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Splenosis Pleurae Thorax: first published as 10.1136/thx.34.1.123 on 1 February 1979. Downloaded from Thorax, 1979, 34, 123-124 Splenosis pleurae A G JARIWALLA AND N K AL-NASIRI' From the Department of Medicine, Royal Gwent/St Woolos Hospitals, Newport, Owent, UK Splenosis is the autotransplantation of splenic trabeculae could be seen. Microscopic examina- tissue, usually after traumatic rupture of spleen. tion (fig 2) showed that red pulp predominated Reports of splenosis pleurae are rare. Of the six over the white. The white pulp consisted of cases reported so far, there is only one (Shaw and clusters of lymphocytes with no germinal centres. Shafi, 1937) in the British literature. On the other In most of these clusters were arterioles either hand, splenosis peritonei has been well docu- lying beside the lymphoid follicles or occasionally mented. The transplants have always followed centrally, indistinguishable from malpighian cor- traumatic splenic rupture, diaphragmatic rupture, puscles. The red pulp consisted of endothelial-lined and splenectomy. It is important to recognise sinusoids, histiocytes, and scattered lymphocytes. this condition to avoid unnecessary surgical The connective tissue capsule, in some areas, was procedures. well vascularised and contained rather large arteries and veins. The fibrous trabeculae normally Case report present in the spleen were not shown in any of the nodules. The adjacent lung showed patchy areas A 17-year-old labourer presented with a few of fibrosis and old haemorrhage compatible with weeks' history of a painful lump in the right groin, previous trauma. lethargy, and weakness. A road traffic accident in 1964 had resulted in fractures of the left inferior CLINICAL PROGRESS pubic ramus and left seventh rib and ruptured The patient made a good postoperative recovery. spleen and diaphragm. Splenectomy and repair of The lymphadenopathy completely regressed, the the diaphragm were undertaken. He remained well cause remaining undiscovered. http://thorax.bmj.com/ until his present illness. He was afebrile, and the only abnormality was painless, generalised Discussion lymphadenopathy. Splenosis rarely follows traumatic splenic rupture INVESTIGATIONS and is an important differential diagnosis of Results of investigations showed haemoglobin multiple pulmonary opacities when there is a 14-3 g/dl, and white cell count 7-3X 103 (normal history of trauma to the spleen. Other causes of differential count). The following tests were similar radiological changes are accessory spleens, normal: Paul Bunnel, ESR (Westergren); viral endometriosis, intrathoracic and metastatic neo- on October 4, 2021 by guest. Protected copyright. agglutinations; serum calcium; liver function, im- plasms, and haemangiomas. Splenotic nodules munoglobulins and protein electrophoresis; urea presumably result from autotransplantation on the and electrolytes; electrocardiography; intravenous pleura after scattering of splenic red pulp frag- pyelogram; and hydatid complement fixation. ments from the ruptured spleen. Blood-borne Chest radiograph (fig 1) showed rounded lesions in spread is unlikely because the splenic tissue is not the left mid-zone. A chest radiograph in 1964 had seen in other organs. been normal. Splenotic nodules were noted (Schilling, 1907) At exploratory thoracotomy, multiple purple, at a laparotomy, but the phenomenon of auto- sessile nodules, some lobulated, were removed transplantation and splenosis was first suggested from the left parietal, visceral, and mediastinal by Buchbinder and Lipkoff (1939). Finger clubbing, pleura. They ranged from one to three centi- dyspnoea, and cervicofacial venous congestion have metres in diameter and had the appearance of been described in association with thoracic trans- small spleens. They were soft and surrounded by position of the spleen. These splenotic nodules thin fibrous capsules, but no definite intrasplenic may be responsible for a relapse of a haemato- 'Present address: Department of Surgical Pathology, St Thomas's logical disorder after removal of the spleen for Hospital, London SEI. the condition (Fleming et al, 1976. The absence 123 Thorax: first published as 10.1136/thx.34.1.123 on 1 February 1979. Downloaded from 124 A G Jariwalla and N K Al-Nasiri Fig 1 Splenic deposits in left lateral hemithorax (arrows). Fig 2 One lymphoid follicle with central arteriole (arrow) removed from left pleural cavity. of Howell-Jolly bodies, siderocytes, and other multiple peritoneal splenic implants following http://thorax.bmj.com/ features found in the peripheral blood film after abdominal injury. Surgery, 6, 927-934. splenectomy may suggest the presence of residual Fleming, C R, Dickson, E R, and Harrison, E G tissue. Various (1976). Splenosis: auto-transplantation of splenic splenic radioisotope scanning tissue. American Journal of Medicine, 61, 414-419. techniques (Jacobson and De Nardo, 1971) have Jacobson, S J, and De Nardo, G L (1971). Splenosis been used to diagnose functioning splenic tissue. demonstrated by splenic scan. Journal of Nuclear Although splenosis pleurae is a very rare con- Medicine, 12, 570-573. dition, this being only the second case report in Schilling, K (1907). Uber Einen Fall von Multiplen British literature, it should be considered in the Nebenmilzen. Virchows Archiv fiur Pathologische on October 4, 2021 by guest. Protected copyright. differential diagnosis of intrapulmonary opacities A natomie und Physiologie und fiur Klinische in the presence of history of splenic rupture. Medizin, 188, 65-87. Shaw, A F, and Shafi, A (1937). Traumatic auto- to our to Dr E G plastic transplantation of splenic tissue in man with We would like express thanks observation on the late results of splenectomy in Anderson, Dr H J Lloyd, and Mr T H L Rosser six cases. Journal of Pathology and Bacteriology, for permission to publish the case and Dr Roger 45, 215-235. Seal for his help. References Requests for reprints to: Dr A G Jariwalla, Depart- ment of Medicine, Llandough Hospital, Penarth, Buchbinder, J H, and Lipkoff, C J (1 939). Splenosis: Cardiff..
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