SDIAP SENEC 2010 case 374 Ludmila Boudová Plzeń
Jan 14, 2016
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