Evaluation of a Deep Learning Algorithm for Automated Spleen Segmentation in Patients with Conditions Directly or Indirectly Affecting the Spleen

The aim of this study was to develop a deep learning-based algorithm for fully automated spleen segmentation using CT images and to evaluate the performance in conditions directly or indirectly affecting the spleen (e.g., splenomegaly, ascites). For this, a 3D U-Net was trained on an in-house dataset (n = 61) including diseases with and without splenic involvement (in-house U-Net), and an open-source dataset from the Medical Segmentation Decathlon (open dataset, n = 61) without splenic abnormalities (open U-Net). Both datasets were split into a training (n = 32.52%), a validation (n = 9.15%) and a testing dataset (n = 20.33%). The segmentation performances of the two models were measured using four established metrics, including the Dice Similarity Coefficient (DSC). On the open test dataset, the in-house and open U-Net achieved a mean DSC of 0.906 and 0.897 respectively (p = 0.526). On the in-house test dataset, the in-house U-Net achieved a mean DSC of 0.941, whereas the open U-Net obtained a mean DSC of 0.648 (p < 0.001), showing very poor segmentation results in patients with abnormalities in or surrounding the spleen. Thus, for reliable, fully automated spleen segmentation in clinical routine, the training dataset of a deep learning-based algorithm should include conditions that directly or indirectly affect the spleen.

What is the Effect of Splenic Involvement Sites in Advanced Ovarian, Tubal and Peritoneal Epithelial Cancer on Overall Survival?

Purpose: In this study, we evaluated the significance of parenchymal, hilar, and capsular involvement of the spleen with regard to the overall survival of patients who required a splenectomy during cytoreduction procedures for primary or recurrent cancer. Methods: This study includes data from 287 patients who underwent a splenectomy during optimal cytoreduction in epithelial ovarian, tubal, and peritoneal cancers. Spleen involvement regions were divided into four main groups, and the groups were classified as capsule, hilus, capsule + hilus, and other region involvement (paranchyma ± other(s) involvement site). The overall survivals of these four groups were compared.Results: The mean age of the study group was 57.9 years, and the mean follow-up period of the patients was 43.2 months. The splenic involvement site was most frequently observed as hilus + capsule (42.2% n:121). Splenic parenchymal involvement was present in 27.9% (n: 80) of the patients. The overall survival for patients was 42 months. In the subgroup analysis, the worst overall survival was found in the group with capsule involvement at 33 months.Conclusion: While parenchymal involvement of the spleen was considered to be stage IV according to FIGO staging, we could not detect low overall survival in patients with parenchymal involvement in our study. Our study, which has the largest number in the literature examining the relationship between splenic involvement and overall survival, can provide a remarkable perspective on the relationship between parenchymal involvement of the spleen and prognosis.

Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis

Sarcoidosis is a multi-system disease of unknown etiology characterized by the formation of granulomas in various organs. It affects people of all ethnic backgrounds and occurs at any time of life but is more frequent in African Americans and Scandinavians and in adults between 30 and 50 years of age. Sarcoidosis can affect any organ with a frequency varying according to ethnicity, sex and age. Intrathoracic involvement occurs in 90% of patients with symmetrical bilateral hilar adenopathy and/or diffuse lung micronodules, mainly along the lymphatic structures which are the most affected system. Among extrapulmonary manifestations, skin lesions, uveitis, liver or splenic involvement, peripheral and abdominal lymphadenopathy and peripheral arthritis are the most frequent with a prevalence of 25–50%. Finally, cardiac and neurological manifestations which can be the initial manifestation of sarcoidosis, as can be bilateral parotitis, nasosinusal or laryngeal signs, hypercalcemia and renal dysfunction, affect less than 10% of patients. The diagnosis is not standardized but is based on three major criteria: a compatible clinical and/or radiological presentation, the histological evidence of non-necrotizing granulomatous inflammation in one or more tissues and the exclusion of alternative causes of granulomatous disease. Certain clinical features are considered to be highly specific of the disease (e.g., Löfgren’s syndrome, lupus pernio, Heerfordt’s syndrome) and do not require histological confirmation. New diagnostic guidelines were recently published. Specific clinical criteria have been developed for the diagnosis of cardiac, neurological and ocular sarcoidosis. This article focuses on the clinical presentation and the common differentials that need to be considered when appropriate.

Microscopic Polyangiitis Presenting with Splenic Infarction: A Case Report

Microscopic polyangiitis (MPA) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The splenic involvement in AAV is known to be rare, and that in MPA has not been reported to date. A 74-year-old woman was admitted owing to left arm numbness and weakness. The patient was diagnosed as MPA with vasculitic neuropathy. Her abdominal computed tomography (CT) revealed splenic infarction incidentally. The splenic infarction had been resolved at follow-up CT after treatment. If splenic involvement of MPA was not considered, treatment may have been delayed in order to differentiate other diseases. Herein, I report the first case of splenic involvement of MPA.

An extremely rare case of Rosai-Dorfman disease in the spleen

Background Rosai-Dorfman disease (RDD) is a rare, multisystemic histiocytic disorder, and commonly manifesting as lymphadenopathy in the young male. Abdominal manifestations of RDD are extremely rare. Case presentation In August 2018, a 42-year-old man underwent an abdominal ultrasonography examination due to his weight loss of 10 kg in only three months and found a giant solid tumor was found in his spleen. Then, he was admitted to our hospital and diagnosed as a splenic mass via abdominal enhanced CT and MRI. Laparoscopic splenectomy was administrated within six days of admission due to the clear surgical indications. The pathogenesis of RDD remained poorly understood and the disease should be diagnosed based on histopathology and immunohistochemistry (IHC). The mutations in ATM and NFKBIA were observed using next generation sequencing (NGS). Conclusion We reported a case of splenic involvement of RDD with NGS genetic testing, indicating the difficulty of making a diagnosis before surgery. This extremely rare case offers new references for the understanding of abdominal viscera RDD.

A case of spleen hydatid cyst

The hydatid cyst of the spleen results from the development of the hydatid worm Echinococcus granulosus, in the splenic parenchyma. Humans are the accidental intermediate host in the development cycle of hydatid disease. Splenic involvement is the third most common location after the liver and lung. Echography and sometimes tomography are needed to confirm the diagnosis. In the absence of truly effective medical treatment, splenic hydatidosis often leads to surgery. Resection of the protruding dome is the treatment of choice due to low morbidity and absence of mortality. We report the case of 27 years old, with no particular medico-surgical history, referred to our hospital for the treatment of a splenic hydatid cyst discovered fortuitously during a radiological assessment. The patient was operated by laparoscopy. The treatment consisted of sterilization of the contents of the cyst with hydrogen peroxide, removal of the contents and resection of the salient dome, the results were unremarkable.

Anaesthetic complications and management of a great dane presenting with acute respiratory distress

Anaesthesia can be challenging in animals with acute respiratory distress. This report details the management of a seven-year-old female great dane who initially presented with acute onset tachypnoea and retching. Under general anaesthesia, the dog was initially tachycardic, hypotensive and developed hypoxaemia. CT revealed a hiatal hernia with complete gastric herniation, gastric dilatation and suspected volvulus. At surgery, a type IV hiatal hernia with splenic involvement was confirmed. Following correction of the hernia and repositioning of the stomach and the spleen, oxygen saturation improved, and volume-controlled ventilation was initiated. The dog recovered from general anaesthesia but developed oliguria, anaemia and became oxygen dependent in the following 48 hours. The dog was subsequently euthanased owing to a grave prognosis.