Splenosis Mimicking Cancer

Abstract

A 62-year-old woman with progressive shortness of breath and a 40-pack-year smoking history was referred for pulmonary evaluation after a radiograph of the chest showed nodularity along the left hemidiaphragm (Panel A, arrows), raising the possibility of cancer. The radiograph was otherwise unremarkable except for hyperinflation suggestive of emphysema and mild thoracic scoliosis. Her medical history was notable for a gunshot wound to the thoracoabdominal region 28 years earlier, which had resulted in injury to the liver, left hemidiaphragm, and spleen, requiring a laparotomy and splenectomy. Computed tomography revealed several small, basilar, pleural nodules on the left side (Panel B, arrows) as well as a diaphragmatic defect and nodules in the splenic bed, with findings of prior splenectomy. A technetium-99m-labeled scan with heat-damaged red cells confirmed the diagnosis of splenosis. This study showed remnants of splenic tissue above and below the left hemidiaphragm, including nodules in the left hemithorax that extended as high as the aortic arch (Fig. S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org). Splenosis refers to heterotopic viable splenic tissue that is implanted because of spillage or intravascular migration of cells from splenic pulp. This condition usually follows splenic trauma with rupture, accidental damage to the spleen during surgery, or elective splenectomy. The degree of immunocompetence was uncertain, and we recommended that the patient be immunized against encapsulated bacteria. She began using an inhaler for chronic obstructive pulmonary disease, which was confirmed with the use of spirometry and explained her initial symptoms of progressive shortness of breath, and had a good response.

Pleural Nodules and Mediastinal Lymphadenopathy in a Smoker: An Unusual Case Report

“…Thoracic splenosis is mostly observed as an incidental finding during imaging studies, with a mean delay of up to 21 years [ 2 ]. Symptomatic thoracic splenosis with symptoms such as pleural pain, hemoptysis and dyspnea is rare, but has been reported [ 3 , 4 ]. Due to the higher rate of trauma in young men, thoracic splenosis has a male-to-female ratio of 30: 8 [ 1 ].…”

“…Both visceral and parietal pleura can be affected, most often on the left side. Cases with mediastinal and parenchymal involvement have also been reported [ 4 , 5 ]. CT imaging shows solitary or multiple well-defined, noncalcified pleural nodules of variable size, predominantly in the left hemithorax.…”

Unusual case of iron overload with cancer-mimicking abdominal splenosis

“…The incidence of splenosis is widely variable, being reported in 25%–65% of patients splenectomised after trauma and in 16%–20% of those undergoing elective splenectomy for haematological disorders 4–6. Diagnosis is often challenging and should be considered whenever intraperitoneal nodules of uncertain significance are incidentally found decades after splenectomy, possibly raising a misleading suspicion of malignancy 7. Most patients are asymptomatic, but complications including haemorrhage, pain or bowel obstruction can rarely occur 8.…”