Tognarelli Alessio, Faggioni Lorenzo, Erba Anna Paola, Faviana Pinuccia, Durante Jacopo, Manassero Francesca, Selli Cesare
Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, Pisa 56126, Italy.
Department of Translational Research and New Technologies in Medicine and Surgery, Section of Diagnostic and Interventional Radiology, University of Pisa, Pisa 56126, Italy.
World J Clin Cases. 2021 Apr 26;9(12):2868-2873. doi: 10.12998/wjcc.v9.i12.2868.
'Splenosis' is defined as the autotransplantation of splenic tissue following trauma or surgery, usually in the form of intraperitoneal nodules. The proliferation of imaging techniques has resulted in increased unexpected discoveries of splenosis nodules, and achieving a differential diagnosis can be challenging. Nuclear medicine studies have been playing an increasingly important role in this process, but the clinical significance of asymptomatic nodules remains uncertain.
We present a case of pelvic splenosis in a 73-year-old man diagnosed 56 years after a splenectomy during a computed tomography (CT) follow-up for B-cell lymphoma, presenting intense contrast enhancement of an 18 mm nodule in the right recto-vesical space. 18F-fluorodeoxyglucose demonstrated weak metabolic activity. Since histological diagnosis was deemed necessary, the nodule was easily removed with robotically assisted laparoscopy, together with another 6 mm left a paracolic lesion. The latter was previously undiagnosed but retrospectively visible on the CT scan.
In a patient requiring differential diagnosis of splenosis nodules from lymphoma recurrence, the robotic approach provided a safe removal with short hospitalization. The Da Vinci Xi robot was particularly helpful because its optics can be introduced from all ports, facilitating visualization and lysis of multiple intra-abdominal adhesions.
