a uniform layer of elastin fibers. With aging, the capsule becomes thick and develops a collagen layer. Conclusion Most trauma directors believe the splenic capsule thickness decreases with age. However, our results demonstrate that the splenic capsule thickness increases during childhood but remains constant in adulthood.

Background.Primary splenic angiosarcoma is a very rare mesenchymal malignant tumor associated with a poor prognosis due to its high metastatic potential. This disease can be easily neglected and spontaneous splenic rupture is a frequent manifestation at the time of diagnosis leading to a poor outcome because of peritoneal dissemination.Case Presentation.We describe the case of a 49-year-old man who presented with asthenia, left upper quadrant abdominal pain, and anemia. Computerized tomography scan showed an enlarged spleen with no nodules and a nontraumatic rupture of the splenic capsule. Splenectomy was performed on account of the severe anemia and histopathology examination showed a primary angiosarcoma.Conclusions.Splenic angiosarcoma should be considered as one of the differential diagnoses in patients with nontraumatic spleen rupture and a specific previous medical history. Regrettably, splenectomy allows for a definitive diagnosis but not a curative treatment.

A 64-year-old woman was found dead at home after undergoing a screening colonoscopy. At autopsy, 1.9 L of blood was discovered within her abdominal cavity. The only major abnormality was nontraumatic avulsion of the splenic capsule. This was the only identifiable abnormality capable of causing the severe hemoperitoneum and demise of the patient. Although rare, splenic capsule avulsion is a recognized complication of colonoscopy. Many have theorized that it results from excessive traction on the splenocolic ligament resulting in a tear of the splenic capsule. Most patients present within the first 24 hours after the procedure with nonspecific symptoms, and many patients may not seek medical attention. The paucity of the literature in the area of splenic capsular avulsion after colonoscopy reinforces the importance of reporting known cases, and by doing so raise awareness of this rare but devastating complication of an otherwise beneficial screening procedure.

The present study was conducted on 40 spleen samples of goat from prenatal to four months and above age. The small pieces from spleen were processed for histo-morphological study. The general histo-architecture of spleen showed capsule, trabeculae, red pulp and white pulp in all age groups. The splenic capsule was found to be composed of outer fibrous layer and inner muscular layer. The thickness of capsule was gradually increasing due to increase in thickness of muscular layer with the advancement of age. The components of outer fibrous layer were wavy and intermingled with collagen, reticular and elastic fibres. The elastic fibres however, became short and fragmented with advancement of age. Variation in the concentration of these fibres in capsule with advancement of age was necessary to provide firmness to the organs from outside during postnatal period and to provide elasticity of organ during prenatal and early postnatal stage. The connective tissue trabeculae radiated from capsule in to splenic pulp and supported the blood vessels. The components of trabeculae were similar to that of capsule.

A total number of eighteen day old Hansli chicks and eighteen day old Vencobb broiler chicks were divided into three age groups viz. group I (up to 1 month), group II (1-3 months) and group III (3-6 months) with six birds in each age group. On each observation day (4th week, 12th week and 24th week), six birds from each breed were used for the study of histochemical features of the thymus, spleen and bursa of Fabricius. It was found that the capsule, septa and tunics of blood vessels revealed age specific PAS activities, whereas the Alcian blue activities varied with age and was restricted to the thymic capsule and trabeculae. The splenic capsule, tunics of blood vessels and intercellular region of splenic white pulp revealed age specific PAS positive activity, whereas the Alcian blue activity was only reported in the splenic capsule of 12th week age Hansli chicken and Vencobb broiler chicken. The apical borders of both follicle associated epithelium and interfollicular epithelium, sub-epithelial region, cortico-medullary junction, medulla of lymphoid follicle, interfollicular connective tissue, central connective tissue core of bursal plicae, walls of blood vessels, tunica muscularis and tunica serosa revealed age specific PAS activities, whereas the apical borders of follicle associated epithelium (FAE), interfollicular epithelium (IFE) and goblet cells of lining surface epithelium, tunica muscularis and tunica serosa showed age specific Alcian blue activities in both the birds.

