Thoracic Splenosis - A necessary differential diagnosis for pleural based nodules with history of thoracoabdominal trauma

Thoracic Splenosis (TS) is a rare medical condition, where there is auto-transplantation of the splenic tissue in the thoracic cavity, often leading to pleural based nodules. Our patient is the first ever case of this condition in Pakistan, and underwent extensive diagnostic procedures as well as medical treatments, before receiving the diagnosis of TS. He underwent HRCT for chronic cough that revealed pleural and mediastinal nodules. This coupled with a vague mass in the testes led to the provisional diagnosis of metastasized testicular tumour, and later a diagnosis of pulmonary tuberculosis was made. However, eventually a 99mTc denatured red blood cell scan confirmed the diagnosis of TS. TS is a benign condition, whereas other causes of pleural nodules are relatively malignant, hence its diagnosis is essential in ruling out malignancies. Among the multiple invasive and non-invasive diagnostic modalities, the gold standard remains 99mTc denatured red blood cell scan, which is a sensitive test that provides an accurate diagnosis and bars the need of multiple invasive procedures. doi: https://doi.org/10.12669/pjms.38.3.4563 How to cite this:Mehmood F, Murtaza MM, Ali S, Ashraf A. Thoracic Splenosis - A necessary differential diagnosis for pleural based nodules with history of thoracoabdominal trauma. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4563 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Splenectomy for Aseptic Splenic Abscess

Highlight :A 26-year-old woman have sterile aerobic and anaerobic bacterial cultures.Pus and splenic tissue examination revealed no bacterial proliferation, while the surgery revealed a splenic abscess.Abstract:We presented a rare case, a 26-year-old woman have sterile aerobic and anaerobic bacterial cultures. Clinical examination of the patient showed a dense cystic mass in the left upper abdomen. Ultrasonography examination suspected a dermoid cyst. However, MRI examination of the abdomen showed turbid cystic lesions. The surgery revealed a splenic abscess, while pus and splenic tissue examination revealed no bacterial proliferation. Based on the literature, the patient had a good prognosis.

A Review on Splenic Diffuse Red Pulp Small B-Cell Lymphoma

Splenic diffuse red pulp small B-cell lymphoma (SDRPL) is a rare disease, representing <1% of all non-Hodgkin lymphomas (NHL). The most common clinical manifestations include splenomegaly, lymphocytosis, and hemocytopenia. A diagnosis of SDRPL can be challenging, as it shares multiple clinical and laboratory features with splenic marginal zone lymphoma (SMZL), hairy cell leukemia (HCL), and HCL variant (HCL-v). Obtaining splenic tissue remains the gold standard for diagnosis. In the cases where splenic tissue is not available, diagnosis can be established by a review of peripheral blood and bone marrow studies. SDRPL is characterized by a diffuse involvement of the splenic red pulp by monomorphous small-to-medium sized mature B lymphocytes effacing the white pulp. The characteristic immunophenotype is positive for CD20, DBA.44 (20 to 90%), and IgG, and typically negative for CD5, CD10, CD23, cyclin D1, CD43, annexin A1, CD11c, CD25, CD123, and CD138. The Ki-67 proliferative index is characteristically low. Cyclin D3 is expressed in the majority of SDRPL in contrast with other types of small B-cell lymphomas, thus facilitating the recognition of this disease. There is no standard treatment regimen for SDRPL. Initial treatment options include splenectomy, rituximab monotherapy, or a combination of both. Chemoimmunotherapy should be considered in patients with advanced disease at baseline or progression.

How to Diagnose and Treat CD5-Positive Lymphomas Involving the Spleen

Patients with CD5-expressing lymphomas presenting with splenomegaly are frequently diagnosed with chronic lymphocytic leukemia. The most important differential diagnosis is mantle cell lymphoma, both in its classical and leukemic, non-nodal forms, given its prognostic and therapeutic implications. Other small B-cell neoplasms that frequently involve the spleen and occasionally express CD5 include the splenic marginal zone lymphoma, hairy cell leukemia and, rarely, lymphoplasmacytic lymphoma. The frequency of CD5 positivity depends in part on the sensitivity of the detection methods employed. Usually, a combination of morphological, immunophenotypic and molecular findings allows for a precise sub-classification of CD5-positive, low-grade B-cell lymphomas of the spleen. Some of these tumors may display a mixture of small and larger B cells, raising the possibility of more aggressive lymphomas, such as diffuse large B-cell lymphomas (DLBCL). Approximately 5–10% of DLBCL are CD5-positive and some may manifest as primary splenic lesions. When available, the morphology of DLBCL in the splenic tissue is distinctive and a leukemic picture is very rare. In conclusion, the appropriate morphological and clinical context assisted by flow cytometry panels and/or immunohistochemistry allows the differential diagnosis of CD5-positive, non-Hodgkin, B-cell lymphomas involving the spleen.

