Hiyama Kazuhiro, Kirino Izumi, Fukui Yasuo, Terashima Hideo
Department of Surgery, Atago Hospital, Kochi, Japan.
Department of Surgery, Atago Hospital, Kochi, Japan.
Int J Surg Case Rep. 2022 Apr;93:107023. doi: 10.1016/j.ijscr.2022.107023. Epub 2022 Apr 2.
Splenic tumors are rare and are sometimes found incidentally. In such cases, laboratory tests and imaging studies should be performed based on the diagnostic algorithm to determine whether the tumor is benign or malignant. However, we clinicians sometimes encounter challenging cases. Herein we experienced two challenging cases of splenic tumor which we could not correctly diagnosis preoperatively.
Case 1: A female in her 80s presented to our surgical department to undergo follow-up examinations for Stage IIIa ascending colon cancer. A follow-up CT scan showed marked enlargement of the splenic tumor which suggested metastatic cancer. We performed laparoscopic splenectomy. Case 2: A healthy female in her 50s presented to our internal medicine department to undergo a workup after multiple splenic tumors. A follow-up CT scan showed that the tumors had grown slightly. We could not completely rule out a malignant tumor. She rejected further follow-up study and chose splenectomy.
We experienced two cases of splenic hemangioma with different clinical presentations and imaging findings. Although some studies have reported that biopsying a splenic tumor is a safe and effective way of distinguishing among splenic tumors, in our country splenic biopsies are seldom performed due to fears of causing intraabdominal bleeding or tumor dissemination. Clinicians should consider whether it would be better to perform follow up with a biopsy or splenectomy as a definitive treatment on a case-by-case basis.
Laparoscopic splenectomy can be used for definitive management in cases involving malignancy or an uncertain etiology.
脾脏肿瘤较为罕见，有时是偶然发现的。在这种情况下，应根据诊断算法进行实验室检查和影像学研究，以确定肿瘤是良性还是恶性。然而，我们临床医生有时会遇到具有挑战性的病例。在此，我们经历了两例具有挑战性的脾脏肿瘤病例，术前未能正确诊断。
病例1：一名80多岁的女性因Ⅲa期升结肠癌到我们外科进行随访检查。随访CT扫描显示脾脏肿瘤明显增大，提示转移性癌。我们进行了腹腔镜脾切除术。病例2：一名50多岁的健康女性因多个脾脏肿瘤到我们内科进行检查。随访CT扫描显示肿瘤略有生长。我们不能完全排除恶性肿瘤。她拒绝进一步的随访研究，选择了脾切除术。
我们遇到了两例临床表现和影像学表现不同的脾脏血管瘤病例。尽管一些研究报告称，对脾脏肿瘤进行活检是区分脾脏肿瘤的一种安全有效的方法，但在我国，由于担心引起腹腔内出血或肿瘤播散，很少进行脾脏活检。临床医生应根据具体情况考虑是进行活检随访还是进行脾切除术作为确定性治疗更好。
腹腔镜脾切除术可用于涉及恶性肿瘤或病因不明的病例的确定性治疗。
