Laparoscopic Resection of a Left Upper Quadrant Mass Leading to a Surprise Diagnosis

Background. Resplenectomy is most commonly done for the treatment of recurrent idiopathic thrombocytopenic purpura (ITP) refractory to medical management due to the regrowth of a missed accessory spleen. Case Report. A 66-year-old male had undergone open splenectomy for traumatic rupture 40 years ago. He presented with a leiomyosarcoma of his leg, which was surgically removed. When he developed metastatic disease, chemotherapy was started. He developed left upper quadrant pain, and on CT scan, a 5 cm mass compatible with a sarcoma was found between the tail of the pancreas and the left adrenal gland. During laparoscopy, dense adhesion of the omentum to the abdominal wall and the stomach from his previous splenectomy was divided. The lesser sac was opened through the gastrocolic ligament, and the splenic flexure was taken down. Superior and dorsal to the tail of the pancreas next to the left adrenal gland, the mass was identified and carefully dissected out. The vascular pedicle, which originated from a side branch of the splenic vessels at the tail of the pancreas, was stapled. The gastric fundus showed multiple nodules, and therefore, a modified sleeve gastrectomy was done; also, a 2 cm nodule in segment 5 of the liver and an omental nodule were removed. The tumors and gastrectomy specimen were placed in an endobag and removed through a periumbilical mini-incision. The patient recovered without any complications from the procedure and his LUQ pain resolved. Pathology revealed no sarcoma metastases but accessory spleens in all specimens. Discussion. Splenosis with multiple implants within the abdomen after splenectomy for trauma is a rare condition. In our patient, this seems to have been triggered by chemotherapy for his sarcoma resulting in extramedullary hemopoiesis. Laparoscopic removal of accessory spleens can be safely done.

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Accessory Spleen in the Greater Omentum: Embryology and Revisited Prevalence Rates

Cells Tissues Organs ◽

10.1159/000458754 ◽

2017 ◽

Vol 203 (6) ◽

pp. 374-378 ◽

Cited By ~ 4

Author(s):

Nikita Gill ◽

Areeba Nasir ◽

Jennifer Douglin ◽

Bettina Pretterklieber ◽

Hanno Steinke ◽

...

Keyword(s):

Venous Blood ◽

Rare Condition ◽

Accessory Spleen ◽

Vascular Supply ◽

Congenital Disorder ◽

Greater Omentum ◽

Prevalence Rates ◽

Male Specimen ◽

Rare Congenital Disorder ◽

Accessory Spleens

Purpose: To investigate in a large sample the prevalence rates of accessory spleens located in the greater omentum and to explain the embryological background and the vascular supply of this rare congenital disorder. Methods: Evaluation of the presence of accessory spleens located in the greater omentum was performed in 5 different international anatomical centers investigating a total of 1,045 body donors. Arterial and venous blood supply and the precise location of the respective vasculature within the splenic ligaments are described based on dissection of this rare condition in a male specimen. Results: The reported prevalence rates from 5 different centers were: 0.5% (out of 380 body donors), 0% (out of 230 donors), 0% (out of 200 donors), 2% (out of 200 donors), and 0% (out of 35 donors). The cumulative prevalence rate obtained from 1,045 anatomical dissections was 0.6%. The identified accessory spleen measured 3 × 3 × 2.5 cm and was located in the left upper abdominal quadrant. A vascular stag 7.5 cm in length was identified within the gastro-splenic ligament, containing an artery and a vein piercing the greater omentum from posterior. Conclusion: An accessory spleen located in the greater omentum is a rare congenital disorder. Physicians should be aware of the fact that in patients without any representative symptom history a nodular mass located within the greater omentum could be an accessory spleen.

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An extremely rare case of a gastric accessory spleen: case report and review of the literature

BMC Gastroenterology ◽

10.1186/s12876-021-01852-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Guiqin Chen ◽

Lei Nie ◽

Tijiang Zhang

Keyword(s):

Rare Case ◽

Accessory Spleen ◽

Gastric Fundus ◽

Pathological Examination ◽

Review Of The Literature ◽

Gastric Bleeding ◽

Computed Tomographic ◽

Normal Spleen ◽

Elevated Lesion ◽

Lesser Curvature

Abstract Background The accessory spleen has no anatomical or vascular relationship with the normal spleen, The tissue structure and physiological function of the accessory spleen are the same as those of the normal spleen, which usually locate in the splenic hilum and the tail of the pancreas. The aims of this manuscript are to present a rare case of the gastric accessory spleen and a review of the literature. Case presentation A 19-year-old male patient was sent to the emergency department with stomach bleeding after drinking alcohol. The computed tomographic scan showed a 1.2 cm × 1.7 cm mass at the lesser curvature of the gastric fundus. Gastrointestinal endoscopy displayed a submucosal elevated lesion on the gastric fundus, and gastrectomy was performed. Postoperative pathological examination proved an accessory spleen in the stomach. The postoperative course was uneventful, and the patient was discharged on the 6th day after the surgery. Conclusions The accessory spleen at the fundus of stomach is extremely rare, especially in this case, which is accompanied by acute gastric bleeding, and it is difficult to diagnosis before operation. Many literatures reported that it was misdiagnosis as tumor, so it is necessary to diagnose accessory spleen correctly.

