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CASE REPORT
Year : 2022  |  Volume : 55  |  Issue : 2  |  Page : 52-55

Pelvic splenosis in a patient with a 20-year history of splenectomy


Division of Colorectal Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan

Date of Submission28-Apr-2021
Date of Decision21-Jan-2022
Date of Acceptance21-Jan-2022
Date of Web Publication25-Apr-2022

Correspondence Address:
Chun-Ting Chu
Department of Colorectal Surgery, Chia-Yi Christian Hospital, #539, Chung Hsiao Road, Chiayi City 600
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_85_21

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  Abstract 


Pelvic splenosis, also called ectopic pelvic spleen, is a rarely reported clinical condition. Pelvic splenosis refers to autotransplantation of splenic tissue resulting from seeding into the pelvic space that typically occurs after trauma. This report presents the case of a 39-year-old male with a rectal lesion. After a laparoscopic low anterior resection of rectosigmoid colon with colorectal anastomosis, the lesion was resected and diagnosed as an ectopic pelvic spleen. Pelvic splenosis requires no treatment in most cases. Surgery is considered only if it is accompanied with acute complications. When the diagnosis remains unclear, further biopsy or laparoscopy is recommended. If pelvic splenosis is confirmed, careful follow-up is beneficial. Finally, pelvic splenosis should be considered in the differential diagnosis of pelvic masses in patients with a history of splenectomy.

Keywords: Pelvic tumor, spleen, splenectomy, splenosis


How to cite this article:
Huang WL, Chu CT. Pelvic splenosis in a patient with a 20-year history of splenectomy. Formos J Surg 2022;55:52-5

How to cite this URL:
Huang WL, Chu CT. Pelvic splenosis in a patient with a 20-year history of splenectomy. Formos J Surg [serial online] 2022 [cited 2022 May 26];55:52-5. Available from: https://www.e-fjs.org/text.asp?2022/55/2/52/343820



Splenosis is usually an incidental finding and commonly occurs after splenic trauma or after splenectomy.[1] The pathogenesis is possibly the autotransplantation of spleen fragments. It is mostly detected in the peritoneal cavity, with seeding of the peritoneum, omentum, or mesentery.[2] Here, we have reported a patient with pelvic splenosis mimicking gastrointestinal stromal tumor.


  Case Report Top


A 39-year-old male presented with incidental finding of pelvic tumor adhering to the rectum in computed tomography (CT) evaluation for a liver mass [Figure 1]. The patient was asymptomatic. Further imaging with a multiparametric pelvic magnetic resonance imaging revealed a 7 cm × 4.3 cm lobulated mass between the rectum and urinary bladder [Figure 2], [Figure 2], [Figure 3], [Figure 4], [Figure 5].
Figure 1: The axial view of a contrast-enhanced computed tomography obtained during the venous phase showing a 6.3 cm × 5.5 cm lobulated homogeneous soft tissue mass with contrast enhancement in the pelvis adhering to the rectum (arrow)

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Figure 2: Nonenhanced T1-weighted sequence, pelvic magnetic resonance imaging axial view, showing a 7 cm × 4.3 cm lobulated mass lesion (arrow) between the rectum (r) and urinary bladder (b); the lesion has low-signal intensity

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Figure 3: T2-weighted sequence, axial view, showing high-signal intensity

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Figure 4: T2-weighted sequence, sagittal view

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Figure 5: Diffusion-weighted imaging: the lesion showing hyperintensity (arrow)

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The patient had a splenectomy due to spleen rupture during a traffic accident about 20 years ago. Colonoscopy showed no obvious lesion in the lumen of the rectum. Laparoscopic low anterior resection of rectosigmoid colon with colorectal anastomosis was performed, and the pathology revealed ectopic spleen tissue [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]. The patient subsequently recovered well after surgery.
Figure 6: Surgical specimen showing a large lobulated mass with venous engorgement, adhering to the upper rectum

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Figure 7: Dissected surgical specimen showing no mucosal invasion of the rectum

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Figure 8: Pathological examination (Hematoxylin and Eosin staining at 10 × original magnification) showing normal rectal tissues. (M = Mucosa; MM = Muscularis mucosa; SM = Submucosa; ME = Muscularis externa)

