1/98. Inflammatory pseudotumor of the spleen associated with a cavernous hemangioma diagnosed at intra-operative cytology: report of a case and review of literature.This report presents a case of a 40 year old Caucasian female with a 15 cm inflammatory pseudotumor (IPT) of the spleen with associated areas of splenic hemangioma of the cavernous type. Abdominal CT showed a largely fatty splenic mass with enhancing septations, and scattered calcifications, and a small density in the liver. Grossly, the splenic lesion showed a lobulated cut surface with areas of myxoid change, necrosis, hemorrhage and cystic softening. The diagnosis of IPT was suggested at intraoperative consultation using cytologic smears and was, subsequently confirmed on permanent sections. Histologically, the lesion consisted of a densely collagenized spindle cell stroma with patchy aggregates of lymphocytes and plasma cells, and scattered foci showing hemosiderin-laden macrophages extracellular calcium deposits and osseous metaplasia. The stromal spindle cells were immuoreactive for smooth muscle actin and vimentin confirming their myofibroblastic phenotype. There were extensive areas of infarction within the mass. The patient, however, remained asymptomatic preoperatively. Histologic analysis in this case raises the possibility that low grade, perhaps repetitive, trauma to the hemangioma may have resulted in intralesional hemorrhages which, through a process of organization, may have evolved into this sizable inflammatory pseudotumor. In addition, this report reviews the current literature on the clinical significance and presentation, morphologic and immunohistochemical findings, prognosis, differential diagnosis, pathogenesis and therapy of the splenic IPT.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/98. Splenic peliosis: a rare complication following liver transplantation.In this article, we report a rare case of isolated splenic peliosis in an individual who had recently undergone liver transplantation. The disorder had remained clinically and radiologically undiagnosed until he suffered a traumatic rupture of the affected organ. The relevant literature on this topic is briefly reviewed.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/98. Community-acquired staphylococcus epidermidis endocarditis complicated by splenic disease 9 years after aortic valve replacement.We describe here a case of staphylococcus epidermidis prosthetic aortic valve endocarditis 9 y after valve replacement. Surprisingly, the microorganism was community-acquired, highly virulent and associated with splenic disease. The patient recovered following emergency valve replacement and prolonged antibiotic therapy. splenectomy was not required.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
4/98. Gastric pseudotumor.The authors present a case report of a pseudotumor of the stomach and a brief discussion about this very unusual entity. A 75-year-old female patient was admitted with melena and a large epigastric tumor; she underwent upper gastrointestinal endoscopy, abdominal ultrasound, magnetic resonance imaging, guided needle aspiration and angiography. Preoperative diagnostic hypothesis included a partially thrombosed aneurysm of the splenic artery, pancreatic cystic neoplasm with gastric invasion and pancreatic pseudocyst complicated with hemorrhage. laparotomy revealed a gastric tumor and the patient was submitted to a radical subtotal Billroth II gastrectomy. Only the pathologic examination revealed the unexpected definitive diagnosis of an organized intramural gastric hematoma. There were no postoperative complications and she remains asymptomatic 10 months after surgery.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
5/98. ultrasonography of hemorrhagic splenic cysts.cysts arising from the spleen are much less common than those arising from other organs such as kidney, liver, and ovary (1). Hemorrhagic cysts of the spleen are rare (1), but we have encountered two patients with this entitiy. The ultrasonograms in each patient demonstrated gravity-dependent layering of two fluids of distinctly different echogenicity. The fluids were contained within a spherical mass. Acoustic enhancement was exhibited behind the mass in each case. This suggested the diagnosis of hemorrhagic cyst.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/98. Needlescopic decapsulation of a splenic epithelial cyst.As technology advances, the techniques of laparoscopic surgery are being refined and their application is expanding to include many disease processes and organs. The new-generation laparoscopic instruments are becoming smaller (less than 5 mm). Expected advantages include improvements in cosmesis and patient satisfaction, and decreased postoperative analgesic requirements. Non-neoplastic cysts of the spleen are rare, and their management has evolved from total open splenectomy to laparoscopic cyst decapsulation. A 22-year-old woman with a symptomatic 10-cm epithelial cyst was treated by splenic decapsulation with needlescopic instruments (3 mm or smaller). Three trocars were used: one 12-mm umbilical and two 3-mm subcostal ports. The cyst was punctured by a Veress needle, and after drainage of straw-coloured fluid, circumferential decapsulation with 5-mm laparoscopic shears through the umbilical port site was done. The patient was discharged within 24 hours, having had a single intramuscular injection of meperidine and an excellent cosmetic result.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
