Changes in the filtration function of the spleen after surgery following traumatic organ injuries

The incidence of splenic injuries among all closed injuries of the abdominal cavity is from 15.5 to 30.0 %, and a mortality rate is between 7 % and 26 %. The tactics in the treatment of splenic injuries is determined by the degree of traumatic injury, the patient's condition during the operation, and a concomitant pathology. Studies of tissue regeneration of the operated spleen allow identifying two main options for its regeneration, associated with the nature of blood circulation in the preserved part. Objective — to study the regeneration and filtration function of the spleen after various types of surgery for the management of traumatic spleen injuries. Materials and methods. The results of treatment of 85 patients in the period 2015 — 2020 were analyzed. To investigate the changes in the filtration function of the spleen, a study of the peripheral blood (general blood test) was performed to assess the shape of erythrocytes. In order to determine the size of the residual splenic parenchyma, its structure and regenerative processes were evaluated and sonographic examination was carried out. Results. The average increase in the size of the residual splenic tissue after subtotal resection of the organ with the formation of couplings of the parenchyma averages 40.2 ± 3.4 % one year after surgery, and in patients who underwent subtotal resection of the spleen with covering the cut plane with adhesive hemostatic plate 70 % — 49.14 ± 6.77 %. The study of changes in the filtration function of the spleen in patients, who underwent subtotal resection of the spleen, showed the appearance of target cells, acanthocytes and halocytes in the peripheral blood, but their number was insignificant and did not exceed normal (not more than 3 %). Any destroyed and pathologically altered erythrocytes were not visualized in patients, who underwent atypical resection of the spleen (mass deficit less than 30 %). Conclusions. Spleen regeneration is determined both by the nature of blood supply to the residual splenic tissue and its size, and does not depend on the nature of the pathological process. Organ‑preserving surgical interventions on the spleen allow maintaining the filtration function of the spleen.

Aggressive systemic mastocytosis with diffuse bone marrow 18F-FDG uptake

Mastocytosis is a clonal hematopoietic disorder characterized by proliferation of abnormal mast cells in various organs including the skin, digestive system, lymph nodes, and bone marrow. We report on a 75-year-old woman presenting with abdominal pain, vomiting, diarrhoea, myalgia, and weight loss. Abdominal CT showed hepatosplenomegaly with heterogeneous splenic parenchyma, lymphadenopathy, and osteopenia with areas of osteosclerosis but no primary tumour. An 18F-FDG PET/CT revealed an overall low metabolic activity of the lesions with a diffuse bone marrow involvement raising suspicion of a haematological neoplasm. Subsequently, bone marrow and peripheral blood examinations confirmed the diagnosis of aggressive systemic mastocytosis.

Age-Related Variation in Sympathetic Nerve Distribution in the Human Spleen

Introduction: The cholinergic anti-inflammatory pathway (CAIP) has been proposed as an efferent neural pathway dampening the systemic inflammatory response via the spleen. The CAIP activates the splenic neural plexus and a subsequent series of intrasplenic events, which at least require a close association between sympathetic nerves and T cells. Knowledge on this pathway has mostly been derived from rodent studies and only scarce information is available on the innervation of the human spleen. This study aimed to investigate the sympathetic innervation of different structures of the human spleen, the topographical association of nerves with T cells and age-related variations in nerve distribution.Materials and Methods: Spleen samples were retrieved from a diagnostic archive and were allocated to three age groups; neonates, 10–25 and 25–70 years of age. Sympathetic nerves and T cells were identified by immunohistochemistry for tyrosine hydroxylase (TH) and the membrane marker CD3, respectively. The overall presence of sympathetic nerves and T cells was semi-automatically quantified and expressed as total area percentage. A predefined scoring system was used to analyze the distribution of nerves within different splenic structures.Results: Sympathetic nerves were observed in all spleens and their number appeared to slightly increase from birth to adulthood and to decrease afterward. Irrespective to age, more than halve of the periarteriolar lymphatic sheaths (PALSs) contained sympathetic nerves in close association with T cells. Furthermore, discrete sympathetic nerves were observed in the capsule, trabeculae and red pulp and comparable to the total amount of sympathetic nerves, showed a tendency to decrease with age. No correlation was found between the number of T cells and sympathetic nerves.Conclusion: The presence of discrete sympathetic nerves in the splenic parenchyma, capsule and trabecular of human spleens could suggest a role in functions other than vasoregulation. In the PALS, sympathetic nerves were observed to be in proximity to T cells and is suggestive for the existence of the CAIP in humans. Since sympathetic nerve distribution shows interspecies and age-related variation, and our general understanding of the relative and spatial contribution of splenic innervation in immune regulation is incomplete, it remains difficult to estimate the anti-inflammatory potential of targeting splenic nerves in patients.