Context: The spleen is the largest single mass of lymphoid tissue in all vertebrates. Histological changes are evident in advancing age along with functional capability of the human spleen. A cross-sectional, descriptive type of study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from January to December 2008, to see the age related microscopic changes in the human spleen. Methods: 30 human spleens were collected from the unclaimed dead bodies that were under examination in the Department of Forensic Medicine of Dhaka Medical College, Dhaka. The samples were divided into three age-groups including group A (15-29 years), group B (30-49 years) & group C (50-69 years). Then 5 best prepared histological slides from each group were taken and examined under the light compound microscope to determine the thickness of capsule, diameter, number and percent amount of white pulp in the human spleen. Results: The thickness of the splenic capsule were found 84.60±7.97 ?m, 117.92±4.16 ?m, and 132.17±6.37 ?m in group A, B and C respectively. The diameter of the white pulp were found 0.32±0.01 mm, 0.32±0.01 mm and 0.31±0.01 mm, while the number of white pulp per sq. mm were 2.28±1.04, 2.38±0.93 and 2.04±0.76 in group A, B and C respectively. Moreover, the amounts of the white pulp were determined 23.09±1.38, 24.45±1.84 and 22.54±1.08 in group A, B and C respectively. The difference in thickness of the splenic capsule was statistically significant among the study groups (p

Background: The spleen is the largest single mass of lymphoid tissue in all vertebrates. It is presumed that the architectural design of spleen of domestic and wild animal is different from man. Exact knowledge of histological structure of human, cow and goat can be helpful to differentiate among different species in vertebrates. Methods: A descriptive type of study was carried out in the department of Anatomy, Dhaka Medical College, Dhaka, from January to December 2008. Thirty human spleens were collected from the unclaimed dead bodies that were under examination in the Department of Forensic Medicine of Dhaka Medical College, Dhaka. Spleens from cow and goat were collected from a slaughter house of Dhaka city. A total of 15 relatively fresh human samples, six from cows and six from goats were selected for histological study. Results: The mean thickness of the splenic capsule was 111.56±21.45 ?m in human, 196.88±11.91 ?m in cow and 251.44±12.56 ?m in goat. The difference in thickness of the splenic capsule was statistically significant among the human, cow and goat (p

A histomorphological study was performed in the major lymphoid tissues (thymus, bursa of Fabricus and spleen) of the six 21-day-old indigenous ducklings of Bangladesh by H & E staining method during the period from March to May 2011. In the present study, it was observed that the thymus was enclosed by a thin connective tissue capsule. Numerous fine septa of connective tissue originated from the capsule and divided the organ into incompletely separated lobules. Each lobule organized into a peripheral cortex and a central medulla. The bursa of Fabricus was consisted of mucosal folds (plicae). Numerous follicles filled the lamina propria of each fold and each bursal follicle was composed a peripheral cortex and a central medulla. A layer of undifferentiated epithelial cells occupied the periphery of the medulla, which was separated from the cortex by a capillary layer. The darkly stained cortex was composed of many closely packed small lymphocytes. The paler medulla contained fewer cells of various sizes. The spleen was surrounded by a thick splenic capsule and there were a small number of trabeculae. The white pulp was composed of network of reticular cells and reticular fibers within various size lymphocytes and plasma cells were diffusely distributed. The red pulp of the spleen was formed from venous sinuses and anastomosing cord of reticular cells, macrophages, lymphocytes and blood cells. The length and breadth of the thymic lobules, bursal follicles and white pulp of the spleen were 226.68 and 165.78cm, 204.45 and 138.23cm, and 129.05 and 103.43cm respectively. The result of the present work revealed that the immunocompetent cells were arranged scatteredly or densely as an unorganized lymphatic nodules in the lymphoid tissues. The length and breadth of the thymic lobules were higher followed by bursal follicle and splenic white pulps were varied within the lymphoid tissues and even one another in indigenous ducklings. The results of the present study indicate that the architecture and distribution of lymphocytes and lymphoid follicles of ducklings is very close to the chicken and this study might be helpful to understand the changes in the frequency of the population of immunocompetent cells in drug induced, vitamin and mineral supplemented or hormone treated duck in future.DOI = http://dx.doi.org/10.3329/bjvm.v9i1.11212 Bangl. J. Vet. Med. (2011). 9(1): 53-58

