Retroperitoneal Splenosis Simulating a Relapsing Renal Carcinoma

Abstract

We present a case of retroperitoneal splenosis simulating a relapsing renal carcinoma. A 75-year-old male had undergone a left radical nephrectomy for a clear cell neoplasm, pT4 N0; during the operation a splenectomy for an unreparable spleen laceration had been performed. After 1 yr, the patient was asymptomatic; an abdominal CT evidenced a solid 24 mm diameter nodular formation of the left lumbar region, a suspected recurrence of renal carcinoma. This nodule was removed, it was capsulated and violaceous; the histologic examination demonstrated that it was typical splenic tissue. Splenosis nodules are generally due to “insemination” of splenic pulp after trauma or splenectomy, probably more frequent with laparoscopic surgery. The splenosis localizations can be either single or multiple, round in form, a few centimeters at its greatest diameter; the favorite seats are the peripancreatic region, the gastrocolic ligament and the great omentum. The splenosis is generally asymptomatic, but it can simulate tumors of various organs. The echotomographic and CT scan remarks can be aspecific. MRI can be more precise, with the ferumoxide-enhancement effect. The most reliable examination is the “heat damaged” Tc-99 labeled erythrocyte scintigraphy: 1 cm nodules appear evident. We recommend that the diagnosis of suspected neoplasm in splenectomized patients should include the heat damaged red cell scintigraphy.