Giant complex non-parasitic splenic cyst in a young boy: is laparoscopic spleen-preserving surgery safe?

Non-parasitic splenic cysts are an uncommon finding in pediatric patients. We report on a 14-year-old male presenting with a giant abdominal mass. Imaging documented a giant splenic cyst, and preoperative blood tests revealed high levels of CA125. Minimally invasive unroofing of the cyst was performed. Notably, the cyst content was hematic, but histopathological studies described a mesothelial cyst lining. To date, no recurrence has been noted. Laparoscopic spleen-preserving surgery appears to be a valid and safe treatment option in children with complex non-parasitic splenic cyst to preserve the splenic parenchyma.

Impact of region-of-interest size and location on quantitative contrast-enhanced ultrasound of canine splenic perfusion

Background During contrast enhanced ultrasound (CEUS), the features of the regions of interest (ROI) can affect the value of the perfusion-related parameters obtained from a time intensity curve (TIC). In veterinary medicine, conflicting have been reported on the influence of ROI size and location on renal CEUS. There are some disagreeing evidences regarding the optimal method for selecting ROI in quantitative analysis of renal perfusion using CEUS. The aim of this study was to evaluate the effect of the size and location of ROIs in the spleen of conscious dogs on perfusion variables determined using sulphur hexafluoride contrast-enhanced ultrasounds. Results A prospective observational study on 15 client-owned mixed-breed adult dogs was performed using a system equipped with contrast-tuned imaging technology. Qualitative and quantitative assessments of the spleen enhancement pattern were carried out. Three square ROIs (0.05 cm2) were manually drawn in a row and spaced 1 mm apart, placing adjacent ROIs at three different depths. Three medium rectangular ROIs (0.3 cm2) include the 3 smallest ROIs in each row, indicated by the letters A, B and C, and a single large square ROI (1 cm2) was drawn containing all previous ROIs. Software analysis of time-intensity curves generated within each ROI allowed us to calculate the perfusion-related parameters: peak enhancement, time to peak, regional blood flow, mean transit time and regional blood volume. The coefficient of variation for all blood-related parameters was always lower in the larger ROI than in the other smaller ROIs. ROI A and B, positioned proximally and medially, levels respectively, showed similar coefficients of variation to the largest ROI. The analysis of variance model exhibited a significant effect of location and size of the ROIs in the quantitative analysis of canine spleen perfusion, with a reduction of perfusion-related parameters in the distal ROI. Conclusions The recommendation for a quantitative CEUS examination of a dog’s spleen is to analyze splenic perfusion by drawing a sufficiently large ROI proximal to the ultrasound beam on the splenic parenchyma. This may be of clinical relevance in the diagnosis of splenic diseases.

Gross Morphological and Light Microscopic Studies of the Spleen of Malayan Sun Bear (Helarctos malayanus)

Background: Bear specialist group recommended that the basic research on the Malayan sun bear is the highest priority need. Without such information, the establishment and implementation of scientifically-sound conservation plans is difficult. Therefore, present study was designed to provide information on gross morphological and light microscopic architecture of the spleen.Methods: The present study was conducted on the spleen of one Malayan sun bear. After doing the gross parameters the tissues were fixed in 10% neutral buffered formalin and were processed for light microscopic studies. Blocks were cut at 6μ thickness by Leica Semimotorized Rotary Microtome and stained by Harris’ haematoxylin and eosin for routine study. Result: The spleen of Malayan sun bear was located in the left hypogastric region and entirely intrathoracic as the stomach was almost empty. The parietal surface faces the diaphragm and left lateral abdominal wall, whereas the visceral surface was divided into gastric face and intestinal face by the ridge like hilus. The spleen of Malayan Sun Bear was surrounded by a thick connective tissue capsule invested by the peritoneum. The capsule, trabeculae and reticular fibers support the splenic parenchyma composed of a red pulp and a white pulp.

