Splenosis

Classification according to ICD-10
D73.8	Splenosis
ICD-10 online (WHO version 2019)

Under a splenosis (lat. Rinse = spleen) refers to the spread of spleen tissue with implantation at a different location ( heterotopic autotransplantation ), such as may occur during a traumatic rupture of the spleen or abdominal surgery. Depending on the location of the spleen, the abdominal cavity, including the pelvic cavity, is primarily affected. Individual reports also describe splenosis in the thoracic cavity , subcutaneous tissue , liver or cranial cavity . Splenosis must be distinguished from the presence of additional spleens ( secondary spleens), which are innate and the result of an embryological malformation. Above all, it is clinically important to differentiate between malignant tumor diseases.

History

The first description of a splenosis was in 1911 by Faltin , before Buchbinder. and Lipkoff. Introduced the term into scientific literature in 1939.

Epidemiology

Splenosis is said to be somewhat more common in men than in women, which is most likely to be explained by the higher frequency of splenic trauma in men.

Causes and origins

A prerequisite for the development of a splenosis is a rupture of the spleen, usually in the context of an accident or an abdominal operation, especially a splenectomy . Splenosis of the abdominal cavity is said to occur in up to 65% of traumatic ruptures of the spleen. Splenosis affecting the chest cavity is much rarer and requires a simultaneous rupture of the diaphragm. The implantation of parts of the spleen into the subcutaneous tissue can result from surgical abdominal interventions or occur in the context of gunshot wounds. Splenosis of the brain or liver is hypothetically explained by the sowing of spleen tissue via the bloodstream (hematogenous).

pathology

Several implants of different sizes made of spleen parenchyma in the soft tissue of the left upper abdomen (large mesh, mesocolon transversum) in the condition after a traffic accident with ruptured spleen and surgical removal of the spleen four years ago. Liver cirrhosis is a secondary finding.

Macroscopically , the splenosis manifests itself in the form of individual nodules of red-blue color and variable shape, mostly distributed in the abdominal cavity, measuring a few millimeters to 12 cm. Due to the restricted blood supply to the spleen nodules, the size of the individual foci is usually less than 3 cm. These sit directly on the implantation site, but can also be connected to it via a tissue stem. Histologically , the splenic parenchyma consists of red and white pulp , similar to the structure of an adjacent spleen .

clinic

An average of 10 years (5 months to 32 years) elapse between injury to the spleen and manifestation of splenosis. Since most patients do not show any symptoms, the abnormality is most likely discovered accidentally during a diagnostic procedure, screening or other disease. Some of the patients show symptoms such as abdominal pain, intestinal obstruction, bleeding or hydronephrosis . Symptoms of splenosis affecting the chest cavity sometimes include coughing up blood ( hemoptysis ) or inflammation of the pleura ( pleurisy ).

Diagnosis and differential diagnosis

A definitive diagnosis is often made by removing tissue and examining the specimen histologically by the pathologist. In diagnostic imaging (e.g. sonography , computed tomography , magnetic resonance tomography ), the image of multiple lesions that often increase in size over time can imitate the image of a malignant tumor disease. In the differential diagnosis, lymphomas , tumor metastases , carcinosis of the peritoneum or pleura, primary kidney or liver tumor, endometriosis or non-tumor-related lymph node swellings are to be differentiated from splenosis .

therapy

As a benign and usually symptom-free abnormality, splenosis often does not require treatment. In symptomatic patients, surgical removal of the foci may be performed.

Individual evidence

1. ↑ ^{a b c d e} R. D. Fremont, TW Rice: Splenosis: A Review. In: South Med J. 2007; 100 (6), pp. 589-593. PMID 17591312 .
2. ↑ R. Faltin: Milzartige formation in the peritoneum. In: German journal for surgery . 1911, pp. 160-175.
3. ↑ JH Buchbinder, CJ Lipkoff: Splenosis: multiple peritoneal splenic implants following abdominal injury. In: Surgery . 1939; 6, pp. 927-930.
4. ↑ ^{a b} J. N. Yammine, A. Yatim, A. Barbari: Radionuclide imaging in thoracic splenosis and a review of the literature. In: Clin Nucl Med. 2003; 28, pp. 121-123, PMID 12544129 .
5. ↑ AH Huang, K. Shaffer: Case 93: thoracic splenosis. In: Radiology. 2006; 239, pp. 293-296, PMID 16567490 .
6. ↑ CR Fleming, ER Dickson, EG Harrison, Jr: Splenosis: auto-transplantation of splenic tissue. In: Am J Med. 1976; 61, pp. 414-419. PMID 96170

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !