Splenic inflammatory pseudotumor mimicking angiosarcoma

Splenic tumors are rare. Differentiation of the tumors before operation is of great value regarding the outcome. A case of a 32-year-old man with a splenic inflammatory pseudotumor (IPT) mimicking splenic angiosarcoma is described. The tumor was highly suspected of being splenic angiosarcoma based on radiological findings preoperatively. However, after splenectomy, histopathological examinations revealed splenic IPT. Splenic IPT and angiosarcoma are rare and often pose diagnostic difficulties because the clinical and radiological fi ndings are obscure. Due to large differences in prognosis, we briefl y reviewed the clinical, radiological, and pathological features of both of the tumors.

Pancreas-preserving segmental duodenectomy for gastrointestinal stromal tumor of the duodenum and splenectomy for splenic angiosarcoma

BACKGROUND: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract and occur rarely in the duodenum. Splenic angiosarcoma is an aggressive neoplasm with an extremely poor prognosis. METHODS: We report a case of a 70-year-old man hospitalized for abdominal pain in the upper quadrants, dyspepsia and nausea, previously treated for Hodgkin lymphoma 30 years ago. Abdominal CT showed a solid nodular lesion in the third portion of the duodenum, the presence of retropancreatic, aortic and caval lymph nodes, and four nodular splenic masses. 111 In-octreotide scintigraphy revealed pathological tissue accumulation in the duodenal region, and in the retropancreatic, retroduodenal, aortic and caval lymph nodes, suggesting a nonfunctioning neuroendocrine peripancreatic tumor. RESULTS: At exploratory laparotomy, an exophytic soft tumor was found originating from the third portion of the duodenum. Pancreas-preserving duodenectomy with duodenojejunostomy, splenectomy and lymphnodectomy of retropancreatic aortic and caval lymph nodes were performed. Pathological evaluation and immunohistochemical studies showed the presence of a duodenal gastrointestinal stromal tumor with low mitotic activity and a well-differentiated angiosarcoma localized to the spleen and invading lymph nodes.CONCLUSIONS: We speculated that the angiosarcoma and duodenal gastrointestinal stromal tumors of this patient were due to the treatment of Hodgkin lymphoma with radiotherapy 30 years ago. Pancreas-preserving segmental duodenectomy can be used to treat non-malignant neoplasms of the duodenum and avoid extensive surgery. Splenectomy is the treatment of choice for localized angiosarcomas but a strict follow-up is mandatory because of the possibility of recurrence.

胰腺内副脾误诊2例报告

副脾是指正常脾脏以外存在的,与主脾结构相似,有一定功能的脾脏组织,其中完全被胰腺包裹的胰腺内副脾(IPAS)发生率仅为2%,因其临床症状不典型,影像学特征与胰腺神经内分泌肿瘤、胰腺实性假乳头状瘤以及其他胰腺占位性病变较为相似,临床上容易误诊。本文报道了2例分别被误诊为胰腺神经内分泌肿瘤和胰腺实性假乳头状瘤的IPAS患者,并分析误诊原因,总结诊疗经验,以期提升临床对IPAS明确鉴别诊断的认识。

Reappraisal of surgical decision-making in patients with splenic sclerosing angiomatoid nodular transformation:Case series and literature review

BACKGROUND Many clinicians and surgeons are unfamiliar with the sclerosing angiomatoid nodular transformation(SANT),which is gaining recognition as a benign splenic tumor.We challenge that SANT is rare and whether surgical intervention could be avoided through critical imaging review.AIM To evaluate the incidence of SANT among splenic tumors and the decisionmaking process of SANT management.METHODS Twenty hospitalized patients who underwent splenectomy in 2018 and 2019 in a tertiary university hospital were retrospectively reviewed,and their data on imaging,diagnosis,surgical indications,and courses were recorded.All pathology results were confirmed by pathologist.Discriminative features differentiating SANT from other non-SANT splenic tumors were descriptively analyzed in this case series.RESULTS Fourteen out of 20 patients who underwent splenectomy had splenic tumors,including 3 SANTs(21%splenic tumors),6 non-SANT benign lesions(43%),2 metastatic tumors,and 3 lymphomas.Hypointensity on T2-weighted magnetic resonance imaging(MRI),spoke wheel enhancing pattern in contrasted computed tomography or MRI,and cold spot(low fluorodeoxyglucose uptake)in positron emission tomography(PET)scan helped establish the diagnosis of SANT.Lymphoma,presenting with a hot spot on the PET scan were differentiated from SANT.Surgical indications were reformatted for splenic tumors.Splenectomy need not be performed in patients with typical imaging features of SANT.CONCLUSION SANT is not a rare disease entity in clinical practice.Splenectomy should not be routinely indicated as the only management option for SANT with typical imaging features.