Blunt splenic injuries are most frequently caused as a result of motor vehicle collisions and are associated with high mortality rates. In order to accurately assess the risk of automotive related spleen injuries using tools such as finite element models, tissue level tolerance values and suitable material models must be developed and validated based on appropriate biomechanical data. This study presents a total of 41 tension tests performed on spleen parenchyma coupons and 29 tension tests performed on spleen capsule/parenchyma coupons. Standard dog-bone coupons were obtained from fresh human spleen and tested within 48 h of death. Each coupon was tested once to failure at one of the four loading rates to investigate the effects of rate dependence. Load and acceleration data were obtained at each of the specimen grips. High-speed video and optical markers placed on the specimens were used to measure local displacement. Failure stress and strain were calculated at the location of failure in the gage length of the coupon. The results of the study showed that both the spleen parenchyma and the capsule are rate dependent, with higher loading rates yielding higher failure stresses and lower failure strains. The results also show that the failure stress of the splenic capsule is significantly greater than that of the underlying parenchyma. Overall, this study provides novel biomechanical data that demonstrate the rate dependent tissue level tolerance values of human spleen tissue in tensile loading, which can aid in the improvement of finite element models used to assess injury risk in blunt trauma.

Distal pancreatectomy is indicated for lesions in the pancreatic body and tail. Understanding of the anatomical structure of the pancreas and its surroundings is required in various situations in left upper abdominal surgery including the laparoscopic approach. Spleen-preserving distal pancreatectomy is indicated for lesions confined to the pancreas. Two major spleen-preserving procedures reported are the Warshaw procedure that conserves the spleen by blood flow from the short gastric vessels and the Kimura procedure that preserves the spleen with splenic vessels. Considering the laparoscopic approach, the surgeon may preserve splenic vessels from the median toward the splenic hilum without mobilization of the spleen. A standard distal pancreatectomy using the medial approach is presented on video. The intraoperative complications of distal pancreatectomy can be minimized by avoiding splenic capsule injury, by careful differentiation of the splenic artery from the common hepatic artery, and by secure closure of the splenic vein stump. The incidence of postoperative pancreatic fistula following distal pancreatectomy is reported to be 13% in a nationwide pancreatic cancer registry. Based on the results of an international randomized trial of hand-sewn and staple closure of the pancreatic stump, the closure method of the pancreatic stump can be the surgeon's choice.

Case Description—A 7-year-old mixed-breed stallion was admitted because of colic. Clinical Findings—Entrapment of the left colon in the renosplenic space was diagnosed via rectal palpation and ultrasonographic examination, despite a renosplenic space ablation 6.5 years earlier. Treatment and Outcome—The renosplenic entrapment was corrected with a combination of phenylephrine administration, rolling, and ballottement of the horse's abdomen during general anesthesia. The following week, left flank laparoscopic renosplenic space ablation was performed with the horse standing. On examination of the previous surgical site, only 4 bands of fibrous adhesion remained of the original space ablation. The renosplenic space was again closed by suturing the perirenal fascia and renosplenic ligament to the splenic capsule. The horse was discharged from the hospital and recovered at home. No complications or recurrence of entrapment was reported following the procedure. Clinical Relevance—There have been no previous reports of recurrence of renosplenic entrapment following procedures to permanently ablate the renosplenic space. Recurrence in this patient may be attributed to the horse's young age at the time of initial surgery or inadequate size or spacing of the sutures through the perirenal fascia and splenic capsule.

This report presents the case of a 70-year-old woman with a previous history of a left nephrectomy for renal cell carcinoma (RCC), who developed general malaise and fatigue. Abdominal computed tomography demonstrated an enhancing 6 × 7 cm necrotic lesion in the lower pole of the spleen suggestive of a metastasis. Given the highly suspicious nature of the lesion we proceeded to splenectomy. The tumour did not breach the splenic capsule, and there was no local diaphragmatic involvement. The mass was concluded to be a true metastasis of the original RCC rather than local recurrence of the disease. The causes of isolated solid splenic lesions are wide and varied, however a past or present history of malignancy should lead to a high index of suspicion for a splenic metastasis. We report an extremely unusual case of spread from a RCC.

