SDIAP SENEC 2010

case 374

Ludmila Boudová

Plzeń

Subcutis

Mentální retardace, epilepsie

Medikace1. Mysoline (primidone)2. Sodanton (diphenylhydantoine)3. Apo-Haloperidol (butyrofenon. incis. neuroleptikum)4. Rivotril (clonazepam)5. Nitrazepam F 6. Apaurin (diazepam) při záchvatu7. Topamax (topiramat)8. Tisercin (levopromazin)

Flavobion, Ascorutin, Pancreolan

Vomitus, obstipace, zvětšení rezistence v levém podbřišku4 dny

Muž, 23 let

Incarcerated inguinal hernia?4 cm mass

• Blood count, CRP: normal

• HBsAg positivity

Diagnosis?

A mass in the subcutis 8 x 7 x 5 cm

Case history• Born 1982• Children cerebral palsy, left sided hemiparesis• Epilepsy, mental retardation• 1992 - trauma - spleen laceration, renal

contusion, brain commotion; splenectomy• 1993 – first operation of splenosis

in the abdominal scar • corrective operations of lower extremities• 2005 – suspected hernia in cicatrice;

second operation for splenosis• 2010 - alive and well

Splenosis

Autotransplantation of splenic tissuefollowing abdominal trauma or surgery

LocalizationCommon: peritoneumRare: pericardium, pleura, retroperitoneum, subcutis

May be cystic

Splenosis• Diagnostic problem - clinical, imaging

• Case history

• Mostly: small, asymptomatic

• Rarely: intestinal obstruction, mass effect on abdominal organs, pelvic pain, bleeding

Splenosis - differential diagnosis

Splen accessorius = spleniculus

Splenic hilus, lig. gastrosplenicum

Tail of pancreas, mesentery

Tumours, metastasis, endometriosis, incarcerated hernia…

Splenosis

Normally functioning splenic tissue

Benefits and problems after splenectomy

Subcutaneous splenosis of the abdominal wall

Am J Dermatopathol. 2006 Jun;28(3):208-10.

Boudová L, Kazakov DV, Hes O, Zahálka M, Mukensnabl P, Kocová J, Michal M.

Splenóza jater u nemocného po operaci seminomu. Rozhl. Chir., 2005, 84, 9, s. 452-455.

Třeška V., Skalický T., Chudáček Z., Boudová L.,Hes. O

Drug-induced abnormalities of lymph nodes and spleen

Antiepileptic, ATB, NSAR,

Phenytoin

Spleen:T- cell hyperplasia

Expansion of PALS by CD4

T-lymphocytes

IOACHIM: Lymph node pathology