The spleen of Sonali chicken: morphohistology and biometric analysis at post hatching ages

Although Sonali chicken is introduced to the poultry industry of Bangladesh during 1999-2000 and after that playing a pivotal role in national economy, no literature is available regarding histomorphometry of spleen of Sonali chicken. As spleen is a key component of chicken’s defense mechanism, the study was designed to investigate the age related development of spleen of Sonali chicken, i.e, morphohistology and biometry at several postnatal stages. The investigation was carried out on 25 healthy Sonali chickens representing different ages at after hacting days 1, 14, 28, 42, and 56 (n=5). After ethically sacrifice (cervical subluxation method), spleen was collected and subjected for both macro and microscopic examinations. Haematoxylin and Eosin stain was done for the later. Morphologically, spleen was found lying dorsally at the right side of the abdominal cavity. It was oval or rounded organ, reddish brown in color. The gross morphometric observations (average weight, organ index, length, width and thickness) found significantly increasing throughout the tenure (p<0.001). In microscopic study, no trabeculae and identifying marginal zone was recorded in the splenic parenchyma of Sonali chicken. And a component of white pulp (lymphatic nodules) appeared at day 14 onward. This study gives an insight about the age correlated development of spleen of Sonali chicken at different age intervals which advance our knowledge and leads an array for further immunization researches about immunological activities and molecular detection of spleen, which would be impossible without learning the basic anatomy. Asian J. Med. Biol. Res. March 2021, 7(1): 69-75

A242 THE AIR BETWEEN US: A CASE OF PSEUDOCYST PERFORATION POST-ENDOSCOPIC CLIPPING OF A BLEEDING PANCREATIC-COLONIC FISTULA

Background Pancreatic fistula is an uncommon complication of pancreatitis and is associated with increased morbidity. We discuss a case of pancreatic-colonic fistulization followed by the first reported case of pseudocyst perforation post-colonoscopy. Aims Case Methods A 51 year-old female with decompensated alcoholic cirrhosis admitted with hepatic encephalopathy developed large volume hematochezia during admission. Past medical history includes pancreatic pseudocyst, GERD and remote hernia repairs. For the hematochezia, she was investigated with an EGD and colonoscopy. In the distal descending colon, a bleeding lesion was identified and treated with clips and epinephrine injection (Figures 1 and 2). Five hours post-procedure, she developed abdominal distention. CT abdomen pelvis revealed large volume of free air and simple fluid within the abdominal cavity likely secondary to rupture pseudocyst rupture. The previously visualized pseudocyst was filled with gas plastered against the descending colon. She remained medically stable with conservative management. Results Discussion Conclusions Pancreatic-colonic fistula is an uncommon but potentially life-threatening complication of acute pancreatitis associated with high risk of complications. They are found in 4% of admitted inpatients with acute pancreatitis. There are three proposed mechanisms for their development: firstly, inflammation and activated pancreatic lytic enzymes; secondly, pressure necrosis from a contiguous mass; thirdly, localized portal hypertension. Classically, pancreatic-colonic fistulas present with diarrhea, fever and hematochezia. Gastrointestinal bleeding occurs in 60% of cases. The source of bleed has been described to be originating most commonly from the splenic artery and to a lesser extent, the margin of the fistula or, rarely, erosion of splenic parenchyma. Reported therapeutic management strategies include: hemoclippings and Greenplast sprayings, endoscopic pancreatic stent, transgastric nasocystic drainage catheter placements, injection of N-butyl-2-cyanocrylate and transpapillary nasopancreatic drainage. Pseudocysts arise in 25% of patients with chronic pancreatitis. Pseudocysts may regress through a variety of mechanisms: spontaneously after inflammation from pancreatitis resolves, natural drainage through the pancreatic duct into the duodenum, or through a complicating fistulous tract connecting to the gastrointestinal tract. Rarely, the pseudocyst can resolve as it leaks or perforates into the abdominal cavity. Pancreatic pseudocysts may perforate spontaneously into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity, or through the abdominal wall. We report the first case, to our knowledge, of pancreatic pseudocyst perforation post-clipping of bleeding pancreatic-colonic fistula. Funding Agencies None

