1/37. Systemic infection with Alaria americana (trematoda).Alaria americana is a trematode, the adult of which is found in mammalian carnivores. The first case of disseminated human infection by the mesocercarial stage of this worm occurred in a 24-year-old man. The infection possibly was acquired by the eating of inadequately cooked frogs, which are intermediate hosts of the worm. The diagnosis was made during life by lung biopsy and confirmed at autopsy. The mesocercariae were present in the stomach wall, lymph nodes, liver, myocardium, pancreas and surrounding adipose tissue, spleen, kidney, lungs, brain and spinal cord. There was no host reaction to the parasites. Granulomas were present in the stomach wall, lymph nodes and liver, but the worms were not identified in them. hypersensitivity vasculitis and a bleeding diathesis due to disseminated intravascular coagulation and a circulating anticoagulant caused his death 8 days after the onset of his illness.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
2/37. Gastric cancer with sarcoid reactions in the regional lymph nodes, the stomach wall, and the splenic parenchyma: report of a case.A 66-year-old man was referred to our institute for investigation of heartburn and epigastralgia. Endoscopic examination demonstrated a type 4' gastric cancer which occupied the whole stomach. At laparotomy, multiple small nodules were found in the spleen which were diagnosed as metastases of the gastric cancer. Thus, total gastrectomy with distal pancreatectomy, splenectomy, cholecystectomy, and left adrenalectomy, combined with D4 lymph node dissection, was performed. Microscopic examination of the tumor revealed tubular and mucinous adenocarcinoma which invaded the muscularis propria. Sarcoid reactions were observed in the submucosa adjacent to the carcinoma tissue. Only one lymph node from station no. 8a demonstrated tumor metastasis, while those from station nos. 1, 2, 7, 8, 9, 10, 11, 13, and 16 revealed sarcoid reactions without tumor metastases. Subsequently, the multiple small nodules that had been presumed to be splenic metastases at laparotomy were found to be sarcoid reactions similar to those seen in the submucosa and regional lymph nodes. Since no skin or ocular lesions indicative of systemic sarcoidosis were seen in this patient, a diagnosis of advanced gastric cancer associated with sarcoid reactions was established. To our knowledge, there have been no previous reports regarding an association between sarcoid reactions in the spleen and gastric cancer.- - - - - - - - - - ranking = 2keywords = spleen (Clic here for more details about this article) |
3/37. Systemic bartonella henselae infection with hepatosplenic involvement.BACKGROUND: Systemic manifestations of bartonella henselae infection are rare in the immunocompetent host. The infection generally has initial symptoms of prolonged fever and multiple granulomatous lesions in liver and spleen. methods: Retrospective analysis of the records of all patients with hypoechogenic lesions in the liver and/or spleen diagnosed from 1990 through 1996 in three pediatric clinics in northern italy. RESULTS: Among the 13 patients reviewed, 9 had evidence of B. henselae infection and hepatosplenic involvement: five had prolonged and unexplained fever lasting from 3 to 16 weeks, and four had typical cat-scratch disease and peripheral lymphadenitis. All patients had increased sedimentation rate and normal aminotransferase serum activity. Five children had a liver biopsy, by laparotomy in three and by needle in two. In all, the predominant liver lesion was a necrotizing granuloma. All patients were treated with broad-spectrum antibiotics. fever lasted from 3 to 16 weeks, and hepatic and splenic lesions resolved in all with residual splenic calcification in one. CONCLUSIONS: Systemic B. henselae infection represents an important cause of inflammatory hypoechogenic hepatosplenic lesions in children. serology provides rapid diagnosis, avoiding multiple and invasive investigations. Hepatosplenic involvement can be found even in children with typical cat-scratch disease without apparent systemic manifestations. The frequency of liver and/or splenic involvement in cat-scratch disease is probably underestimated.- - - - - - - - - - ranking = 2keywords = spleen (Clic here for more details about this article) |
4/37. Hepatic and splenic involvement in cat-scratch disease: imaging features.Hepatosplenic involvement in cat-scratch disease, probably underdiagnosed, is characterized by multinodular lesions throughout the liver and spleen. Radiologic features of ultrasound, computed tomography, and magnetic resonance imaging are not specific. The key of the diagnosis relies on a history of cat or kitten contact. A specific serological test can confirm the diagnosis without invasive procedures such as biopsy.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
5/37. Epithelial inclusion cyst (epidermoid cyst) formation with epithelioid cell granuloma in an intrapancreatic accessory spleen.The histologic characteristics of a case of epidermoid cyst formation with an epithelioid cell granuloma that developed in intrapancreatic accessory spleen were investigated, with the aim of clarifying its origin as well as etiologic factors. The patient, a 48-year-old male, was found to have a cystic lesion in the tail of the pancreas and renal cell carcinoma (clear cell carcinoma) during a medical check up. The pancreatic mass appeared to be a so-called "mucinous tumor" on imaging, and combined resection of the body and tail of the pancreas and the spleen was performed together with a left nephrectomy. The lesion in the tail of the pancreas was then demonstrated to have accessory splenic tissue with cyst formation in its central region. The cystic wall was covered with stratified squamous epithelium and ductal epithelium with squamous metaplasia, and pancreatic islet cells were evident at various sites within the accessory spleen. Formation of epithelioid cell granuloma tissue was observed around the cysts. The epithelium of the cyst was positive for CA19-9 and negative for antibodies against mesothelial cells, whereas the pancreatic island cells were positive for insulin. These results suggested that cystic epithelium in the accessory spleen could be derived from pancreatic duct epithelium. Frequent recurrence of chronic inflammation and epitheloid cell granuloma formation may have resulted from an aberration of the ectopic remaining pancreatic tissue in the spleen.- - - - - - - - - - ranking = 9keywords = spleen (Clic here for more details about this article) |
6/37. Granulomatous renal disease in a patient with common variable immunodeficiency.common variable immunodeficiency (CVID), the most common cause of primary hypogammaglobulinemia, is characterized by a decreased serum immunoglobulin level, recurrent infections, and the occurrence of various autoimmune diseases. Granulomatous disease has been reported previously in several patients with CVID, with granuloma occurring in the lymph nodes, spleen, liver, central nervous system, and bone marrow. We report the first published case of renal granulomatous disease in a CVID patient presenting with subacute renal failure. Renal function partially recovered after corticosteroid treatment and intravenous immunoglobulin infusions. The pathogenesis of granulomatous disease in CVID is unclear but may involve monocyte and T-cell abnormalities.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
7/37. fusariosis, myasthenic syndrome, and aplastic anemia.fusarium, a fungus, produces a potent mycotoxin that, when ingested with contaminated cereal grains, produces a serious illness in man called alimentary toxic aleukia (ussr) and Akakabi-byo (japan). The illness includes gastrointestinal symptoms and weakness and if ingestion of fusarium contaminated grain persists, culminates in aplastic anemia. A 66-year-old woman had Eaton-Lambert syndrome and a clinical course similar to alimentary toxic aleukia. Several months before her death, pancytopenia, initially thought guanidine-induced, developed and progressed to aplastic anemia despite discontinuation of guanidine 2 1/2 months before death. autopsy showed numerous granuloma in the liver, spleen, esophagus, and cecum from which fusarium oxysporum was isolated. Although the unique finding of systemic fusariosis may relate to altered host resistance terminally, a causal relationship with her defect of neuromuscular transmission and/or aplastic anemia is a distinct possibility.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
8/37. Splenic granulomas in crohn disease.Granulomas have been described in a wide variety of organs in patients with crohn disease, but not in spleen. This report describes a patient with noncaseating granulomas of the liver and spleen that responded promptly and fully to glucocorticoid therapy.- - - - - - - - - - ranking = 2keywords = spleen (Clic here for more details about this article) |
9/37. Systemic granulomatous necrotizing vasculitis in a MPO-ANCA-positive patient.We present a case of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis that demonstrated a systemic granulomatous lesion at autopsy. The patient initially showed anorexia, general malaise and anemia. colon fiber was examined to detect the bleeding site, which revealed ischemic mucosal damage associated with venous fibrin thrombus. Because a high titer of MPO-ANCA was found, ANCA-associated vasculitis was suspected and the patient was started on steroid pulse therapy. However, anemia, renal failure and respiratory failure worsened and the patient died of sudden cardiac failure 2 days after the start of the therapy. An autopsy revealed systemic arteritis in multiple organs including the kidneys, liver, spleen, gastrointestinal system and genital organs that indicated fibrinoid necrosis accompanied by granulomatous reaction with multinucleated giant cells; the granulomatous reaction further extended along the splenic capsule. glomerulonephritis and diffuse pulmonary damage, which are common in MPO-ANCA-associated vasculitis, were almost absent but parapleural fibrosis was present. The direct cause of death was presumed to be hemorrhagic shock due to rupture of an aneurysm in the gastric subserosa. As far as we know, this is the first case of a systemic granulomatous reaction in MPO-ANCA-positive vasculitis, although the cause of the granulomatous lesion is unknown.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
10/37. Disseminated infection with bartonella henselae as a cause of spontaneous splenic rupture.A 65-year-old man developed massive hemoperitoneum secondary to spontaneous splenic rupture. Histopathological analysis of the spleen demonstrated necrotizing granulomas. Results of serological tests indicated infection with a species of Bartonella, and immunohistochemical staining established bartonella henselae as the cause of splenitis. To our knowledge, this represents the first reported case of spontaneous splenic rupture caused by infection with a species of Bartonella.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
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