99mTc-Sn-colloid SPECT/CT in thoracic splenosis after esophageal cancer surgery

Document Type : Case report

Authors

1 Department of Radiology, Kitasato University Hospital, Sagamihara, Kanagawa, Japan

2 Department of Radiology, Fuchinobe General Hospital, Sagamihara, Kanagawa, Japan

Abstract

Splenosis occurs as a result of autotransplantation of splenic tissue following splenic injury or splenectomy. A 56-year-old man with esophageal cancer underwent thoracoscopic-assisted subtotal esophagectomy accompanied by three-field lymph node dissection, and retrosternal gastric tube reconstruction. The spleen was injured during the surgery and was removed. A retrosternal nodule of 12 mm in diameter was detected near the reconstructed gastric tube on computed tomography (CT) performed 3 years and 6 months postoperatively.
Retrospectively, the nodule was observed in the same area on early postoperative CT and gradually increased in size. No accessory spleen was identified on the preoperative CT. Splenosis was suspected, and 99mTc-Sn-colloid single photon emission computed tomography (SPECT)/CT was performed. It revealed intense uptake in the retrosternal nodule, consistent with the diagnosis of thoracic splenosis. Subsequently, the patient has been under observation without treatment. 99mTc-labeled colloid SPECT/CT allowed confident diagnosis of thoracic splenosis following esophageal cancer surgery. This examination is considered valuable for the evaluation of ectopic splenic tissue.

Keywords

Main Subjects


  1. Fleming CR, Dickson ER, Harrison EG Jr. Splenosis: autotransplantation of splenic tissue. Am J Med. 1976; 61: 414-419.
  2. Fremont RD, Rice TW. Splenosis: a review. South Med J 2007; 100:589-593.
  3. Khan AM, Manzoor K, Malik Z, Yasim A, Shim C. Thoracic splenosis: know it-avoid unnecessary investigations, and thoracotomy. Gen Thorac Cardiovasc Surg. 2011; 59, 245-253.
  4. Vikse J, Sanna B, Henry BM, Taterra D, Sanna S, Pekala P, et al. The prevalence and morphometry of an accessory spleen: A meta-analysis and systematic review of 22,487 patients. Int J Surg. 2017; 45:18-28.
  5. Henry D, Brown ML, Drum DE, Sylvester JM, Ziessman HA. Procedure guideline for hepatic and splenic imaging. J Nucl Med. 1998; 39: 1114-1115.
  6. John R. Sty, James J. Conway. The spleen: development and functional evaluation. Seminars in Nucl Med. 1985; 15:276-98.
  7. Lopes B, Almeida LR, Vicente AA, Marcellos DC, Corassa M, Romano RF, et al. Thoracic splenosis as a differential diagnosis of juxtapleural nodules. Respir Med Case Rep. 2014; 11:1-3.
  8. Pachowicz M, Mocarska A, Staroslawska L, Pietzyk B, Chrapko B. Accessory spleen mimicking pancreatic tumour: evaluation by 99mTc-labelled colloid SPECT/CT study. Report of two cases and a review of nuclear medicine methods utility. Folia morphologica. 2015; 74: 532-539.
  9. Israel, O, Pellet, O, Biassoni, L, De Palma D, Estrada-Lobato E, Gnanasegaran G, Kuwert T, et al. Two decades of SPECT/CT – the coming of age of a technology: An updated review of literature evidence. Eur J Nucl Med Mol Imaging 2019; 46: 1990-2012.
  10. Kim SH, Lee JM, Han JK, Lee JY, Kim KW, Cho KC, et al. Intrapancreatic accessory spleen: Findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol. 2008; 9:162-74.
  11. Ittrich H, Peldschus K, Raabe N, Kaul M, Adam G. Superparamagnetic iron oxide nanoparticles in biomedicine: applications and developments in diagnostics and therapy. Rofo. 2013; 185:1149–1166.