Splenosis Mimicking Peritoneal Carcinomatosis

Abstract

A 44-year-old man came to the emergency room for two-week progressive dyspnea. His medical history included morbid obesity, active smoking and childhood severe trauma that required splenectomy. The computed tomography (CT) pulmonary angiography performed to rule out a pulmonary embolism revealed several peritoneal nodules in the upper abdomen (Figure 1A). The additional abdominal contrast-enhanced CT revealed multiple other nodules and homogeneous disseminated peritoneal masses (Figure1B-C). Splenosis nodules were suspected given the history of splenic trauma and the lack of cancer history. A Tc-99m-tagged heat-damaged

Pelvic mass causing hematospermia: splenosis

“…In general, splenosis grows slowly and rarely causes invasion. Patients usually have no discomfort symptoms, and it is often accidentally found in physical examination, imaging examination, abdominal surgery and other cases [ 2 , 4 ]. Spleen tissue or cells can be transplanted not only in various parts of the abdominal cavity [ 4 , 6 , 8 , 13 – 15 ], but also in the retroperitoneal cavity, the chest and even the brain [ 1 , 3 , 6 , 16 – 18 ].…”

“…Splenosis occurs after rupture of the spleen or splenectomy [8], and its essence is heterotopic autologous splenic tissue implantation [2][3][4]. Splenosis was first reported by Albrecht [9] in 1896, and Buchbinder and Lipkoff [10] named this disease in 1939.…”

“…After splenic rupture or splenectomy, the splenic fragments or splenic cells spread to the abdominal cavity or adjacent organ tissues. These cells or tissues are implanted, and they receive blood supply from adjacent tissues and gradually differentiate into mature splenic tissues [1][2][3]. Due to limited blood supply, most implanted spleens are nodular and smaller than 3 cm in diameter, often do not need surgical intervention.…”

Perirectal intraperitoneal splenosis: A case report of MRI with laparoscopic correlation

“…Splenosis is the heterotopic implantation of splenic tissue after trauma or surgery [10] . Usually it is asymptomatic, unless complications, such as infarction, pain, intestinal obstruction, adhesive bands or gastrointestinal haemorrhage, occur [7] .…”

“…Usually, ectopic splenic tissue presents on CT and MRI with similar signals as normal splenic tissue. Principally, splenosis could have been non-invasively confirmed with a Tc99m-DRBC scintigraphy [ 10 , 14 ]. On cross-sectional imaging, the deep spaces of the lesser pelvis can be difficult to differentiate and can be challenging for radiologists to assess.…”