Sabato 27 ottobre 2012 - Pacini Editore

COmuNiCaziONi ORali
Immunohistochemical analysis revealed a positive staining of the
tumor cells for CD117, smooth muscle actin, a focal positivity for
CD34 and a negativity for S-100.
Conclusions. When two or more tumors onset simultaneously
or consecutively in several organs or systems, it is possible to
talk about synchronous tumors, whereas metachronous tumors
are those arising at different time. GIST is an uncommon mesenchymal
neoplasm of the digestive tract but it has been reported
as synchronous tumor with several kind of malignancies, such as
adenocarcinoma, carcinoid, colorectal carcinoma, renal cell caricinoma,
carcinoid. Several aetiopathogenetical hypothesis have
been postulated but the mechanism of this sinchronicity is still
unknown. At the best of our knowledge, this seem to be the first
case reporting a simultaneous development of two mesenchymal
tumor and several considerations could be suggested in this case.
references
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5 Ruka W, Rutkowski P, Nowecki Z, et al. Other malignant neoplasms
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7 Kaffes A, Hughes L, Hollinshead J, et al. Synchronous primary adenocarcinoma,
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Intra-abdominal splenosis: a case report
of a challenging entity
G. Crisman1 , E. Di Cola1 , I. Cicchinelli1 , A.R. Vitale2 , T. Curti2 ,
G. Calvisi3 , L. Scipioni4 , G. Coletti3 , P. Leocata1 1 Anatomia Patologica, Dipartimento di Scienze della Salute, Università
dell’Aquila, L’Aquila, Italia; 2 U.O.C. Anatomia Patologica, P.O. “SS
Filippo e Nicola”, Avezzano (AQ), Italia; 3 U.O.C. Anatomia Patologica
Ospedale Civile “San Salvatore”, L’Aquila, Italia; 4 U.O.C. Chirurgia
Generale, P.O. “SS Filippo e Nicola”, Avezzano (AQ), Italia
Background. Intraabdominal splenosis represents a benign, non
uncommon, generally asymptomatic entity due to auto-implantation
of spleen fragment into other sites randomly, not spleen
bed, which grow and form small splenic nodules which closely
resemble, in anatomy and physiology, a normal spleen. This condition
is usually diagnosed by a CT scan or MRI, or even surgical
procedure. Firstly described by Von Kuttner in 1910, during an
autopsy, the term splenosis has been suggested for the first time
by Buchbinder and Lipkopf in 1939. Splenic implants are usually
multiple and may be located anywhere in the peritoneal cavity,
unusual locations are represented by pleural cavity, pelvis and
subcutaneous tissue. Due to its variable clinical presentation, it
could be misdiagnosed as a malignancy and anamnestic data (i.e.,
history of splenectomy, blunt abdominal trauma) and histopathological
correlation play a pivotal role in the aim to achieve the
correct diagnosis.
Material and methods. We report on a case of a 51-year-old man
presented with diffuse abdominal pain, arising in the epigastric
region and irradiated to the whole abdomen, nausea, fatigue and
Fig. 1. Histopathological features closely resemble a normal splenic
tissue (H&E, 4x magnification).
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severe acidity. The patient referred a history of left post-traumatic
nephrectomy and splenectomy about twenty years before. Admission
studies included complete blood count, which revealed
anemia (hemoglobin was 7.8 mg/dl; reference range: 13.8 to
17.2 mg/dl), whereas an abdominal non-contrast CT scan showed
multiple, diffuse, rounded masses formations with a maximum of
6 cm in-diameter. An incisional biopsy of the biggest lesion has
been performed.
Results. Histological examination of the specimens revealed a
mass mainly composed by lymphocytes of small and medium
size associated with neutrophils and eosinophils, plasma cells,
histiocytes and follicular structures, sometimes with a prominent
germinal center, within a fibrous stroma organized in a reticular
pattern. Immunohistochemical analysis revealed a positivity of
the lymphocytes for CD3, CD4, CD20. CD8 and CD31 positivity
highlight the presence of a typical splenic vascular structure. The
negativity for Factor VIII, glycophorin C, Myeloperoxidase and
Bcl-2 led us to exclude an extramedullary hematopoiesis.
Conclusions. Intraabdominal splenosis is a benign condition
characterized by ectopic auto-transplantation of splenic tissue
after trauma or surgery, often misdiagnosed as a metastatic process
for its characteristic radiological pattern. It is usually easy to
distinguish an intraabdominal splenosis from an accessory spleen.
As a matter of fact, the latter usually present as a single lesion
(rarely more than three) and is supplied by a branch of the splenic
artery. Over 75% of accessory spleens are found in the splenic
bed and they are present in up to 40% of autopsies. Clinical
manifestations of intraabdominal splenosis are nonspecific and
diffuse abdominal pain represents the most common symptom.
Thus, especially in this kind of entity an accurate anamnestic
data collection represents important diagnostic tool. An history
of blunt abdominal trauma and/or splenectomy in patients pre-
Fig. 2. the positivity of the vascular structures for Cd8 confirmed
their splenic origin. (Cd8, 10x magnification).