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SDIAP SENEC 2010 case 374 Ludmila Boudová Plzeń. Subcutis.

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Presentation on theme: "SDIAP SENEC 2010 case 374 Ludmila Boudová Plzeń. Subcutis."— Presentation transcript:

1 SDIAP SENEC 2010 case 374 Ludmila Boudová Plzeń

2 Subcutis

3 Mentální retardace, epilepsie Medikace 1. Mysoline (primidone) 2. Sodanton (diphenylhydantoine) 3. Apo-Haloperidol (butyrofenon. incis. neuroleptikum) 4. Rivotril (clonazepam) 5. Nitrazepam F 6. Apaurin (diazepam) při záchvatu 7. Topamax (topiramat) 8. Tisercin (levopromazin) Flavobion, Ascorutin, Pancreolan Vomitus, obstipace, zvětšení rezistence v levém podbřišku 4 dny Muž, 23 let

4 Incarcerated inguinal hernia? 4 cm mass Blood count, CRP: normal HBsAg positivity

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7 Diagnosis?

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10 A mass in the subcutis 8 x 7 x 5 cm

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14 Case history Born 1982 Children cerebral palsy, left sided hemiparesis Epilepsy, mental retardation 1992 - trauma - spleen laceration, renal contusion, brain commotion; splenectomy 1993 – first operation of splenosis in the abdominal scar corrective operations of lower extremities 2005 – suspected hernia in cicatrice; second operation for splenosis 2010 - alive and well

15 Splenosis Autotransplantation of splenic tissue following abdominal trauma or surgery Localization Common: peritoneum Rare: pericardium, pleura, retroperitoneum, subcutis May be cystic

16 Splenosis Diagnostic problem - clinical, imaging Case history Mostly: small, asymptomatic Rarely: intestinal obstruction, mass effect on abdominal organs, pelvic pain, bleeding

17 Splenosis - differential diagnosis  Splen accessorius = spleniculus Splenic hilus, lig. gastrosplenicum Tail of pancreas, mesentery Tumours, metastasis, endometriosis, incarcerated hernia…

18 Splenosis Normally functioning splenic tissue Benefits and problems after splenectomy

19 Subcutaneous splenosis of the abdominal wall Am J Dermatopathol. 2006 Jun;28(3):208-10. Boudová L, Kazakov DV, Hes O, Zahálka M, Mukensnabl P, Kocová J, Michal M.

20 Splenóza jater u nemocného po operaci seminomu. Rozhl. Chir., 2005, 84, 9, s. 452-455. Třeška V., Skalický T., Chudáček Z., Boudová L., Hes. O

21 Drug-induced abnormalities of lymph nodes and spleen Antiepileptic, ATB, NSAR, Phenytoin Spleen:T- cell hyperplasia Expansion of PALS by CD4 T-lymphocytes I OACHIM: Lymph node pathology


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