Background Nonoperative management (NOM) has been established as the standard treatment for isolated blunt organ injury in hemodynamically stable pediatric patients. Although delayed splenic rupture or bleeding is a rare complication in NOM, it is an issue that many pediatric surgeons are greatly concerned about. We herein report a rare pediatric case concerning the mechanisms involved in delayed splenic rupture after NOM. Case presentation A 9-year-old boy with severe abdominal pain was transferred to our hospital. Twenty-one hours before the admission, he had been kicked in the region of his left lateral abdomen. Contrast-enhanced abdominal computed tomography revealed a severe intra-parenchymal hematoma and multiple lacerations of the spleen with a large amount of hemoperitoneum without active bleeding. His condition was diagnosed as a grade III injury on the AAST splenic injury scale. After fluid resuscitation, his vital signs became stable. The patient was treated with NOM in our intensive care unit. However, suddenly after defecation (72 h after the injury), he started complaining of severe abdominal pain and left shoulder pain. His blood pressure dropped to 70/35 mmHg, and he started to lose consciousness. Abdominal ultrasonography (US) revealed increased ascites. Fluid resuscitation and blood transfusion were performed. His symptoms and abdominal US findings suggested that splenic re-bleeding had caused delayed splenic rupture to occur. Emergency splenectomy was performed. The resected spleen was enlarged with a large parenchymal hematoma. The posterior-lateral side of the splenic capsule was ruptured. Conclusions The mechanism of delayed splenic rupture in our case was considered to be the result of a tear in the subcapsular hematoma caused by stretching the splenocolic ligament related to a bowel movement during defecation. Although delayed splenic rupture or bleeding is unpredictable, it is very important to understand the mechanisms and to educate the family of the children with splenic injuries of the warning signs of delayed rupture or bleeding.

Estudou-se a viabilidade do autotransplante de tecido esplênico, um terço do baço, associado à esplenectomia parcial, e verificou-se a cinética evolutiva de sua regeneração, sob o aspecto macroscópico e histológico. Foram utilizados 28 ratos Wistar, adultos, machos, com média de peso de 300g, distribuídos em quatro grupos experimentais. Cada animal foi submetido à esplenectomia parcial, e um fragmento de baço foi transplantado para o omento maior, por períodos de 30, 60, 90 e 120 dias. Após cada período pré-estipulado, os tecidos esplênicos autotransplantados foram coletados e analisados histologicamente. Os resultados mostraram regeneração da cápsula esplênica, dos vasos sanguíneos e das polpas branca e vermelha. Aos 90 dias, a arquitetura microscópica apresentava-se semelhante à do baço normal.

In splenic rupture after blunt trauma, iatrogenic spleen injury or non-traumatic cases it is essential that the surgeon makes correct decisions. Conservative treatment must include continual monitoring and repeated, stringent evaluation of the splenic injury (the American Association for the Surgery of Trauma – AAST) in order to avoid any delay in diagnosis of delayed spleen rupture and the high mortality it causes. We present the case of an unexpected complication after radical nephrectomy performed for renal cell carcinoma. A 61-year old man sought medical help for acute abdominal pain. He presented with some cardiovascular risk factors (diabetes mellitus, smoker of 30 cigarettes per day) and moderate alcohol use. In the Emergency Unit, computed tomography scan revealed an incidental tumour of the left kidney. Nephrectomy via the laparoscopic approach was done without any iatrogenic complications, with less than 500 cc of blood loss. Firm adhesions between the spleen and abdominal wall, which caused some minor traction that resulted in a small subcapsular haematoma, were the only surprising intraoperative finding. Within the first 6 h, the patient presented with haemodynamic instability, while the drain evacuated less than 50 cc of discharge. However, CT scan showed that subcapsular haematoma had increased to the size of 10 × 10 cm without free peritoneal fluid present. Unfortunately, 6 h later emergency surgery had to be performed due to rupture of the subcapsular splenic haematoma. Massive haemoperitoneum was evacuated and the splenic capsule was the only remnant of the spleen that could be found on re-intervention. So far, it is the first case describing an increasing subcapsular haematoma of the spleen, most likely caused by the traction of firm adhesions to the organ. We discuss means to avoid such a complication: with liberation of the adhesions, placement of a perisplenic mesh, embolization of the splenic artery or subcapsular nephrectomy. An acute splenic rupture or delayed one demands from the surgeon practical knowledge of how to prevent subcapsular haematoma and how to treat splenic rupture.