Pelvic splenosis mimicking a suspicious adnexal mass

A 58-year-old asymptomatic woman was referred to our gynecologic oncology unit for the management of a left adnexal mass found during a routine gynecologic examination. Her personal history included an emergency splenectomy at the age of 4 years old, following traumatic splenic laceration after a car accident. The patient’s work-up (including transvaginal ultrasound and MRI) confirmed a pelvic solid mass, which was reported as suspicious for malignancy and classified as Ovarian-Adnexal Reporting & Data System-MRI 5. An exploratory laparoscopy was performed, showing a reddish blue lesion located at the left broad ligament. Histologic analysis showed the presence of splenic tissue and normal adnexa. The postoperative follow-up was uneventful.Pelvic splenosis is a challenging diagnosis rarely made preoperatively due to concern for malignancy. In the presence of a pelvic mass, the collection of a detailed patient’s history, including information about previous splenic rupture, might raise suspicion for pelvic splenosis.

The diagnostic role of Next Generation Sequencing in uncovering isolated splenomegaly: A case report

Many diseases can induce splenomegaly, however, about 5% of splenomegalies are idiopathic. When there is no underlying treatable cause, and the splenomegaly significantly affects the quality of life, splenectomy is the best therapeutic choice. A 67-year-old woman had idiopathic and asymptomatic splenomegaly. The increase in splenomegaly resulted in hypersplenism with cytopenia and symptoms related to abdominal discomfort. The patient underwent splenectomy which led to clinical improvement. A histological examination showed the presence of hematopoietic tissue. Peripheral blood Next Generation Sequencing with the myeloid panel SOPHiA Genetics showed the following mutations: ASXL1, SRSF2, KRAS and TET2. Three out of these four mutations were also found in the splenic tissue. Next Generation Sequencing could be useful in the diagnosis of splenomegalies associated with myeloproliferative neoplasms otherwise defined as idiopathic, in order to address a therapeutic strategy.

Effectiveness of Echinacea purpurea extract on immune deficiency induced by azathioprine in male albino rats

This study was performed to evaluate the effectiveness of Echinacea purpurea (E.P.) on azathioprine (AZA)-induced immune deficiency in albino rats. Thirty six male albino rats were divided into six equal groups. The first group served as normal control, the second and third groups were treated with two doses of AZA (3 and 5mg/kg/b.w/day IP), respectively for six weeks. The fourth group was treated with 50 mg kg/b.wt/day of Echinacea. The fifth and sixth groups were treated with3 and 5 mg AZAm respectively followed by50 mg E.P. administration. At the end of the experimental period, both doses of AZA revealed a significant reduction in total body and spleen weights, increase in tissue total protein with a significant increase in serum total protein and albumin, a marked decrease in the number of WBCS associated with a decrease in the number of lymphocytes, a significant decrease in serum total anti-oxidant capacity. Also,concentration of immunoglobulins (IgG and IgM) and interleukins (IL4 &IL6) showed a significant increase, while the level of IL10 decreased significantly in splenic tissue. The dose of AZA (5 mg /kg b.wt.) only resulted in a highly significant increase in serum level of T3 and T4. However, treatment with Echinacea purpurea extract had a significant influence on immune deficiency induced by azathioprine. These findings demonstrated that E.P. extract is a promising immunomodulatory agent with a potent therapeutic value in stimulating the immune response.

CT semiotics of traumatic and bon-traumatic spleen injures

Purpose. To demonstrate capabilities and features in spleen pathology diagnostics based on clinical experience of Botkin City Hospital.Materials and methods. The analysis of 89 patients with spleen abnormalities was performed in the term from 01/2014 till 08/2020. All the patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI) with contrast enhancing. All cases verified surgically and/or clinically.Results. There were 37 cases of trauma (42%). Accuracy and precision of the method was 100%. In detection of active bleeding the highest diagnostic accuracy (100%) was shown with extravasation symptom – 7 cases. In non-traumatic group (n = 52, 58%) two biggest sub-groups were abscesses (n = 19, 36% in this group) and infarctions (n = 15, 29%). There were 8 cases of cysts (15%), 3 of them – hydatid, 5 cases of spleen hemangiomas. (9.6%), 3 cases of spleen metastases (6%). There was 1 case of angiosarcoma (2%) and 1 case cystic lymphangioma (2%).Conclusion. The most frequent condition in spleen pathology, diagnosed in radiology department is trauma. In non-traumatic cases two biggest groups are abscesses and infarctions. CT features of spleen infarction are pyramidal wedge of hypoperfused splenic tissue with the apex pointing towards the hilum, and the base on the splenic capsule. In all cases in our study cysts were incidental findings. Spleen metastases are rare due to organ hemodynamics. The most rare lesions of the spleen are primal tumors.