Extensive intrathoracic and intraperitoneal splenosis mimicking mesothelioma: a case report

Our plain-English summary of Extensive intrathoracic and intraperitoneal splenosis mimicking mesothelioma: a case report, by B. Föh, M.M. Sieren, M. Both, et al (Journal of Medical Case Reports, 2022).

The study

• Authors: B. Föh, M.M. Sieren, M. Both, M. Seeger, R. Günther
• Journal: Journal of Medical Case Reports
• Published: 2022;16(1):73
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Splenosis is the heterotopic autotransplantation of splenic tissue after severe splenic trauma and/or splenectomy. The epidemiology is elusive, but splenosis is frequently misdiagnosed as malignant tumors of gastrointestinal, gynecological, or hematological origin before the correct diagnosis is ultimately found. We herein report a rare case of combined, extensive intraabdominal and intrathoracic splenosis initially presenting as pleural mesothelioma.

Case Presentation: A 63-year-old Caucasian male presented with dyspnea and recurring thoracic pain. Initial X-ray and computed tomography scans showed disseminated intrathoracic and intraabdominal lesions. Consequently, thoracoabdominal mesothelioma or a polytopically metastasized cancer of unknown origin was suspected. A thorough examination of the patient's medical history and contrast-enhanced ultrasound by a skilled examiner revealed the diagnosis of extensive abdominal and thoracic splenosis as a consequence of an abdominal gunshot wound with a ruptured diaphragm several decades earlier. Timely diagnosis by noninvasive measures prevented the patient from potential complications of harmful diagnostic procedures, including nuclear imaging and biopsies. The patient is currently treated for hepatitis C and chronic obstructive lung disease, whereas no specific treatment for splenosis is required.

Conclusions: We present a case of rare intrathoracic and intraperitoneal splenosis mimicking mesothelioma. Contrast-enhanced ultrasound and thorough patient history were used for diagnosis and prevented this patient from having to undergo potentially harmful diagnostics. Splenosis can occur after splenic trauma and, consequently, needs to be considered as a rare differential diagnosis to malignant tumors of various origins when a matching patient history is obtained.

© 2022. The Author(s).

In plain English

This case report described one patient, a 63-year-old Caucasian man with long-standing mild shortness of breath and recurring left chest-wall pain. Earlier X-rays at another hospital had shown masses on the left chest lining, and pleural mesothelioma was considered. At the authors' hospital, CT scans showed two masses in the front of the chest (2 and 4 cm across), two left chest-wall lesions up to 5 cm, and many similar masses in the abdomen and pelvis. His spleen was missing. To his knowledge he had never worked in an asbestos-polluted environment, and the scans showed no fluid around the lungs. Questioning revealed an abdominal gunshot wound in the early 1970s that had damaged his spleen and diaphragm. Contrast-enhanced ultrasound showed the lesions behaving like spleen tissue rather than cancer. The authors diagnosed splenosis (spleen tissue growing elsewhere after injury) without a biopsy. After 12 months the lesions had not grown. The authors concluded that splenosis should be considered as a rare alternative to cancer when a patient has a history of spleen injury, but that needed cancer testing must not be delayed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 63-year-old Caucasian male patient with years of mild dyspnea and recurring left thoracic wall pain, seen at the authors' hospital; history of intravenous drug use, more than 30 years of smoking, and untreated hepatitis C
• Exposure: No asbestos exposure: to his knowledge the patient had never worked in an asbestos-polluted environment. The relevant history was an abdominal gunshot wound in the early 1970s with damage to the spleen and diaphragm and removal of the spleen.
• Main results:
  • A few months before, X-rays at another hospital had shown suspicious masses at the left costal pleura, and pleural mesothelioma was considered
  • CT showed two masses in the anterior mediastinum measuring 2 and 4 cm in diameter, plus two lesions on the left costal wall up to 5 cm in diameter
  • Multiple similar lesions were found in the abdomen and pelvis, and the spleen was missing
  • The CT scans showed no pleural effusions, which the authors noted would typically be expected for mesothelioma
  • On detailed interview, the patient recalled an abdominal gunshot wound in the early 1970s in which his spleen and diaphragm were severely damaged and needed surgical repair
  • Contrast-enhanced ultrasound showed the pattern of splenic tissue, with persistent late-phase enhancement, unlike malignant masses
  • Follow-up examinations after 12 months showed no progress of the lesions; no biopsy was performed
  • No specific treatment for splenosis was needed. Treatment for hepatitis C and chronic obstructive pulmonary disease was started, and oral pain medication resolved his pleurisy
• The authors' conclusion: The authors concluded that splenosis should be considered as a rare differential diagnosis for malignant tumors of the abdominal and thoracic cavities when there is a matching history of splenic trauma, and that patients should be asked about abdominal injuries and splenectomy, even decades in the past.
• Limitations the authors state:
  • No medical reports from the time of the original injury were available; the history of spleen and diaphragm damage rested on the patient's recollection, along with CT evidence that the spleen had been removed
  • The authors cautioned that necessary testing for malignant tumors must not be delayed, and that biopsy or tissue examination is needed if there is no history of splenic injury or if lesions progress

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Intrathoracic, Mesothelioma, Epidemiology, Pleural Mesothelioma, Dyspnea, Ultrasound, Diaphragm, Obstructive Lung Disease.

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