We report a case of spontaneous splenic rupture (SSR) caused by a Bacillus species (sp.) infection. A 36-year-old man on warfarin therapy since an aortic valve replacement at the age of 13 was admitted to our hospital with a 3-week history of a high fever. He had been asymptomatic until 4 months previously, when he suffered a cerebral embolism despite adequate oral anticoagulation. Abdominal computed tomography revealed splenic infarctions, which resulted in splenic rupture 2 days later. After embolization of the splenic artery, splenectomy was successfully performed. Pathologic examination revealed splenic infarction, resulting from septic emboli, with associated rupture of the splenic capsule, but no abscess was found. Bacillus sp. was isolated from cultures of arterial blood preoperatively, and the excised splenic specimens, postoperatively. In addition to rupture of the suppurating intrasplenic vessels with hematoma formation, the anticoagulant therapy possibly contributed to distension of the intrasplenic hematoma.

Rupture of the spleen occurred in five patients (aged 44-59 years) in the course of chronic or chronic recurrent pancreatitis. In three patients the rupture was a consequence of perisplenic adhesions associated with subclinical chronic pancreatitis, in another there was direct enzymatic erosion of the splenic capsule via the phrenicosplenic ligament, and in the fifth patient haemorrhagic infarction followed splenic venous thrombosis. In four patient there was a history of chronic pancreatitis related to alcohol abuse. On admission all patients complained of breathing-related pains radiating into the shoulder. Three patients also had abnormal radiological signs in the left lower lung field (high diaphragm, effusion, infiltration). The findings can be explained pathogenetically by infiltration of the phrenicosplenic ligament which connects the tail of the pancreas with the splenic hilus and the diaphragm. The final diagnostic confirmation and indication for surgery was in all cases made by computed tomography. This is thus the imaging procedure of choice if splenic involvement is suspected in the course of chronic pancreatitis.

A case of endosalpingiosis appearing as a huge multilocular cyst in the spleen of a 31-year-old woman is reported. The cystic lumens were smooth, and lined by fallopian tubal epithelium containing ciliated and secretory cells. The epithelial lining showed neither atypia nor foci of papillary proliferation, with only 3-5% MIB-1 labeling index. The epithelial lining was histochemically negative for mucin, but positive for MUC1 and progesterone receptor. Despite the appearance of a tumor-like mass, it was diagnosed as florid cystic endosalpingiosis as there was a normal tube-like epithelium. Regarding etiology, it was considered to derive from the secondary mullerian system of the splenic capsule.

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.

Papillary thyroid carcinoma (PTC) commonly metastasizes to cervical lymph nodes. Distant metastases are unusual with the lungs most frequently involved. Well-differentiated thyroid carcinoma very rarely presents with metastases to the spleen. This is the case of a 25-year-old man with a history of PTC (1.4 cm primary; no capsular invasion and negative lymph node metastases). One year after initial surgery, recurrent disease was found in multiple neck nodes by central neck dissection. Whole body scan (WBS) following a therapeutic ablation dose of 150 mCi I(131) revealed mediastinal metastases. Computerized axial tomography (CT) of the chest one year later showed no gross mediastinal or pulmonary disease. However, multiple large splenic lesions were incidentally noted. Evaluation by ultrasound (US) showed lesions to be solid echogenic masses without remarkable Doppler characteristics to suggest vascular tumors. US-guided percutaneous fine-needle aspiration biopsy (FNAB) of one lesion was nondiagnostic. After withdrawal from Levothyroxine, serum TSH was >100 mU/L with a thyroglobulin of 9.4 ng/mL and negative anti-thyroglobulin antibodies. Diagnostic WBS revealed faint splenic uptake but was otherwise unremarkable. Following treatment with 192 mCi I(131), WBS demonstrated increased activity in the mediastinum as well as in the spleen suggesting mediastinal and splenic metastases. Contrast CT of the abdomen showed multiple low-attenuated heterogeneously enhancing splenic masses, normal liver and no intra-abdominal lymphadenopathy. The largest mass (4.5 x 3.5 cm) was exophytic and in close proximity to the splenic capsule. Despite the serum thyroglobulin of only 9.4 ng/mL, the finding of I(131) accumulation within solid splenic masses led to a preoperative diagnosis of thyroid carcinoma metastases. To establish the diagnosis and to remove the risk for splenic rupture, a laparoscopic splenectomy was performed. Histopathologic analysis showed large littoral cell angiomas (LCA). False-positive radioiodine scintigraphy in the setting of PTC involving a vertebral hemangioma has been reported. To our knowledge, this is the first case that describes multiple angiomas mimicking metastatic thyroid carcinoma to the spleen. In one-third of all cases reported, LCA co-exists with various visceral organ cancers or malignant lymphoma. This is the first report of an association between LCA and thyroid carcinoma.

In the summer of 2001, Usutu virus (USUV) was isolated for the first time in Europe, from an episode of mass mortality in Eurasian blackbirds (Turdus merula). In the present study, 40 of the birds (representing three species), confirmed as cases of USUV infection, were examined by four methods (histopathology, immunohistochemistry [IHC], in-situ hybridization [ISH] and reverse-transcriptase polymerase chain reaction [RT-PCR]). The major macroscopical finding was hepatosplenomegaly; histologically, neuronal necrosis, myocardial lesions, and coagulative necrosis of the liver and spleen were observed. IHC with cross-reactive polyclonal antibodies to West Nile virus detected viral antigen predominantly in brain neurons (40/40 birds; 100%), myocardial fibres (25/32; 78%), cells of the splenic capsule (29/33; 88%), renal glomeruli (22/35; 63%), tunica muscularis of intestines (17/22; 77%), proventricular glands (16/19; 84%), lungs (18/33; 55%) and hepatic Kupffer cells (7/38; 18%). ISH with an USUV-specific oligonucleotide probe demonstrated viral nucleic acid predominantly in brain neurons (40/40; 100%), myocardial fibres (24/33; 73%), splenic macrophages (12/34; 35%), renal tubular cells (19/36; 53%), tunica muscularis of intestines (13/32; 41%), proventricular glands (19/22; 86%), lungs (7/34; 21%) and hepatic Kupffer cells (12/38; 32%). All of 33 birds tested additionally by USUV-specific RT-PCR gave positive results.

The presence and intraorgan distribution of the acetylcholinesterase (AChE)- positive nerve structures in the guinea-pig spleen were studied by means of the direct thiocholine method. Visualized AChE-positive nerve fibres entered the guinea-pig spleen at its hilum in the vicinity of the splenic artery branches and intra parenchyma were gradually distributed to form thicker periarterial nerves and also fine adventitial nerve plexus. In described topography the AChE-positive nerve fibres were identified in association with the central artery running through the white pulp. Some of the perivascular nerve fibres associated with the central artery extended away and passed into the periarterial lymphatic sheath (PALS) to reach the marginal zone and in continuation entered into the mantle zone of lymphatic follicles. Several AChE-positive nerve fibres were seen in the red pulp but less in the splenic capsule. We did not find any AChE – positive nerve cells in the guinea-pig spleen.

Heterotropic splenic tissue in the renal fossa is characteristically asymptomatic and is usually an incidental finding that has been reported to mimic renal or adrenal tumors. A 50-year-old man with renal cell carcinoma had undergone radical nephrectomy with splenectomy because of the invasion of the splenic capsule. During a follow-up examination, nodules were detected by computed tomography in the subdiaphragmatic region. Although local recurrence was highly suspected, and these masses were diagnosed as ectopic splenic tissues by a technetium-99m-sulfur colloid scintigraphy and unnecessary surgical exploration was avoided.

Purpose: In this study the effect of continuous stimulation of gonadotropins on sex cord stromal tumors in the rat was examined. Methods: Sex cord stromal tumors were induced by transplantation of ovaries under the splenic capsule of ovariectomized rats. Beginning 180 days after transplantation, these tumors were taken out and cut into several pieces, which were then retransplanted (by isotransplantation) under the splenic capsule of 80 either intact or ovariectomized rats. Results: Most of the tumor grafts grew up to a median size of 0.7 cm in ovariectomized rats. However, some of the tumors recovered from recipient rats that were retransplanted with donor tumors differed significantly from the others. Characterized by a high mitotic rate, nuclear atypia, size (up to 3.8 cm) as well as growth in intact animals, these tumors were defined as malignant. They could be kept in culture and always led to the development of metastases after retransplantation into other rats. Conclusion: Benign sex cord stromal tumors can show malignant growth after transplantation. This study for the first time demonstrates that gonadotropins are involved in the induction of ovarian malignancies.

Laparoscopic splenectomy (LS) is an alternative to open surgery. However, there is a theoretic risk of splenosis and abdominal cavity dissemination of splenic cells if the splenic capsule is broken, as seen by experimental evidence of tumoral cell mobilization by the pneumoperitoneum. We evaluated the features of splenosis after splenectomy operated via an open approach or under laparoscopic control in an experimental model in the rat. A total of 65 Sprague-Dawley rats were distributed in seven groups that included the open approach, CO2 pneumoperitoneum LS, or wall lift LS with or without a splenic graft. Splenic function was evaluated 90 day later through (1) scintigraphy with Tc-labeled heat-damaged erythrocytes; (2) determination of circulating "pitted" cells; and (3) analysis of the distribution of splenic pulp in the peritoneal cavity. Scintigraphy did not show viable residual tissue in any group after splenectomy; splenic activity in the splenic fossa was observed in 40% of the animals with grafts. Splenectomy increased the "pit" cell count, but it was reduced to normal values with a splenic graft. Necropsy showed normal splenic tissue in the splenic fossa in 100% of animals with a graft. Abdominal implants were observed significantly more frequent after CO2 LS than after the open surgery or a wall lift LS (80% vs. 20% vs. 30%; p0.05). In addition, trocar site implants were observed with CO2 LS (n = 3) or wall lift LS (n = 2), whereas there were no implants in the wound in the open group. We conclude that in an experimental rat model the pneumoperitoneum may facilitate abdominal splenosis after LS if the splenic capsule is ruptured or if splenic tissue spills compared with surgery without gas (open or laparoscopic).

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.

We report an epithelioid angiosarcoma involving the splenic capsule. This neoplasm developed because of a gauze sponge, retained for 38 years following left-sided nephrectomy. Clinical, radiological, and histological features of this angiosarcoma add to the validity of the concept of inert foreign body tumorigenesis in humans.

Laparoscopic surgery in small-animal models provides insight into basic physiopathological aspects of laparoscopy. However, laparoscopic work in small animals entails precise skill and long operative times. We present an easy and shorter three-trocar procedure (two of 5 mm and one of 2 mm) for splenectomy in a rat model. Miniature instruments (2-mm forceps, 3-mm endoscope, and 5-mm endoapplier) were used. Forty laparoscopic splenectomies were attempted. The operative time was 30 +/- 4 minutes. There was no postoperative mortality, and scintigraphy ruled out the presence of residual splenic tissue. Laparoscopic splenectomy in a rat is feasible. When using experimental laparoscopic models for splenectomy, an easy technique is of great importance in order to avoid cumbersome manuevers that can cause rupture of the splenic capsule and cell spillage or postoperative bleeding. The development of surgical laparoscopic instruments with thinner devices (5-mm endoclip appliers and 2-mm ports and instruments) facilitates the procedure and permits a significantly shorter operative time.

