A 42-year-old man attended our outpatient department with melena for 1.5 years and
vague epigastric pain for 2 days. He had a history of splenectomy because of trauma
17 years ago. Physical examination did not reveal any abdominal mass or enlargement
of Virchow’s lymph nodes. A rectal digital examination and blood tests were also unremarkable.
Gastroscopy revealed a submucosal mass with a superficial bleeding ulcer in the gastric
fundus. Endoscopic ultrasound (EUS) showed that the structure of the gastric wall
was intact but a giant mass was present due to extragastric compression at a few sites.
The mass was closely adherent to the gastric wall ([Fig. 1]). Contrast computed tomography (CT) demonstrated an exogenous enhancing mass over
the fundus of the stomach approximately 5 cm in size, with a complete mucosal layer
and boundaries clearly demarcated from the surrounding tissues. No obviously enlarged
lymph nodes were seen ([Fig. 2]). Laparotomy revealed a red mass on the gastric wall of the fundus. Partial gastrectomy
was carried out, with negative margins established by frozen section examination.
Gross inspection of the specimen showed sinusoids on cross-section. Finally, pathological
examination confirmed the diagnosis of ectopic spleen. The patient had a rapid recovery,
with disappearance of his symptoms.
Fig. 1 Gastroscopic view in a 42-year-old man with melena and vague epigastric pain and
a history of splenectomy. Note the submucosal mass with superficial bleeding ulcer
(arrow). Endoscopic ultrasound (EUS) revealed that the mass was caused by extragastric
compression.
Fig. 2 Computed tomography (CT) demonstrating an exogenous enhancing mass (arrowhead).
Splenosis is a rare condition involving autotransplantation of splenic tissue to ectopic
multiple locations, including kidney, omentum, peritoneum, and liver [1]
[2]. The present report describes a rare case of splenosis involving the gastric wall,
that mimicked gastrointestinal stromal tumor (GIST). The symptoms of splenosis depend
on the location of the ectopic spleen. An ectopic spleen presenting as an intraperitoneal
mass may be confused with some malignant tumors, or manifest as acute abdomen, such
as torsion of the splenic implant and hemorrhage of the digestive tract owing to the
invasion of the bowel wall by the ectopic spleen. It is usually difficult to make
a definite diagnosis of splenosis preoperatively. However, splenosis should be considered
in the differential diagnosis in patients who have a history of splenectomy, with
absence of Howell–Jolly bodies on the peripheral blood smear [3]. Some imaging tests, including CT, magnetic resonance imaging (MRI), 99 mTc-labelled erythrocytes, and Doppler ultrasonography are useful in distinguishing
the condition from other diseases [4]. In the present case, a submucosal mass with superficial bleeding ulcer in the gastric
fundus was found and preoperatively diagnosed as GIST. EUS plays an important role
in localization and elucidating the characteristics of submucosal gastric lesions
[5]. In our case, the preoperative EUS revealed that the structure of the gastric wall
was intact and the mass was due to extragastric compression. This finding is in accordance
with the diagnosis of splenosis in the gastric wall. However, since the lesion had
caused chronic hemorrhage, the possibility of malignancy could not be excluded completely.
Therefore laparotomy was carried out.
Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB
