腹腔异位脾的临床及病理特征分析:13例报告

Clinical and pathological characteristics of abdominal ectopic spleen:13 cases report

目的总结分析腹腔异位脾的临床表现、疾病诊断及病理特点。方法回顾性分析海军军医大学附属长海医院2013年1月-2018年12月确诊为腹腔异位脾患者的临床、病理特征以及随访资料。结果共确诊腹腔异位脾13例,其中因体检发现7例(53.8%)。13例中,术前诊断为异位脾的仅1例,其余术前诊断主要考虑为肿物邻近脏器肿瘤。13例腹腔异位脾中位于胰腺的共6例,均位于胰腺尾部。所有手术标本大体病理均表现为边界清楚的结节状肿物,镜下均可见脾实质结构。术后病理检查2例未见脾小梁及明显中央小动脉,其余11例均可见多少不一的脾小梁、中央小动脉及次级滤泡结构。13例随访结果中仅1例因胃癌进展去世,1例失访,其余11例均存活。结论腹腔异位脾缺乏特异性临床表现,须与腹腔肿瘤行鉴别诊断。脾组织植入与副脾可能具有不同病理特征,副脾与正常脾脏结构类似,脾组织植入可能缺乏典型脾脏白髓结构。

Objective To analyze the clinical manifestation,diagnosis and pathological features of abdominal ectopic spleen(AES)cases.Methods The clinical and pathological characteristics were retrospectively analyzed along with the followup data of patients diagnosed as AES in the Changhai Hospital affiliated to Naval Medical University from Jan.2013 to Dec.2018.Results A total of 13 cases of AES were diagnosed,of whom 7 cases(53.8%)were found due to medical examination,and only one case was diagnosed before operation,while the rest were considered as having tumor of the abdominal organ near the mass.Out of the 13 cases,the AES in 6 cases were located at the pancreas tail.The surgical excision samples showed an appearance of nodular lesion with clear contour,and the structure of spleen parenchyma could be identified under microscope.Among the 13 cases,spleen trabecular and obvious central arterioles were absent in 2 cases with history of surgery,while the rest 11 cases shared the pathological features of spleen trabecular,central arterioles and secondary follicles.All the 13 patients survived except one died due to progression of gastric cancer and another one missing of follow-up.Conclusions The AES lacks specific clinical features,which requires antidiastole with abdominal tumors.It is inferred from clinicopathological features that splenosis may differ from accessory spleen,that is,splenosis may lack typical spleen white pulp.