Heterotropic splenic tissue in renal fossa is characteristically asymptomatic and is usually an incidental finding that has been reported to mimic renal or adrenal tumors. A 55-year-old man with renal cell carcinoma had undergone radical nephrectomy together with splenectomy because of disrupture of the splenic capsule. During a follow-up examination, three nodules were detected by computed tomography scan in the splenorenal area and they slowly enlarged. Although local recurrence was highly suspected, we decided to rule out splenosis. We successfully diagnosed these masses as ectopic splenic tissues by a technetium sulfur colloid scan and unnecessary surgical exploration was avoided.

Background Laparoscopic cholecystectomy (LC) is generally safe and well-accepted. In rare cases, it is associated with complications (intra- e postoperative bleeding, visceral injury and surgical site infection). Splenic lesion has been reported only after direct trauma. We report an unusual case of splenic rupture presenting after “uncomplicated” LC. Case presentation A 77-year-old woman presented with distended abdomen, tenderness in the left upper quadrant and severe anemia 12 hours after LC. Clinical examination revealed hypovolemic shock. Abdominal computed tomography confirmed the diagnosis of splenic rupture, and the patient required an urgent splenectomy through midline incision. The post-operative course was uneventful and the patient was discharged on 7th postoperative day. Splenic injury rarely complicates LC. We postulate that congenital or post-traumatic adhesions of the parietal peritoneum to the spleen may have been stretched from the splenic capsule during pneumoperitoneum establishment, resulting in subcapsular hematoma and subsequent delayed rupture. Conclusions Splenic rupture is an unusual but life-threatening complication of LC. Direct visualization of the spleen at the end of LC might be a useful procedure to aid early recognition and management in such cases.

Aim : The authors studied changes in splenic volume after partial splenic embolization (PSE) in children who had thrombocytopenia caused by splenomegaly. Materials and Methods : Five children with hypersplenism (ages of 1, 6, 7, 10, and 14 years) underwent PSE. The follow-up period ranged from 1 month to 8 years 9 months. Whole and infarcted splenic volumes were measured from computed tomography images obtained before and after PSE. Results : Within 2 weeks after PSE, the whole splenic volume increased to 110% to 140% of the pre-PSE volume. The infacted area disappeared 3 to 4 months after PSE, and the whole splenic volume decreased markedly. The decreased volume tended to be stable during the follow-up period. The splenic enlargement before PSE ranged from 7.2 to 14.2 times the standard splenic volume for a corresponding body weight. The splenic volume did not become normal after PSE; it remained between 2 and 7 times larger than standard. Platelet counts stayed above 10 × 10 4 /mm 3 when the splenic volume reduced to 2 times the standard volume. Conclusion : The first 4 weeks after PSE is the most dangerous period for the development of splenic rupture because of marked expansion of the splenic capsule. The infarcted parenchyma is absorbed 3 to 4 months after PSE, and the whole splenic volume is reduced. Thereafter, the splenic volume is stable for several years. Reembolization is not likely to be necessary in the majority of patients who have had splenic embolization with an infarction rate of ≥80%.

A 6-year-old girl falls out of a car (traveling 35 mph) onto her left side. She is taken to the hospital with C-spine precautions. On arrival, the patient is alert and oriented. The C-spine films are negative. The patient is hemodynamically stable in the emergency room without evidence of external injuries other than superficial abrasion. She has no long-bone fractures, and two peripheral (18-gauge) intravenous (IV) lines are inserted. Her hematocrit (Hct) is 30 %. Just as she is about to be discharged she complains of abdominal pain. An abdominal computed tomography (CT) scan reveals intraperitoneal fluid and a ruptured splenic capsule. The patient is scheduled for an emergency laparotomy and transported to the operating room with oxygen, 6 l per minute, breathing spontaneously with a mask airway. A Jackson Rees modification of the Ayres T-piece is used to provide oxygen. In the elevator, the patient complains of sudden onset of chest pain and difficulty in breathing.