Laparoscopic splenectomy for splenic littoral cell angioma

AIM:To establish the safety and feasibility of laparoscopic splenectomy(LS) for littoral cell angioma(LCA).METHODS:From September 2003 to November 2013,27 patients were diagnosed with LCA in our institution.These patients were divided into two groups based on operative procedure:LS(13 cases,Group 1) and open splenectomy(14 cases,Group 2).Data were collected retrospectively by chart review.Comparisons were performed between the two groups in terms of demographic characteristics(sex and age); operative outcomes(operative time,estimated blood loss,transfusion,and conversion); postoperative details(length of postoperative stay and complications); and follow-up outcome.RESULTS:LS was successfully carried out in all patients except one in Group 1,who required conversion to hand-assisted LS because of perisplenic adhesions.The average operative time for patients in Group 1 was significantly shorter than that in Group 2(127 ± 34 min vs 177 ± 25 min,P = 0.001).The average estimated blood loss in Group 1 was significantly lower than in Group 2(62 ± 48 m L vs 138 ± 64 m L,P < 0.01).No patient in Group 1 required a blood transfusion,whereas one in Group 2 required a transfusion.Two patients in Group 1 and four in Group 2 suffered from postoperative complications.All the complications were cured by conservative therapy.There were no deaths in our series.All patients were followed up and no recurrence or abdominal metastasis were found.CONCLUSION:LS for patients with LCA is safe and feasible,with preferable operative outcomes and longterm tumor-free survival.

Laparoscopic splenectomy for splenic hamartoma:Case management and clinical consequences

Splenic hamartoma is a rare benign tumor,and although minimally invasive surgery may be suitable for this condition,there have only been 2 previous reports of laparoscopic surgery.Here we report the third case of splenic hamartoma managed by laparoscopic splenectomy.A 37-year-old male was incidentally diagnosed by abdominal ultrasonography with a hypoechoic mass measuring 2.5 cm × 2.4 cm in the spleen.Color Doppler sonography showed multiple flow signals within the mass and contrast-enhanced computed tomography revealed strong enhancement of the lesion.On T1-and T2-weighted magnetic resonance images,the splenic mass was demonstrated as isointense and hyperintense respectively.Although a malignant tumor could not be ruled out,a hand-assisted laparoscopic splenectomy was performed because the splenic mass was limited in size and had not invaded adjacent organs.The pathological diagnosis was splenic hamartoma.The postoperative course was uneventful and the patient was discharged by the seventh postoperative day.Although splenic hamartomas have some specific imaging features,more reports and analyses of these cases are required to increase the reliability of the diagnosis and management.Hand-assisted laparoscopic splenectomy may play a pivotal role in the postoperative diagnosis and management of this condition.

Splenic lymphangioma that manifested as a solid-cystic mass:A case report

Lymphangioma,a congenital malformation of the lymphatic system,is usually found in children,and generally occurs in the neck and mediastinum.It is rarely found in the spleen.The clinical features of splenic lymphangioma typically include abdominal pain,nausea,and abdominal distention.Frequently,however, this condition is asymptomatic and is incidentally detected by abdominal ultrasonography or by an abdominal computed tomography(CT)scan.In this paper,we retrospectively describe a case of incidentally detected splenic lymphangioma in a 30-year-old woman with special abdominal contrast material-enhanced CT findings,which was accurately diagnosed by histopathology.The clinical and physical examinations related to the mass were negative.A few cases of splenic lymphangioma have been reported previously;however,the presentation of the mass and the enhancement pattern in the contrast medium-enhanced CT images were quite extraordinary.These findings had misled our abdominal radiologists to consider it as other neoplastic diseases of the spleen.

