Follow up for Prostate Cancer

Jonathan Gordon, M.D., Ph.D.

January 18, 2006

Discussion

Thoracic splenosis is a rare condition of auto-transplantation of splenic tissue into the thoracic cavity. It occurs following trauma resulting in splenic rupture with diaphragmatic perforation allowing the migration of splenic fragments. In this case, the patient had this exact history from MVA years prior to the exam. First described in 1937, the lesions are left-sided and usually discovered on chest x-ray or CT scan and easily mimic lymph nodes, pulmonary nodules or metastatic deposits. They are always pleural based, from which they derive their blood supply and may act as functioning splenic tissue which may protect against postsplenectomy infection. The deposits may be found as soon as 3 years following the traumatic episode and the vast majority are asymptomatic. If splenosis is suspected, biopsy may provide the diagnosis, however it is most easily established by nuclear medicine exams which image the reticuloendothelial system using technetium-99m sulfur colloid, Indium-111 tagged WBC's or technetium-99m heat damaged RBC's. Indium-111 tagged WBC's or technetium-99m heat damaged RBC's are regarded as more sensitive and specific. Nevertheless, the majority of diagnoses are made postoperatively. In addition to the thoracic cavity, splenic tissue may migrate throughout the abdomen or pelvis mimicking masses, nodes and causing various symptoms based on their location including GI bleeding and bowel obstruction.

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