Abdominal Splenosis Mimicking a Colon Tumour

Splenosis is a benign condition which results from the self-implantation of splenic tissue on intra or extraperitoneal surfaces, after splenic trauma or splenectomy. Patients are usually asymptomatic but may present with varied symptoms related to the implantation site. The diagnosis is a challenge because abdominal splenosis can mimic several diseases, including neoplasm. The gold standard examination for its diagnosis is scintigraphy with 99mTc-labelled heat-denatured erythrocyte. When splenosis is found in an asymptomatic patient, surgical removal is not indicated. A 57-year-old male patient presented with sporadic epigastric pain and a suspected mass in the recto-sigmoid transition. Abdominal ultrasound, CT and MRI identified this mass, its characteristics and location, but failed to distinguish its nature. However, given the patient’s past history of splenectomy and because the mass showed a similar sign to that of the splenic parenchyma, a hypothesis of abdominal splenosis was raised, which was confirmed by scintigraphy with 99mTc-labelled heat-denatured erythrocyte. In this case, the diagnosis was obtained before the patient was subjected to more invasive procedures, which are associated with high morbidity, and, as in most cases, no targeted intervention was necessary.

Primary Splenic Pleomorphic Liposarcoma in a Bitch

Background: Liposarcoma is a malignant neoplasm of lipoblasts with low incidence in dogs, representing 1.7% of neoplasms diagnosed in the spleen. In veterinary medicine, this neoplasm is classified morphologically into the myxoid, well-differentiated, undifferentiated and pleomorphic subtypes, the latter being one of the most aggressive forms, mainly in cavity organs. This study reports a case of primary splenic pleomorphic liposarcoma in a female dog, addressing anatomopathological and immunohistochemical aspects.Case: A 14-year-old, 35 kg female mongrel canine with a history of absence of defecation, progressive weight loss, difficulty walking, sensitivity to abdominal palpation, prostration, pale mucous membranes, tachypnea and abdominal distention. The condition evolved to death and, on necroscopy, there was an increase in splenic volume with neoformation of whitish and reddish color, measuring 32 × 27 cm in its largest axes and weighing 8.9 kg. The neoformation exhibited areas of firm and soft consistency, and sectioning revealed the existence of focal areas of extensive necrosis and cavity collections of different diameters that allowed the flow of liquid serous contents with a brownish red color. Microscopy showed cells of neoplastic morphology infiltrating the splenic parenchyma, mostly with slightly acidophilic cytoplasm and few intracytoplasmic lipid vacuoles, which varied in size and distribution. The nuclei of the cells were large, eccentric and irregular, with round to oval morphology, grossly lacy chromatin and single or multiple evident nucleoli. These cells exhibited marked anisocytosis, anisokaryosis and pleomorphism, with more than one mitotic figure per high magnification field visible. Moderately inflammatory infiltrate, predominantly lymphocytic, permeated the neoplastic cells, and marked depletion of lymphoid follicles and atrophy of the red pulp were found in the remaining splenic parenchyma. Immunohistochemical tests revealed marked and discrete immunostaining for anti-vimentin and anti-S100 antibodies, respectively. No staining was observed for anti-pan cytokeratin, anti-desmin, anti-alpha smooth muscle actin or anti-CD20 antibodies. Based on anatomopathological and immunohistochemical aspects, it was concluded to be a splenic pleomorphic liposarcoma of primary origin.Discussion: the spleen is not a common anatomical site for the development of liposarcoma, a neoplasm whose origin remains unclear. Similar to what occurs in humans, liposarcoma is believed to develop from the adipose tissue of the splenic hilum. Thus, it should be considered as a differential diagnosis of invasive abdominal tumors. For the identification and classification of liposarcoma as a pleomorphic subtype, we considered mainly histological findings such as marked cell atypia and intracytoplasmic lipid vacuoles, which may or may not be present in neoplastic cells. Immunohistochemical examination favored the diagnosis of liposarcoma, regardless of the subtype, due to the marked immunostaining for the anti-vimentin antibody, unlike immunostaining for the anti-S100 antibody, for which it was variable. This fact is related to adipocyte differentiation, where lower amounts of intracytoplasmic lipids translate into lower immunostaining intensity for anti-S100. Histological and immunostaining aspects should be regarded with caution in the diagnosis of pleomorphic liposarcoma, as it is a distinct neoplastic entity, with a complex karyotype and without correlation with the other subtypes.