Pelvic splenosis mimicking ovarian metastasis of breast carcinoma: a case report

Abstract

Splenosis is the heterotopic autotransplantation of splenic tissue that usually follows traumatic splenic rupture and splenectomy. Implanted splenic tissue may give rise to a mass or masses in the chest, abdomen, or pelvis which the clinician must distinguish from benign or malignant tumors. A 38-year-old multiparous woman presented for a routine gynecological examination during breast cancer treatment. She had undergone splenectomy following traumatic splenic rupture at the age of 13. Pelvic examination revealed a left adnexal mass. Transvaginal ultrasonography showed a 39x56x40 mm diameter hyperechoic, hypervascular solid tumor on the left ovary. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. The postoperative histological diagnosis was splenic tissue. Splenosis must be considered in the differential diagnosis of previosly splenectomized patients who present with unexplained masses.

Cul-de-sac splenosis - An unusual location

“…The average interval between trauma and the detection of the splenic tissue was reported to be at least 10 years [6]. Fewer than 100 cases of splenosis have been reported in the literature [3]. The most common location of splenosis is found in the abdominal cavity, primarily within the peritoneal cavity, omentum and/or mesentry [2].…”

“…Pelvic and/or gynecological splenosis has rarely been reported. Uncommon locations like the thoracic cavity, subcutaneous tissue and the brain have also been encountered [3,7]. The mechanism of intra thoracic and subcutaneous splenic tissue is when trauma causes a path of entry [7].…”

“…Splenosis at a first glance can be concerning for a neoplastic process [5]. Since splenosis mimics metastases it is important to keep in mind in patients with cancer to avoid unnecessary surgery or chemotherapy [3]. If it occurs in the pelvis, pelvic pain, dysmenorrhea or other gynecologic symptoms may occur [8].…”

“…Commonly, splenosis is seen in the peritoneum, omentum, and mesentery. Pelvic splenosis makes up a minority portion in the literature [2,3]. Pelvic splenosis in women can be challenging to diagnose due to the numerous gynecological benign and malignant conditions that are more commonly encountered in these patients [4][5][6].…”

Gallbladder splenosis: a hereto unreported mimicker of a gallbladder neoplasm

“…Implantation of splenic tissue can occur anywhere in the body, including the liver, kidneys, ovaries, thorax, and brain [2][3][4][5] and, though a completely benign process, can mimic a primary mass or metastasis. Here, we report the first known case of gallbladder splenosis in a patient with an extensive surgical and medical history.…”