Anatomy, Sonographic Features, and Dimensional Variations of Spleen among Individuals with Different Sociodemographic and Anthropometric Measurement

The spleen is a vital lymphoid soft organ located in the left hypochondrium region. It is a multi-dimensional organ that enlarges in all dimensions during some disease conditions. Recently, splenomegaly prevalence has been increasing throughout the world. Due to the lack of attention in clinical practice, splenomegaly has become quite a common problem in all parts of the world. The detection of the spleen by palpation is not approval of enlarged spleen because normal spleen may be palpable. A detailed knowledge of morphometric variations of the spleen is of great value in diagnosing splenomegaly clinically, radiologically, and for surgical procedures. Measurement of spleen size by sonography is important as it gives true result than splenic palpation and for identification of disorders present with enlargement or reduction of the spleen. Therefore, this study aimed to assess the anatomy, sonography, and dimensional variation of spleen among individuals with different sociodemographic and anthropometric measurements. The current study reviews different types of literature conducted on spleen all over the world. The result from overall spleen dimensions review shows measurements vary: spleen length (7–14 cm), spleen width (2–7.5 cm), spleen thickness (2–7 cm), and spleen volume (20–350 cm3). The literature revealed that spleen dimensions are affected by geographical differences, races, nutritional status, physical exercise, and anthropometric measurements. The result from reviews shows that spleen dimensions are larger in males than females. As age increases, spleen dimensions significantly decrease. Spleen dimensions positively correlate with height, weight, body mass index, and body surface of individuals. The spleen dimensions were higher in males than in females and have significant positive correlation with height, weight, body mass index, and body surface area. Clinicians, radiologists, and surgeons should confirm splenomegaly by both palpation and sonography. Spleen dimensions variation due to geographical sex, age, and other anthropometric measurements should be taken into consideration during their clinical investigation. Radiologists should measure all dimensions of spleen rather than the length to rule out splenomegaly correctly.

A Cadaveric Study on Morphometric Features of Spleen and Splenomegaly with Accessory Spleen in Hilum

Background: Anatomical knowledge regarding the external morphology of the spleen is essential for surgical intervention and radiological diagnosis. Splenomegaly is defined as pathologic enlargement of the spleen measured by size or weight. A normal spleen has a craniocaudal length of no more than 12 cm and weighs less than 200 g. It is surrounded by a thin capsule. The spleen is usually not palpable unless it is enlarged; therefore, a palpable spleen is almost always abnormal. At times the spleen may be difficult to palpate, but dullness to percussion during inspiration in the area of the lower left intercostal space in the left anterior axillary line suggests splenic enlargement. Massive splenomegaly, weight >1000 g usually occurs in lymphoma, myeloproliferative disorders, visceral leishmaniasis, and malaria. Materials and Methods: This study was conducted in different medical institutions, to find morphometric features, spenomegaly in cadaver during routine anatomy dissection as part of curriculum, 100 cadavers were observed to find out splenomegaly. Results: Out of 100 spleens studied, 81 cases wedge shaped spleen was the most common, followed by 12 tetrahedral shaped spleens and 7 oval shaped spleens. Average weight of the spleen was 175g. Average length of the spleen was 11.64cm, Average breadth of the spleen was 7.3cm and average thickness of spleen was 3.6cm. Out of 100 cadavers observed only one cadaver observed with massive splenomegaly with one accessory spleen in hilum. The spleen weight was 875gm, length was 18.15 cm, width was 8.65cm, thickness was 5.75cm and extended upto 7 rib and it is easily palpable below the rib cage from lumbar aspect. The cadaver was male and age around 55 years. Conclusion: The morphometric knowledge of spleen will helpful for surgeons and for understanding deceases related spleen. The knowledge of splenomegaly is important in finding splenic disorders and accessory spleen information helpful in understanding embryonic development of spleen. KEY WORDS: Splenomegaly, Spleen, Hilum of Spleen, Accessory spleen.