7/98. Splenic abscess: report of six cases and review of the literature.Splenic abscesses are rare but appear to be increasing in frequency. Recent advances in radiologic techniques have affected the diagnosis and management. The purpose of this study was to evaluate these effects. The medical records of one institution were retrospectively reviewed and six cases of splenic abscesses seen between 1989 and 1999 were identified. All patients had predisposing conditions with metastatic hematogenous infection in three and one each with trauma, immunodeficiency, and a contiguous site of infection. fever was present in all patients with chills and vomiting in five and three patients, respectively. Left upper quadrant tenderness appeared in four patients and leukocytosis was found in every patient except one with the acquired immunodeficiency syndrome. Chest roentgenograms were abnormal in five patients with a left pleural effusion most common. Ultrasound revealed the defect in both patients it was utilized in and computed tomography was diagnostic in all cases. The causative organisms were anaerobes in two cases and candida albicans, streptococcus viridans, escherichia coli, and citrobacter freundii each present in one case. radiology guided percutaneous drainage was attempted in four patients but was only successful in one. splenectomy with antibiotics was curative in the remainder with a 100 per cent survival. These data suggest that percutaneous drainage may be appropriate for certain patients initially, but the high failure rate demonstrates that splenectomy remains the standard treatment.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
8/98. Laparoscopic splenopexy by peritoneal and omental pouch construction for intermittent splenic torsion ("wandering spleen").wandering spleen is an extremely rare anatomic variant with potentially serious clinical implications. Usually, splenectomy is advocated for treatment of this disease. Various methods for preserving the wandering spleen by means of splenopexy have been described, including two reports on laparoscopic splenic refixation. We describe the third case in which laparoscopic splenopexy was used to manage chronic intermittent splenic torsion. In a 25-year-old woman, splenopexy was successfully performed by laparoscopic reposition and fixation of the spleen by omental pouch creation. At laparoscopy with a normal operating room setup and four trocars, a free-floating, macroscopically normal spleen attached to an abnormally long vascular pedicle with no gastrosplenic or phrenicosplenic ligaments was detected in the lower right quadrant. The spleen was repositioned and placed in the left phrenorenal angle. Splenopexy was achieved by suturing the left colophrenic ligament to the lateral diaphragm, thus creating a pouch for the inferior part of the spleen, and by suturing the gastrocolic ligament to the anterior diaphragm to create a pouch for the upper splenic pole. The postoperative course was uneventful. At a follow-up examination 3 months after the operation, the patient was well, with no further episode of recurrent abdominal pain. Ultrasonographically, the spleen was seen easily in the left hypochondrium in its normal physiologic position. Laparoscopic splenopexy is a useful option for organ-preserving therapy of the wandering spleen.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/98. Concomitant inflammatory pseudotumor of the liver and spleen.We report the case of a 53-year-old man with inflammatory pseudotumor (IPT) of the liver and spleen. This concomitant association has rarely been reported. The patient presented with a hypoechoic mass in the liver and a clinical picture of recurrent sepsis; hematochemical exams and imaging data were nonspecific. Antibiotic therapy improved the clinical course, but did not resolve it definitively. After 50 days of therapy, as the hepatic mass decreased a similar lesion appeared in the spleen. The final diagnosis was made on splenectomy and an intra-operative biopsy of the residual liver lesion. The diagnostic problems encountered in this very rare association of IPT of the liver and spleen were similar to those for isolated IPT in the respective single organ sites. After 15 months of follow-up, the patient is in good health and no recurrence of symptoms or masses has been observed.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
10/98. Heterotopic ovarian splenoma: report of a first case.We present a case of ovarian splenoma, a form of heterotopic splenic hamartoma consisting of red pulp tissue. The hamartoma was located in ovarian stroma in an otherwise normal ovary. The histology showed interanastomosing vascular channels of splenic sinusoidal red pulp lined by cells that were immunoreactive for antibodies to von Willebrand antigen and CD8, findings consistent with splenic lining cells. The sinuses were lined by cuboidal to flattened cells with ovoid and grooved bland-looking nuclei. Ultrastructurally, the tumor cells showed weibel-palade bodies and lysosomes. To our knowledge, this is the first case of splenic tissue arising in an ovary, and it underlines the trend noted in the literature that splenic hamartoma,although a rare entity, can arise in many retroperitoneal organs, including the ovary.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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