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Figure 9: Pathological examination (Hematoxylin and Eosin staining at 10 × original magnification) showing an intact capsule around the splenic tissues. (C = Capsule; R = Red pulp; Arrow = White pulp)

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Figure 10: Pathological examination (Hematoxylin and Eosin staining at 40 × original magnification) revealing splenic tissue, composed of red, white pulp, and central artery, facilitating the diagnosis of pelvic splenosis. (R = Red pulp; W = White pulp; Arrow = Central artery)

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  Discussion Top


Splenosis is an incidental finding as the patients are usually asymptomatic.[1] The interval of time between the initial trauma and the diagnosis varies from 3 to 45 years with an average interval of 21 years.[3] Splenosis refers to autotransplantation of splenic tissue resulting from seeding that typically occurs after trauma.[4] It is mostly detected in the peritoneal cavity and seldom in the thoracic cavity after diaphragmatic trauma. Another proposed mechanism for this condition is hematogenous spread as has been postulation that reported cases of intrahepatic[5] and cerebral splenosis.[6] Splenosis is a benign condition. Splenic tissue is slow-growing and noninvasive. Surgical removal is generally inadvised.[7] However, due to the rarity of this condition and concern for malignancy, tissue diagnosis is usually pursued intraoperatively.[8]

In our case, we had considered preoperative CT-guided percutaneous biopsy of the tumor but deterred due to possible risks including tumor spreading, rectal wall injury, bleeding, or hollow organ perforation. Intraoperative frozen section biopsy revealed an unremarkable lymph node. However, we could not exclude the probability of malignancy. Due to the concern of tumor spreading, laparoscopic low anterior resection of rectosigmoid colon with colorectal anastomosis was performed instead of tumor excision and colon preservation to ensure the en bloc resection.

Once considered a rare condition, abdominal or pelvic splenosis is reported in more than 65% of splenic rupture cases.[9] Our patient had a 20-year-interval between splenectomy and splenosis diagnosis. In conclusion, pelvic splenosis should be considered in the differential diagnosis of pelvic masses in patients with a history of splenectomy.[10]

Ethical statement

This study was approved by IRB of Chia-Yi Christian Hospital, IRB number: IRB2021005. The patient consent was waived by the IRB.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Fremont RD, Rice TW. Splenosis: A review. South Med J 2007;100:589-93.  Back to cited text no. 1
    
2.
Gupta K, Ahluwalia A, Jain T, Saggar K. Abdominal splenosis mimicking peritoneal deposits – A case report. Pan Afr Med J 2014;17:269.  Back to cited text no. 2
    
3.
Yammine JN, Yatim A, Barbari A. Radionuclide imaging in thoracic splenosis and a review of the literature. Clin Nucl Med 2003;28:121-3.  Back to cited text no. 3
    
4.
Tsitouridis I, Michaelides M, Sotiriadis C, Arvaniti M. CT and MRI of intraperitoneal splenosis. Diagn Interv Radiol 2010;16:145-9.  Back to cited text no. 4
    
5.
Kwok CM, Chen YT, Lin HT, Su CH, Liu YS, Chiu YC. Portal vein entrance of splenic erythrocytic progenitor cells and local hypoxia of liver, two events cause intrahepatic splenosis. Med Hypotheses 2006;67:1330-2.  Back to cited text no. 5
    
6.
Rickert CH, Maasjosthusmann U, Probst-Cousin S, August C, Gullotta F. A unique case of cerebral spleen. Am J Surg Pathol 1998;22:894-6.  Back to cited text no. 6
    
7.
Bugiantella W, Crusco F, Avenia N, Fabio R. Thoracic splenosis. Report of a case and review of the diagnostic workup. Ann Ital Chir 2016;87:S2239253X16025834.  Back to cited text no. 7
    
8.
Wu C, Zhang B, Chen L, Zhang B, Chen X. Solitary perihepatic splenosis mimicking liver lesion: A case report and literature review. Medicine (Baltimore) 2015;94:e586.  Back to cited text no. 8
    
9.
Huang AH, Shaffer K. Case 93: Thoracic splenosis. Radiology 2006;239:293-6.  Back to cited text no. 9
    
10.
Lemos AA, Crespi S, Costa S, Marini A. Splenosis of the abdomen and pelvis complicated by torsion of a splenic implant clinically mimicking an acute bowel ischemia. BJR Case Rep 2018;4:20180024.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]



 

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