原发性脾脏肿瘤125例临床分析

目的探讨原发性脾脏肿瘤的临床病理特点及外科治疗效果。方法回顾性分析125例原发性脾脏肿瘤的治疗情况。结果 125例患者中查体发现53.6%(67例)。124例行手术切除肿瘤,1例行活检。病理结果血管瘤41例,淋巴瘤59例,脾血管肉瘤10例,淋巴管瘤5例,肌纤维母细胞肿瘤4例,间皮瘤2例,血管内皮瘤2例,脾脏肉芽肿1例,脾脏转移瘤1例。术后良性肿瘤均长期生存,恶性肿瘤平均生存时间11.2个月。结论原发性脾脏肿瘤缺乏特异性症状,B超和CT为首选检查方法 ,手术切除为治疗的主要手段。

原发性脾脏良性肿瘤的诊断与治疗

目的 探讨原发性脾脏良性肿瘤的诊断和治疗对策。方法 回顾性分析 2 7例原发性脾脏良性肿瘤的临床表现、影像学特点和疗效。 2 6例患者行B超检查 ,其中 2 3例行CT检查 ,2例行MRI检查。 2 4例作脾脏切除术。结果 原发性脾脏良性肿瘤临床表现无特异性 ,仅 16例有非特异性临床表现。影像学检查多表现为脾实质内单发或多发的实性或囊性结节 ,B超定位诊断率为 10 0 % ,CT、MRI对良性脾脏肿瘤的定性诊断率为 90 %以上 ,尤其适用于脾脏血管瘤和囊肿的诊断。脾脏切除术疗效好。结论 原发性脾脏良性肿瘤的诊断关键在于提高警惕 ,并选用合适的影像学检查以确诊。

脾脏肿瘤32例诊治体会

目的 探讨脾脏肿瘤的临床诊断与治疗。方法 对 32例经外科手术并经病理证实的脾脏肿瘤临床资料进行回顾性分析。结果 32例均经 2 3例进行 CT检查。5例转移性脾肿瘤行选择性脾动脉造影 ,术后病理示 :良性肿瘤 12例 ,原发性恶性肿瘤 15例 ,转移性肿瘤 5例 ,均行脾切除术 ,无手术死亡 ,良性肿瘤预后好 ,恶性肿瘤预后差。结论 影像学检查是脾脏肿瘤主要诊断方法 ,良性肿瘤应行脾切除术 ,恶性肿瘤及转移性肿瘤强调以手术为中心结合化疗。

15例原发性非霍奇金脾淋巴瘤的临床、病理特征

研究原发性非霍奇金脾淋巴瘤 (脾NHL)的临床和病理特征与手术治疗的效果。方法 :1 96 4年— 1 998年本院获确诊并治疗 1 5例原发性非霍奇金脾淋巴瘤 ,并作术后随访。结果 :脾NHL的主要临床表现为左上腹痛或不适 ,脾肿大 ,贫血和发热。B超显示脾内多发性占位。Ahmann’s分期 ( 1 4例 ) :Ⅰ期 3例 ,Ⅱ期 4例 ,Ⅲ期 7例。脾切除及脾切除联合腹腔其他脏器切除 1 3例。术后均予化疗 ,其中 2例配合放疗。术后生存 3月— 2 9年不等。手术死亡 3例。大体病理形态多为粟粒结节型 ,病理诊断 (工作分类 ) :低度恶性 7例 ;中度恶性 5例 ;高度恶性2例 ;分类不详 1例。结论 :脾NHL诊断多为术后诊断 ,脾切除既是诊断手段又是治疗手段 ;如果必要 ,积极的外科手段如脾切除联合腹腔其他脏器切除应予考虑。

脾脏肿瘤的诊断和治疗(附22例报告)

目的:总结脾脏肿瘤的诊断治疗经验。方法:回顾性分析1997～2005年本院收集的22例脾脏肿瘤临床病例资料。结果:22例中良性肿瘤8例,恶性肿瘤14例,其中15例行手术切除,无手术死亡。良性肿瘤预后良好,恶性肿瘤预后较差。结论:良、恶性脾脏肿瘤鉴别可根据CT、血管造影、病理活检。根治手术和综合治疗是改善脾脏恶性肿瘤预后的重要措施。

