Persistent Abdominal Pain Associated with Splenic Lymphangioma in An Adult Patient: A Case Presentation

Splenic lymphangioma is a rare benign lesion, predominantly seen in the pediatric population and exceptionally in adults. It is usually associated with lymphatic system malformations caused by secondary lymphangiectasia due to abnormal communication between lymphatic ducts. It often coexists with complex clinical syndromes, such as Klippel-Trenaunay syndrome, congenital epithelial cysts, or, in less frequent conditions, infectious or post-traumatic triggering events. It typically presents in the neck or axillae, with intra-abdominal cases accounting for less than 5% of all cases. We present the clinical case of a 44-year-old male patient who presented with a clinical course of approximately one month, characterized by progressive abdominal pain associated with nausea, multiple episodes of emesis, anorexia, and involuntary weight loss. A diagnostic laparoscopy was performed, revealing a poorly differentiated lesion in the splenic topography, for which a biopsy was performed, leading to the definitive diagnosis. In this scenario, splenic lymphangioma should be considered among the differential diagnoses of persistent abdominal pain, and definitive interventions should be determined based on clinical characteristics.

Hepato-splenic lymphoma:a rare entity mimicking acute hepatitis:A case report

We reported a case of non-Hodgkin's lymphoma where liver involvement was the predominant clinical manifestation.A 27-year old man presented wiht markedly elevated serum aspartate aminotrasferase,alanine aminotransferase and lactate dehydrogenase,reduced prothrombin activity,thrombocytopenic purpura and hepato-splenomegaly without adenopathy.Viral,toxic, autoimmune and metabolic liver diseases were excluded. Bone marrow biopsy showed an intracapillary infiltration of T-lymphocytes with no evidence of lipid storage disease. Because of a progressive spleen enlargement,splenectomy was performed.Histological examination showed lymphomatous intrasinuses invasion of the spleen. Immunohistochemical investigation revealed the T phenotype of the neoplastic cells:CD45+,CD45RO+, CD3+,CD4-,CD8-,TIAl-.About 50 % of the lymphoid cells expressed CD56 antigen.The diagnosis of hepatosplenic T cell lymphoma was done.The patient was treated with chemotherapy,which induced a complete remission.Eighteen months later,he had a first relapse with increased aspartate aminotransferase,alanine aminotransferase,lactate dehydrogenase, thrombocytopenic purpura and blast in the peripheral blood. In spite of autologous bone marrow transplantation,he died twenty months after the diagnosis.Even in the absence of a mass lesion or lymphoadenopathy,hepatosplenic T- cell lymphoma should be considered in the differential diagnosis of a patient whose clinical course is atypical for acute hepatic dysfunction.

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.

Septic shock due to Granulicatella adiacens after endoscopic ultrasound-guided biopsy of a splenic mass:A case report

BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy(EUS-FNA or FNB)has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accuracy and safety.To the best of our knowledge,no case report of severe infection after EUS-FNB of a solid lesion in the spleen has been described.Herein,we report a rare case of septic shock after EUS-FNB of a splenic mass.CASE SUMMARY A 45-year-old male patient presented to the outpatient clinic due to an incidentally detected splenic mass.A definitive diagnosis could not be established based on the abdominal magnetic resonance imaging.EUS of the spleen showed a 6 cm-sized,relatively well-demarcated,heterogeneous mass,and EUS-FNB with a 22G needle was performed.Ten days after the procedure patient developed septic shock and a splenic abscess was identified.Blood culture revealed growth of Granulicatella adiacens.After the treatment with antibiotics the patient underwent surgical resection,and the pathological examination showed diffuse large B-cell lymphoma.The patient received chemotherapy and he is in complete remission.CONCLUSION Infection of a splenic mass after EUS-FNB is a rare complication and prophylactic antibiotics might be considered.

Sclerosing angiomatoid nodular transformation of the spleen: A case report and literature review

BACKGROUND Sclerosing angiomatoid nodular transformation(SANT)is a rare disease of the spleen.It has unique pathological features and mimics splenic tumor on radiological imaging.CASE SUMMARY A 47-year-old woman was incidentally found to have a splenic mass on abdominal ultrasound.She had a 10-cm postoperative scar in the lower abdomen due to previous cesarean sections.The patient had a past history of anemia of unknown etiology for 20 years.The patient underwent laparoscopic splenectomy.The postoperative course was uneventful,with a hospital stay of 7 d.The histopathological examination of the spleen revealed SANT.At the 6-mo followup,the patient remained disease-free.CONCLUSION SANT is a rare benign disease mimicking a malignant tumor.A definitive diagnosis can be made only on histopathology.