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Impact of PET data driven respiratory motion correction and BSREM reconstruction of 68Ga-DOTATATE PET/CT for differentiating neuroendocrine tumors (NET) and intrapancreatic accessory spleens (IPAS)

Scientific Reports ◽

10.1038/s41598-020-80855-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Virginia Liberini ◽

Fotis Kotasidis ◽

Valerie Treyer ◽

Michael Messerli ◽

Erika Orita ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Motion Correction ◽

Accessory Spleen ◽

Pancreatic Neuroendocrine Tumor ◽

Reconstruction Algorithm ◽

Data Driven ◽

Operating Characteristics ◽

Quantitative Pet ◽

Pet Ct ◽

Accessory Spleens

AbstractTo evaluate whether quantitative PET parameters of motion-corrected 68Ga-DOTATATE PET/CT can differentiate between intrapancreatic accessory spleens (IPAS) and pancreatic neuroendocrine tumor (pNET). A total of 498 consecutive patients with neuroendocrine tumors (NET) who underwent 68Ga-DOTATATE PET/CT between March 2017 and July 2019 were retrospectively analyzed. Subjects with accessory spleens (n = 43, thereof 7 IPAS) and pNET (n = 9) were included, resulting in a total of 45 scans. PET images were reconstructed using ordered-subsets expectation maximization (OSEM) and a fully convergent iterative image reconstruction algorithm with β-values of 1000 (BSREM1000). A data-driven gating (DDG) technique (MOTIONFREE, GE Healthcare) was applied to extract respiratory triggers and use them for PET motion correction within both reconstructions. PET parameters among different samples were compared using non-parametric tests. Receiver operating characteristics (ROC) analyzed the ability of PET parameters to differentiate IPAS and pNETs. SUVmax was able to distinguish pNET from accessory spleens and IPAs in BSREM1000 reconstructions (p < 0.05). This result was more reliable using DDG-based motion correction (p < 0.003) and was achieved in both OSEM and BSREM1000 reconstructions. For differentiating accessory spleens and pNETs with specificity 100%, the ROC analysis yielded an AUC of 0.742 (sensitivity 56%)/0.765 (sensitivity 56%)/0.846 (sensitivity 62%)/0.840 (sensitivity 63%) for SUVmax 36.7/41.9/36.9/41.7 in OSEM/BSREM1000/OSEM + DDG/BSREM1000 + DDG, respectively. BSREM1000 + DDG can accurately differentiate pNET from accessory spleen. Both BSREM1000 and DDG lead to a significant SUV increase compared to OSEM and non-motion-corrected data.

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Effective Therapy of Insulinoma by Using Long-Acting Somatostatin Analogue. A Case Report and Literature Review

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0031-1287792 ◽

2011 ◽

Vol 120 (02) ◽

pp. 68-72 ◽

Cited By ~ 10

Author(s):

A. Jawiarczyk ◽

M. Bolanowski ◽

J. Syrycka ◽

G. Bednarek-Tupikowska ◽

M. Kałużny ◽

...

Keyword(s):

Adrenal Gland ◽

Somatostatin Receptors ◽

Subcutaneous Administration ◽

Pancreatic Neuroendocrine Tumor ◽

Somatostatin Analogue ◽

Left Adrenal Gland ◽

Glucose Levels ◽

Long Acting ◽

The Right

AbstractWe are reporting a case of 68-year-old woman with insulinoma, after a non-successful tumor surgery and a long-term diazoxide treatment. She had a lot of hypoglycemia cases, and a weight gain of 50 kg. An abdominal CT scan demonstrated a tumor 28 mm in the diameter, in the head of the pancreas. The patient did not agree for the repeated insulinoma surgery. Furthermore, we found a lesion in the left adrenal gland (14 mm in the diameter) and in the right lung (8 mm in the diameter). Pheochromocytoma was diagnosed on the basis of hypertension, elevated levels of normetanephrine in the 24-h urine collection, and an elevated level of norepinephrine in a plasma sample. After the left adrenal gland removal we observed lower blood pressure. Since we had revealed the presence of somatostatin receptors by the somatostatin receptors scintigraphy, we decided to control hypoglycemia by a monthly subcutaneous administration of the long-acting lanreotide. Because of higher glucose levels (300–400 mg/dl) we started an intense insulin therapy. Nowadays, the patient feels better, she has lost 20 kg of her body weight, and we have observed normal blood glucose levels during the long-term lanreotide treatment. We have noticed neither side effects nor hypoglycemic episodes and we have reduced the dose of insulin. The presented case can be an evidence of the effective treatment of the pancreatic neuroendocrine tumor of insulinoma type, with somatostatin analogue.

