In a 43-year-old man, rectal cancer (T3c on MRI criteria) with lymph-node metastases (Figure a) was confirmed by examination of endoscopically obtained biopsy samples. Further investigation (thoracic and abdominal computed tomography and magnetic resonance imaging of the pelvis minor) revealed numerous nodular foci throughout the abdomen. The patient reported abdominal trauma with rupture and resection of the spleen 27 years earlier. Splenic scintigraphy with 99mTc-marked heat-damaged red blood cells was performed to determine whether these nodules represented peritoneal carcinosis or splenosis (Figure b). In the course of degeneration, heat-damaged red blood cells accumulate in splenic and hepatic tissue. The scintigraphy confirmed the suspicion of secondary splenosis. The rate of intra-abdominal autotransplantation of splenic tissue following rupture and post-traumatic resection of the spleen is reported in the literature as 65 to 80%. After neoadjuvant radiochemotherapy and restaging, surgical treatment of the patient’s rectal cancer was planned.
Dr. med. Christoph Erxleben, Klinik und Hochschulambulanz für Radiologie, Charité – Universitätsmedizin Berlin, Campus Benjamin-Franklin, firstname.lastname@example.org
Dr. med. Roland Scherer, Zentrum für Darm- und Beckenbodenchirurgie, Krankenhaus Waldfriede, Berlin
PD Dr. med. Thomas Elgeti, Klinik und Hochschulambulanz für Radiologie, Charité – Universitätsmedizin Berlin Campus Benjamin-Franklin, Klinik für Nuklearmedizin,
Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare
Cite this as: Erxleben C, Scherer R, Elgeti T: Diagnosis: splenosis. Dtsch Arztebl Int 2018; 115: 792. DOI: 10.3238/arztebl.2018.0792