Successful treatment with laparoscopic surgery and sequential multikinase inhibitor therapy for hepatocellular carcinoma:A case report

BACKGROUND Hepatocellular carcinoma(HCC)with massive portal vein tumor thrombosis(PVTT)and distant metastasis is considered unresectable.However,due to recent developments in systemic chemotherapy,successful cases of conversion therapy for unresectable diseases have been reported.Herein,we report a successful multidisciplinary approach for treatment of multi-visceral recurrence with sequential multikinase inhibitor and laparoscopic surgery.CASE SUMMARY A 63-year-old woman with chronic hepatitis B virus infection was diagnosed with HCC.Subsequently,she underwent two rounds of laparoscopic partial hepatectomy,laparoscopic left adrenalectomy,and transcatheter arterial chemoembolization plus sorafenib for recurrence.Four years after initial hepatectomy,she presented with a 43-mm mass in the spleen and tumor thrombus involving the main portal vein trunk with ascites.Her liver function was Child-Pugh B(8),and protein induced by vitamin K absence or antagonist II(PIVKA II)levels were elevated up to 46.291 mAU/mL.Since initial treatment with regorafenib for three months was unsuccessful,the patient was administered lenvatinib.Ten months post-treatment,there was no contrast enhancement of PVTT or splenic metastasis.Chemotherapy was discontinued due to severe diarrhea.Afterward,splenic metastasis became viable,and PIVKA II increased.Therefore,hand-assisted laparoscopic splenectomy was performed.She experienced no clinical recurrence 14 mo after resection.CONCLUSION Conversion surgery after successful multikinase inhibitor treatment might be considered an effective treatment option for advanced HCC.

Splenic hamartoma: case report and review of literature

Splenic hamartoma is a benign malformation composed of an anomalous mixture of normal splenic elements.1 Approximately half of the patients with the tumor are asymptomatic and diagnosed accidentally by autopsy or splenectomy. The tumor-related renal hematological and dermatological abnormalities can be treated by removal of the tumor. Splenic hamartoma which is related to renal diseases including extramembranous glomerulonephritis, membranoproliferative glomerulonephritis and renal adenocarcinoma has been reported previously.

Radical resection of gastric carcinoma with pancreas and spleen preservation and functional cleaning of lymph nodes

OBJECTIVE: To study the clinical value of radical resection of gastric carcinoma with pancreas and spleen preservation (PSP) and functional cleaning of lymph nodes (LNs) of the spleen hillus and along the splenic artery. METHODS: Pancreas and spleen involvement was retrospectively reviewed among 439 cases of resectable carcinoma of the gastric cardia, gastric corpus and total stomach. During gastric surgery, 2 ml of methylene blue was injected into the subserosal space of the gastric cardia or corpus to observe the spread of lymphatic flow in 54 cases of gastric carcinoma. The metastatic rate of LNs in splenic hillus and along the trunk of the splenic artery (No10, No11), postoperative complications and survival rates were investigated in 63 gastric carcinoma patients that had received gastrectomy with pancreas and spleen preservation (PSP). These were compared with the pancreas preservation (PP) group and pancreas and spleen combined resection (PSR) group. RESULTS: Among these 439 cases, only 25 cases were observed with direct invasion to the pancreas (5.7%), and 10 cases with direct invasion to the spleen (2.3%). After pathological examination of the pancreatic body and tail, we found 22 cases with pancreas and spleen combined resection, 4 cases (18.2%, 4/22) with direct invasion of the capsule and 2 with invasion to the superficial parenchyma (9.1%, 2/22), without metastasis to the lymph nodes within the pancreas and spleen. The metastatic rate of No10, No11 lymph nodes were 17.5% (11/63) and 19.1% (12/63) in the PSP group, 20.8% (45/216) and 25% (54/216) in the PP group, and 20% (6/30) and 23.3% (7/30) in the PSR group. There were no statistically significant differences (P > 0.05). Injection of methylene blue into the subserosal space of the stomach did not diffuse into the spleen or pancreatic parenchyma. Postoperative complications, diabetes and mortality in PSP (0%, 0%, 0%) were lower than in PP (4.2%, 0.9%, 0.9%) or PSR (40%, 10%, 3.3%). The 5-year survival rate (5-YSR) and 10-YSR in PSP (57.5%, 52.0%) were higher than in PSR (37.5%, 30.0%). Those patients with stage II and III(a) treated by PSP, improved markedly. CONCLUSIONS: The surgical procedure of pancreas and spleen preservation for gastric cancer is a safe and organ function protected method. Postoperative complications were lower and survival rates were higher, the radicality was not reduced. These results indicate that PSP is preferred in patients with gastric carcinoma of stage II or III(a).