Zusammenfassung
Eine 40 Jahre alte, beschwerdefreie Patientin stellte sich zur Abklärung von multiplen,
abdominellen, lymphomverdächtigen Raumforderungen vor, die im Rahmen eines Ultraschallkursus
aufgefallen waren. Die Anamnese war bis auf eine Splenektomie nach einem Reitunfall
unauffällig. Die Patientin gab keine Beschwerden an. Insbesondere ergab die Anamnese
keine Hinweise auf eine B-Symptomatik. Die Laboruntersuchungen zeigten keine pathologischen
Veränderungen mit unauffälligem Differenzialblutbild und normalen Entzündungsparametern.
In der Abdomensonographie fanden sich multiple, mesenteriale, bis zu 52 × 19 mm vergrößerte
Lymphknoten. Weiterhin zeigte sich unterhalb des linken Leberlappens zum Hilus reichend
eine 30 × 20 mm messende Veränderung. Zur weiteren Abklärung führten wir eine Computertomographie
(CT) von Thorax und Abdomen durch. Der Thoraxbefund war nicht wegweisend. Die Abdomenuntersuchung
bestätigte multiple, peritoneale Herde im ehemaligen Milzlager sowie im rechten Mittelbauch
subhepatisch. In der Single-Photonen-Computed-Tomography (SPECT) konnte eine spezifische
Speicherung von Tc-99 m-markierten Mikropartikeln in den verschiedenen Herden nachgewiesen
werden. Die Feinnadelpunktion eines Herdes im rechten Mittelbauch zeigte zytologisch
Anteile von Milzgewebe mit follikulärer Hyperplasie. Es handelt sich somit um den
Fall einer posttraumatischen Splenose. In 16 - 67 % der Fälle nach Milzruptur werden
die im Sinne einer Autotransplantation von Milzgewebe entstandenen „Neo-Milzen” beobachtet.
Diese stellen somit eine wichtige Differenzialdiagnose unklarer, abdomineller Raumforderungen
bei splenektomierten Patienten dar.
Abstract
A 40-year-old female patient was admitted for work-up of multiple abdominal masses.
The lymphoma-mimicking tumors were detected accidentally during an ultrasound course.
The past medical history was unremarkable besides a status post-traumatic splenic
rupture and splenectomy. The patient was asymptomatic, especially there were no complaints
of fever, night sweats or weight loss. Laboratory tests did not show pathological
results. Ultrasound of the abdomen revealed multiple hypoechoic mesenterial and peritoneal
enlarged tumors as well as a subhepatic mass (30 × 20 mm). Transmission computed tomography
(CT) showed a normal chest, excluded abnormal thoracal masses and confirmed the multiple
abdominal nodules. Microparticles were trapped only by tissue with phagocytocis function as cells of
the reticulohistiocytary system in liver and spleen. Uptake of 99 m Tc-labeled microparticles is specific for splenic tissue. All abdominal masses were
detectable by single photon emission computed tomography (SPECT) after intravenous
administration of this radiotracer. Ultrasound-guided biopsy proved the presence of
spleen tissue with follicular hyperplasia. In conclusion, we report a case of post-traumatic
splenosis. In 16 - 67 % of patients who experienced traumatic splenic rupture autotransplanted
spleen tissue can be detected. Splenosis therefore is an important differential diagnosis
of abdominal masses in splenectomized patients.
Schlüsselwörter
Splenose - Ultraschall - Splenektomie - Single-Photonen-Emission-Computed-Tomography
(SPECT)
Key words
Splenosis - ultrasound - splenectomy - single photon emission computed tomography
(SPECT)
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Dr. med. Jochen Wedemeyer
Medizinische Hochschule Hannover
Carl-Neuberg-Str. 1
30625 Hannover
Germany
Phone: ++ 49/5 11/5 32-31 57
Fax: ++ 49/5 11/5 32-81 57
Email: Wedemeyer.jochen@mh-hannover.de