原发性脾肿瘤39例诊治分析

目的：探讨原发性脾肿瘤的临床特点、诊断和治疗。方法：回顾性分析我院1996年1月-2007年1月收治的经手术和病理证实的39例原发性脾肿瘤临床资料。结果：在脾良性肿瘤20例中，计有脾血管瘤10例，脾囊肿8例。脾淋巴管瘤1例及脾错构瘤1例。在恶性肿瘤19例中，有脾恶性淋巴瘤18例和血管肉瘤1例。B超和CT检查术前定位诊断的准确率均为100％；B超总的定性诊断率和对脾囊肿、脾血管瘤的定性诊断率分别为12．82％（5/9）、50％（4／8）和10％（1／10）；CT总的定性诊断率和对脾囊肿、脾血管瘤的定性诊断率分别为32．43％（12，37）、83．33％（5／6）和70％（7／10），总体优于B超。B超和CT均不能肯定地作出恶性诊断。所有病例均行手术治疗，主要为脾切除术。恶性淋巴瘤术后辅以CHOP化疗方案。良性肿瘤获随访者16例，失访4例，获随访的16例至今情况良好，最长随访时间9年。恶性淋巴瘤获随访的16例中，4例死亡；1例存活5年，3例生存期已超过5年。结论：原发性脾肿瘤术前定位诊断较易，定性诊断困难。治疗以脾切除术为主，原发性脾恶性淋巴瘤结合化疗时预后相对较好。

脾转移性肿瘤临床分析(附22例报告)

目的 分析脾转移性肿瘤的临床特点。方法 对 2 2例脾转移性肿瘤临床资料进行回顾性分析。 结果 原发灶分别为卵巢癌、肺癌及结肠癌各 4例 ,胃癌 3例 ,乳腺癌及肝癌、胰腺癌分别 2例 ,肾癌 1例。 4例为单纯脾转移 ,伴多发脏器转移 1 8例 ,分别经 B超、CT、MRI、选择性脾动脉造影术前诊断 ,手术切除 7例 ,探查活检 1 0例 ,5例未手术。目前死亡 1 6例 ,其中 1年内死亡 1 1例。 结论 脾转移瘤少见 ,影像学检查是脾转移瘤主要术前诊断方法 ,强调以手术中心结合化疗。

原发性脾脏淋巴瘤24例临床预后分析

目的分析原发性脾脏淋巴瘤(primary splenic lymphoma,PSL)的临床病理特征,探讨各临床指标与预后的关系。方法回顾分析1998年1月-2008年12月我院收治的经病理证实24例PLS患者的临床资料及随访结果,应用SPSS17.0软件进行生存分析,并对各临床指标进行log-rank单因素、Cox模型多因素分析。结果 24例PSL患者中,男15例,女9例,中位年龄43岁(18～78岁),超过60岁者5例,中位生存时间71个月,3年总生存率67.9%,5年总生存率46.6%。其中霍奇金淋巴瘤(Hodgkin′s lymphoma,HL)1例,非霍奇金淋巴瘤(nonHodgkin′s lymphoma,NHL)23例。23例NHL患者中,T细胞型6例,B细胞型17例;ECOG行为状态(performancestatus,PS)0～2分16例,3～4分7例;伴消瘦、发热B症状11例;脾脏轻度肿大6例,中重度肿大17例;血乳酸脱氢酶(serum lactate dehydrogenase,LDH)升高11例;log-rank单因素分析显示年龄、PS评分、B症状、LDH、病理免疫分型与生存相关。Cox模型多因素分析发现LDH、脾脏肿大程度与总生存无关。结论 PSL在本组患者男性高于女性,病理以B细胞NHL为主,年龄、PS评分、B症状、免疫分型与预后有关,T细胞PSL预后差。

托出式和原位脾脏切除临床对照研究

目的:对照研究托出式和原位脾脏切除两种手术方式。方法:回顾性分析河南省肿瘤医院普外科2006年1月～2010年6月35例患者因脾脏占位性病变行脾脏切除手术体会。其中使用托出式脾脏切除19例及原位脾脏切除16例。结果:托出式脾脏切除组在出血量、手术时间方面分别为(61.5±16.2)ml、(35.1±6.2)min,较原位切除组的(136.2±19.2)ml及(59.3±5.7)min差异有显著性,而术后并发症发生率,住院时间差异无显著性。结论:原位及托出式脾脏切除手术均是安全而有效的手术方法,但托出式脾脏切除术具有手术时间短、出血少、操作简便等优点。