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Endothelial Cyst of the Left Adrenal Gland in Female Patient Presented as a Cystic Tumor of the Pancreas: A Case Report

10.7176/jhmn/85-06 ◽

2021 ◽

Keyword(s):

Case Report ◽

Adrenal Gland ◽

Female Patient ◽

Cystic Tumor ◽

Left Adrenal Gland ◽

Endothelial Cyst

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A Case of Left Adrenal Gland Metastatic Cancer Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Aspiration

The Korean Journal of Helicobacter and Upper Gastrointestinal Research ◽

10.7704/kjhugr.2012.12.3.202 ◽

2012 ◽

Vol 12 (3) ◽

pp. 202

Author(s):

Jae Young Oh ◽

Eui Jung Kim ◽

Jung Eun Song ◽

Byung Ho Kim ◽

Hyun-Sik Hwang ◽

...

Keyword(s):

Adrenal Gland ◽

Endoscopic Ultrasound ◽

Fine Needle Aspiration ◽

Metastatic Cancer ◽

Needle Aspiration ◽

Left Adrenal Gland ◽

Ultrasound Guided ◽

Fine Needle

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The hepatothorax: An unusual complication of right sided diaphragmatic injuries

10.32512/jmr.1.2.2018/22.25 ◽

2018 ◽

pp. 22-25

Keyword(s):

Surgical Repair ◽

Rare Condition ◽

Definitive Treatment ◽

Traumatic Rupture ◽

Unusual Complication ◽

Key Words Trauma ◽

Acute Setting ◽

Liver Herniation ◽

Post Traumatic ◽

The Right

Right diaphragmatic post-traumatic rupture with liver herniation is an extremely rare condition. The diagnosis is mainly radiological and the rupture may go unnoticed in the acute setting. Depending on the size of the right diaphragmatic defect, the initial herniation can be partial and the total hepatothorax is established progressively. The diagnosis may be delayed and made with the onset of the first symptoms. Hepatothorax leads usually to severe right lung atelectasis with respiratory and cardiac impairment. Definitive treatment consists in surgical repair of the diaphragm. We present hereby the case of an hepatothorax diagnosed 4 years after a penetrating thoracoabdominal trauma. Key words: Trauma, diaphragmatic rupture, hepatothorax.

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Shock vasopléjico luego de la resección de un fecromocitoma: el rol del azul de metileno

Revista Chilena de Anestesia ◽

10.25237/revchilanestv50-03-03 ◽

2021 ◽

Author(s):

Ramos Matías ◽

Fratebianchi Franco ◽

Verlangieri Stella

Keyword(s):

Methylene Blue ◽

Drug Therapy ◽

Adrenal Gland ◽

Adrenergic System ◽

Left Adrenal Gland ◽

Alternative Drug

We present a case of a patient with hypotension refractory to the administration of norepinephrine after laparoscopic pheochromocytoma resection in the left adrenal gland. We describe the use of methylene blue as an alternative drug therapy to the adrenergic system, as well as associated doses, contraindications and complications.

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BECKWITH'S SYNDROME WITH EXTREME ORGAN HYPERPLASIA

PEDIATRICS ◽

10.1542/peds.52.3.372 ◽

1973 ◽

Vol 52 (3) ◽

pp. 372-381

Author(s):

Thomas F. Roe ◽

Ann K. Kershnar ◽

Jordan J. Weitzman ◽

Luis Salinas Madrigal

Keyword(s):

Adrenal Gland ◽

Abdominal Mass ◽

Severe Hypoglycemia ◽

Immunoreactive Insulin ◽

Left Adrenal Gland ◽

Adrenal Steroid ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Pedunculated Tumor ◽

The Right

A large newborn infant with hemihypertrophy, omphalocele, hepatomegaly, left upper quadrant abdominal mass, and zoster-like skin rash had severe hypoglycemia at 4 hours of age. Serum immunoreactive insulin levels were markedly elevated. Hypoglycemia was not controlled by vigorous medical therapy but blood glucose levels returned toward normal following subtotal excision of the markedly hyperplastic pancreas at 24 days of age. At 4½ months of age, a right upper quadrant abdominal mass was noted and urinary adrenal steroid levels were elevated. The right adrenal gland was found to be markedly hyperplastic and it was removed; the left adrenal gland was slightly hyperplastic. Between the ages of 5 and 8 months the umbilical stump enlarged progressively forming a large pedunculated tumor which was removed. This patient presents an unusually severe example of Beckwith's syndrome with both prenatal and postnatal organ overgrowth, severe hypoglycemia and hyperinsulinism.

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