PICTURES IN DIGESTIVE PATHOLOGY

 

Usefulness of Tc-99m labelled heat-denatured red blood cell scintigraphy for diagnosis of peritoneal splenosis in a patient with hepatocellular cancer: a case report

Gammagrafía con hematíes desnaturalizados en el diagnóstico de esplenosis peritoneal en paciente con antecedente de hepatocarcinoma. A propósito de un caso

 

 

Francisco Javier García-Gómez¹, María Dolores Martínez-Valle-Torres², Esperanza Ramos-Moreno², Tomader Amrani-Raissouni², Pedro Moya-Espinosa², Salomé Sanz-Viedma² and José Manuel Jiménez-Hoyuela²

Department of Nuclear Medicine,
¹Hospital Universitario Virgen del Rocío. Sevilla, Spain
²Hospital Universitario Virgen de la Victoria. Málaga, Spain

 

 

Case report

We report the case of a 47-years-old male with diagnosis of hepatocellular carcinoma in a patient with genotype 1a hepatitis C virus cirrhosis (Child-Pugh grade A) who was subject to a splenectomy after an abdominal trauma in the infancy. Lymph nodes larger than 2.5 cm on the left side of the abdomen (Fig. 1A) and subcentimetric lymph nodes in hipogastric area (Fig. 1B) were observed in a routine follow-up computed tomography. For distinguishing between malignant and benign lesion, a whole body positron emission tomography/computed tomography (PET/CT) was performed 60 minutes after injection of 347.4 MBq fluorine-18 deoxyglucose (18F-FDG). The left-sided lesion was observed at PET/CT scan, with maximum standardized-uptake-value (SUVmax) of 1.1 (Fig. 1C), but malignancy could not be determined. Furthermore, a 4.3 cm mass with SUVmax 1.6 was found (Fig. 1D), that could correspond to accessory spleen or splenosis. A Tc-99m labelled heat-denatured red blood cell scintigraphy and a single photon emission computed tomography (SPECT/CT) after injection of 555 MBq radiolabeling autologous red blood cells were performed to confirm the diagnosis of splenosis. The Tc-99m labelled heat-denatured red blood cell scintigraphy revealed two areas of splenosis, one in the upper left abdomen and another in the ileocecal area (Fig. 2). Oncology committee determined the need for clinical and radiological follow-up, avoiding invasive procedures with high risk for bleeding.

 

 

Discussion

The term splenosis was introduced by Buchbinder and Lipkoff (1) to designate the heterotopic autotransplantation of splenic tissue which generally occurs after traumatic splenic rupture or surgery. After incidentally diagnosed in more patients, differential diagnosis of splenosis is needed and includes renal tumors, adrenal masses, lymphomas, and metastatic disease, and it should be kept in mind when approaching a digestive bleeding (2,3). The performance of scintigraphy with 99mTc-labelled heat-denatured erythrocytes allows the non-invasive diagnosis of this entity and avoids more aggressive diagnostic techniques (4).

 

References

1. Buchbinder JH, Lipkoff CJ. Splenosis: Multiple peritoneal implants following abdominal injury. Surgery 1939;6:927-34.         [ Links ]

2. Vásquez Tineo SI, Garcia Ionso MP, Mendoza Paulini A, Paniagua Correa C, Balsa Bretón MA, Mariana Monguía A, et al. Non-invasive diagnosis of posttraumatic thoracic splenosis. Rev Esp Med Nucl 2011;30:311-3.         [ Links ]

3. Arroja B, Almeida N, Macedo CR, Moreira AP, Oliveira P, Tomé L, et al. Gastric splenosis: A rare cause of digestive bleeding. Rev Esp Enferm Dig 2011;103:377-8.         [ Links ]

4. Martínez del Valle Torres MD, Ortega Lozano SJ, Jiménez-Hoyuela García JM, Delgado García A, Gavilán Carrasco JC, Bermúdez Recio FJ. Utility of Tc-99m labeled heat-denatured red blood cell scintigraphy in a case of hepatic splenosis. Gastroenterol Hepatol 2005;28:279-82.         [ Links ]