An extremely rare case of a gastric accessory spleen: case report and review of the literature

Background The accessory spleen has no anatomical or vascular relationship with the normal spleen, The tissue structure and physiological function of the accessory spleen are the same as those of the normal spleen, which usually locate in the splenic hilum and the tail of the pancreas. The aims of this manuscript are to present a rare case of the gastric accessory spleen and a review of the literature. Case presentation A 19-year-old male patient was sent to the emergency department with stomach bleeding after drinking alcohol. The computed tomographic scan showed a 1.2 cm × 1.7 cm mass at the lesser curvature of the gastric fundus. Gastrointestinal endoscopy displayed a submucosal elevated lesion on the gastric fundus, and gastrectomy was performed. Postoperative pathological examination proved an accessory spleen in the stomach. The postoperative course was uneventful, and the patient was discharged on the 6th day after the surgery. Conclusions The accessory spleen at the fundus of stomach is extremely rare, especially in this case, which is accompanied by acute gastric bleeding, and it is difficult to diagnosis before operation. Many literatures reported that it was misdiagnosis as tumor, so it is necessary to diagnose accessory spleen correctly.

Pathogenesis, Diagnosis, and Management of Splenogonadal Fusion: A Literature Review

Introduction. Splenogonadal fusion is a rare congenital anomaly, defined by the presence of ectopic splenic tissue caused by an abnormal connection between the spleen and the gonad or mesonephrotic derivatives during the embryonic period. Materials and Methods. By reporting an observational case and performing a review of the literature according to the CARE guidelines (using the PubMed database and guidelines from urology, general surgery, and pediatric learned societies), we present the embryological genesis of the splenogonadal fusion, the associated anatomical anomalies, and the diagnostic procedure. Observation. We report the case of a patient aged 45, with no notable history, reporting left testicular pain. A small nodule on the upper pole of the left testicular was clinically palpable. Tumor markers were normal, and scrotal ultrasound depicted a hypoechoic hypervascular nodule measuring 8∗6∗8 mm. After validation in a multidisciplinary oncology consultation meeting and opinion from a uro-andrologist expert, the patient underwent an inguinal lumpectomy with an extemporaneous examination which did not objectify any signs of malignancy. Ultimately, it is a normal spleen tissue in the testicular ectopic position. Discussion. Splenogonadal fusion corresponds to a rare congenital malformation; less than 200 cases have been published in the literature, most often affecting boys, with a sex ratio of 15/1. Two types are described, depending on the continuity of the link between the orthotopic spleen and the gonad: the continuous and discontinuous forms. In a third of the cases, there are associated congenital malformations and particularly in the continuous forms (44 to 50% of the cases): anomalies of the limbs, micrognathia, microgyria, and hepatic and digestive abnormalities. Cryptorchidism is associated with the continuous form in 31% of cases. The preoperative diagnosis remains difficult because of its morphological and clinical characteristics suggesting a tumor process.

Splenosis mimicking lymphadenopathy

Splenosis is an autotransplantation of splenic tissue following traumatic rupture of the spleen or splenectomy. Generally, splenosis is asymptomatic. Therefore, most cases are incidental findings made during surgery, autopsy or after imaging studies for other purposes. Splenosis is a benign phenomenon, but it often shows similarity to the metastatic process. We present a case of asymptomatic intraperitoneal splenosis occurring in a 57-year-old male, in whom computed tomography urography showed lymphadenopathy suggesting a neoplastic process. A reconnaissance laparotomy was performed, and specimens were taken and sent for histopathological examination. The microscopic image of all the collected lesions corresponded to the normal spleen tissue. Due to an increasing number of traffic accidents, it is worth taking abdominal splenosis into consideration in the differential diagnosis of tumor-like changes, especially in patients with a history of splenic trauma or spleen removal. As a result, unnecessary surgery can be avoided in many cases.

Splenoptosis in a dairy cow and endoscopic correction of left displacement of abomasum

A third lactation Holstein dairy cow was presented with history of acute reduction in milk yield (‘milk drop’). On combined auscultation and percussion of the left costal area and paralumbar fossa, distinct sounds (‘ping’ or ‘slosh’) were identified ventrally. The case was investigated endoscopically, with two portals set-up either side of the 13th left rib. The abomasum was displaced and congested, and ecchymoses were found on its greater curvature. The spleen was not visible on the initial examination. The spleen became visible following abomasocentesis and deflation of the abomasum. Unlike the normal spleen that has a sharp caudal edge, this one’s edge appeared swollen. The swelling was consistent with splenomegaly, due to the compromised blood circulation following the splenoptosis.