腹腔镜脾部分切除术（附八例报告）

目的探讨腹腔镜脾部分切除术治疗脾脏良性肿瘤的安全性。方法2009年1月至2014年8月，对8例术前CT或MRI检查明确为脾脏良性肿瘤的病人实施腹腔镜脾部分切除术，肿瘤直径5．2～9．1cm，平均直径6．9cm，2例位于脾脏上极，6例位于脾脏下极。其中脾脏囊肿6例，脾脏血管瘤2例。结果8例均于腹腔镜下完成脾脏部分切除，无中转开腹病例，标本均经劈脐纵行小切口取出。手术时间为115-280min，平均166．3min。出血量为100-600ml，均未输血。术后腹腔引流时间3～5d，无腹腔出血、胰漏、腹腔感染等并发症。术后住院4～6d。结论腹腔镜脾部分切除术治疗位于脾脏一侧的良性肿瘤安全可行。虽然技术上较全脾切除费时费力，但保留了部分脾脏及功能，有其重要的临床意义，对年轻病人尤其如此。

腹腔镜保留脾脏的胰体尾切除术在临床上的应用评价

目的:探讨腹腔镜保留脾脏的胰体尾切除术(laparoscopic spleen--preserving distal pancreatectomy,LSPDP)在临床应用中的安全性和有效性。方法:回顾分析我院2008年10月至2014年10月23例腹腔镜胰体尾切除手术(laparoscopic distal pancreatectomy,LDP)病例,其中11例行腹腔镜胰体尾联合脾切除术(laparoscopic distal pancreatectomy with splenectomy,LDPS),12例行LSPDP。结果:23例手术均完全在腹腔镜下完成,未中转开腹,LDPS组与LSPDP组在手术时间(P=0.180)、术中出血量(P=0.494)、住院时间(P=0.459)、手术并发症(P=0.640)方面均无统计学差异;LDPS组术后白细胞计数稍高于LSPDP组[(10.1±3.4)vs.(9.8±2.3),P=0.647],LDPS组血小板较LSPDP组明显升高[(346.0±129.1)vs.(178.0±82.2),P=0.001]。结论:LSPDP在临床应用中,具有一定的安全性和可行性,可在未来临床实践中尝试并推广。

原发性脾脏肿瘤58例临床分析

目的探讨原发性脾脏肿瘤的诊断与治疗。方法选取2006年1月-2014年12月期间收治的58例原发脾脏肿瘤患者进行临床观察。结果脾脏良性肿瘤45例，其中脾血管瘤21例，脾囊肿11例，脾淋巴管瘤8例，脾脏窦岸细胞血管瘤3例，脾错构瘤1例，脾脏硬化性血管瘤样结节性转化1例；脾脏恶性肿瘤13例，其中脾脏B细胞淋巴瘤11例，脾脏霍奇金淋巴瘤及脾脏血管肉瘤各1例。B超和CT是主要的检查方法。全组行脾切除术51例，其中开腹脾切除术23例，腹腔镜脾切除术28例；部分脾切除术5例；脾切除＋胰腺体尾部切除术2例。所有病例无手术并发症。术后随访9个月～9年，平均随访时间（43．8±21．3）个月，41例脾脏良性肿瘤患者预后良好，无复发和转移；11例脾脏恶性肿瘤患者的1、3、5年生存率分别为81．8％、63．6％和27．2％。结论原发性脾脏肿瘤的诊断主要依靠临床表现和影像学检查。手术切除不仅是脾脏肿瘤一种有效的治疗手段，也是重要的确诊方法。脾脏局限性良性肿瘤可选择部分脾切除术以保留脾脏功能。早期手术及术后联合放化疗可改善脾脏恶性肿瘤的预后。

脾脏良性肿瘤多层螺旋CT诊断(附13例报告)

目的探讨脾脏良性肿瘤CT表现及诊断价值,以提高诊断水平。方法回顾性分析13例经病理证实脾脏良性肿瘤CT资料,其中海绵状血管瘤5例,脾囊肿6例,淋巴管瘤2例。结果海绵状血管瘤增强扫描呈边缘强化并向中心充填,延期扫描病灶可完全弥合与脾成等密度;脾囊肿呈圆形或椭圆形囊状占位,水样密度,边缘光滑,不强化为其特点;淋巴管瘤的典型表现是多发低密度灶,可有间隔状强化。结论脾脏良性肿瘤具有比较特征性的螺旋CT表现,可作出较准确的定位、定性诊断。