Cryo-Gel embedding compound for renal biopsy biobanking

Optimal preservation and biobanking of renal tissue is vital for good diagnostics and subsequent research. Optimal cutting temperature (OCT) compound is a commonly used embedding medium for freezing tissue samples. However, due to interfering polymers in OCT, analysis as mass spectrometry (MS) is difficult. We investigated if the replacement of OCT with Cryo-Gel as embedding compound for renal biopsies would enable proteomics and not disturb other common techniques used in tissue diagnostics and research. For the present study, fresh renal samples were snap-frozen using Cryo-Gel, OCT and without embedding compound and evaluated using different techniques. In addition, tissue samples from normal spleen, skin, liver and colon were analyzed. Cryo-Gel embedded tissues showed good morphological preservation and no interference in immunohistochemical or immunofluorescent investigations. The quality of extracted RNA and DNA was good. The number of proteins identified using MS was similar between Cryo-Gel embedded samples, samples without embedding compound and OCT embedded samples. However, polymers in the OCT disturbed the signal in the MS, while this was not observed in the Cryo-Gel embedded samples. We conclude that embedding of renal biopsies in Cryo-Gel is an excellent and preferable alternative for OCT compound for both diagnostic and research purposes, especially in those cases where proteomic analysis might be necessary.

2888. STAT4 Mutation in Three Generations with Disseminated Coccidioidomycosis (DCM) also Exhibits Increased Susceptibility to Coccidioidal Infection in Transfected Mice

Background Reported coccidioidomycosis has increased with case rates of 198/100,000 in Arizona (2012). In California alone, 2000–2011 hospitalizations were $2.2B. Dissemination occurs in 8% of reports with significant morbidity and occasional deaths. DCM was found in 3 generations: grandmother (skin), mother (skin), and son (bone). Whole exome sequencing identified a heterozygous (het) STAT4 mutation (p.E626G) in all three. This mutation alters the phosphotyrosine binding pocket and is predicted to impair STAT4 function, interfering with (i) receptor binding and phosphorylation, (ii) nuclear localization, and/or (iii) transcription. Expression profiling of antigen-stimulated peripheral blood mononuclear cells from one patient showed dampening of known STAT4 targets compared with controls. Methods STAT4 p.E626G was generated and confirmed in C57BL/6NJ (WT) mice using CRISPR-Cas9. With continued breeding, neither homozygous (hom) nor het mice had gross abnormalities. There were normal spleen and lung lymphoid cell numbers. Thymus and bone marrow had normal development of lymphoid subsets. We performed intranasal infection with reduced virulence C. posadasii strain 1038 or with F. tularensis live vaccine- strain (LVS). Naïve or Δcps1-vaccinated mice were tested for resistance to C. posadasii strain Silveira. Results At day 21 post Cp 1038 infection, hom, het, and WT mice had similar lung fungal burdens (~104.7 cfu). All p.E626G mice died between days 31 and 39 with lung burden significantly higher (~9 × 106 cfu) than WT sacrificed on day 44 (7 × 105 cfu, P = 0.015). After LVS infection, p.E626G mice had increased lung bacterial cfu and all had dissemination to the spleen compared with WT lung bacterial burden and no splenic dissemination. Immunized het and WT mice all had significantly reduced lung cfu 14 days following C. posadasii infection compared with unvaccinated WT mice. Conclusion The STAT4 p.E626G mutated mouse recapitulated patients’ increased susceptibility to coccidioidal infection. The decreased fungal burdens seen in Δcps1-vaccinated mice suggest that vaccination may be effective in those persons genetically susceptible to DCM. Given the increasing frequency and economic burdens of coccidioidomycosis, pursuit of vaccination strategies should continue. Disclosures All Authors: No reported Disclosures.

Diagnostic challenge for giant left retroperitoneal accessory spleen: a case report

An accessory spleen refers to single or multiple splenic tissues that appear outside the normal spleen position and have structures and functions similar to those of a normal spleen. We herein present a rare case of a 31-year-old woman who was hospitalized because of a 14-year history of sudden left upper abdominal pain after running. Abdominal computed tomography suggested a large soft tissue mass at the left renal hilum surrounded by several enlarged lymph nodes, which was totally different from computed tomography scanning of normal accessory spleen. The mass was resected by robot-assisted laparoscopic surgery. Histopathological examination confirmed the diagnosis of accessory spleen. The incidence of retroperitoneal accessory spleen is very rare, which should be differentiated with retroperitoneal tumors.