When is a spleen not a spleen?

RE: When is a spleen not a spleen?

Anthony Dennison — Mon, 02 Nov 2020 16:33:03 GMT

Well, dog is now in Canada. I certified him as fit to fly last Thursday!

RE: When is a spleen not a spleen?

Stephen Courtney — Sun, 01 Nov 2020 11:43:21 GMT

I think if there was swab left in there, there would have been evidence on the histology of foreign material.

I would suspect that this was some sort of myelolipoma - not unheard of in the spleen - that necrosed for some reason, possible a torsion, possibly due to loss of normal tissue?

The osseous metaplasia is something that can happen where there is dystrophic or metastatic calcification if I remember rightly, so while interesting, is not likely to provide clues as to what really happened. Basically you see little islands of bone tissue, including marrow, appearing in odd places. Pretty cool and pretty weird

Interesting case, and great that the dog is picking up - seems he was feeling below par before this was found!

RE: When is a spleen not a spleen?

Anthony Dennison — Thu, 22 Oct 2020 15:24:30 GMT

So, dog is doing extremely well post op! Owner says he seems even brighter than he was before. Only other previous history of abdominal surgery was 6.5 years ago when he had surgery for a retained testicle, but they said they couldn't find it - possible swab left in from there? Has had BOAS surgery done too when he was younger. Neoplastic testicle invading spleen?

Dog is flying to Canada next week now!

Additional histology report:

DIAGNOSIS Well differentiated adipose and fibrous connective
tissue with extensive necrosis, haemorrhage and multifocal
mineralisation and osseous metaplasia please see below

Four additional sections are examined (blocks E-H) and reveal
similar findings. There is abundant well differentiated
adipose tissue with extensive necrosis and chronic and acute
haemorrhage.
I have shared this case with my colleague Lou Dawson, Chris
Palgrave and Alan Stevens to discuss interpretation. The
samples are difficult to interpret due to the large areas of
necrosis. Large portions of the tissue appear to be composed
of well differentiated adipose tissue. There is no
recognisable splenic parenchyma, however, because there are
extensive areas of necrosis and haemorrhage it is not possibly
to rule out the possibility that some portions of this sample
are necrotic splenic parenchyma. Interpretation of the changes
is difficult due to the extensive necrosis. The possibility of
a strangulated/traumatised abdominal lipoma cannot be ruled
out, but that wouldn t explain the absence of spleen. The
possibility of a large splenic myelolipoma/lipoma that is
ruptured with extensive of necrosis should also be considered.
I didn t see changes suggestive of a malignancy, but this is portions of tissue that are assessable. Complete excision of
lipomas/myelolipomas is expected to be curative, so excision
of the mass could be curative in this case. However, due to
the difficulties in interpretation, ongoing monitoring is
recommended.

RE: When is a spleen not a spleen?

Julian Earl — Mon, 19 Oct 2020 18:40:58 GMT

Is TB a ridiculous suggestion for a caseous while mass in lymphoid tissue? Just a thought, sorry!

RE: When is a spleen not a spleen?

Anthony Dennison — Sun, 18 Oct 2020 20:06:45 GMT

Histo Report is back. I'll speak to the owner's normal practice and get a full history. Male entire bulldog so not a swab left in after neutering. I've spoken to the CD of the practice who the dog is registered with and he didn't mention anything about prior to surgery. The fact there is osseous metaplasia is a weird one!

PRELIMINARY DIAGNOSIS (a further report is pending)
Pending additional sections

CLINICAL HISTORY
Duke was clinically well and had a fitness to fly exam and a
scan showed what appear to be a mass on the spleen. There is an
approximately 20 x 12 cm mass in the area where spleen should
be that was well adhered to the left body wall and surrounding
mesentery. No normal spleen found. Hard calcified lesions felt
within one of blood vessels. Centre of the mass necrotic with
possible calcification.

HISTOLOGY
Description: 4 samples are received and evaluated

Spleen 1, 2 sections (block A-B): The sections contain
well-differentiated adipose tissue, fibrous connective tissue
and extensive areas of necrosis and haemorrhage. There is
multifocal mineralisation within the areas of necrosis. There
is multifocal deposition of bright yellow material (interpreted
as haematoidin).

Spleen 2, one section (block C): The section contains
well-differentiated adipose tissue with extensive necrosis and
acute and chronic haemorrhage.

Calcification by spleen, 2 sections (block D): The sections
contain well-differentiated adipose tissue and fibrous
connective tissue and multifocal areas of mineralisation with
osseous metaplasia.

COMMENT
Histopathology of the sections examined so far reveal
well-differentiated adipose tissue, small amounts of connective
tissue and extensive necrosis and haemorrhage with areas of
mineralisation and osseous metaplasia. In some areas, this
lesion has the appearance of a
necrotic/traumatised/strangulated lipoma but it would be
unusual for a lipoma to engulf the spleen so I have requested additional sections to be processed in case the
reveal more information and results will follow in a further
report.

RE: When is a spleen not a spleen?

Aine Seavers — Sat, 17 Oct 2020 22:51:28 GMT

A Glossypiboma-from a swab left by elsewhere vet clinic post desexing. I would be thinking the swab or else given its a bulld dog then a tracking FB the omentum then trapped.

RE: When is a spleen not a spleen?

Rach — Sat, 17 Oct 2020 19:28:28 GMT

Was it a bitch or a dog and was it neutered? Could it be some sort of teratoma?

RE: When is a spleen not a spleen?

Roland Bulkyn-Rackowe — Thu, 15 Oct 2020 07:36:24 GMT

Looks a lot like a mass I removed adherent to large bowel some years back. It had a pyometra surgery 5 years before and was likely a swab.

RE: When is a spleen not a spleen?

Lindsey Edwards — Wed, 14 Oct 2020 21:54:22 GMT

I operated on one almost identical years ago but hundreds of adhesions, likely from intermittent bleeds, dog had arrived collapsed and cachexic but without the expected haemoabdomen. Patient never looked back after surgery and thrived to old age (after I finally figured out how to extract it abdomen!)

RE: When is a spleen not a spleen?

Gillian Mostyn — Wed, 14 Oct 2020 15:25:09 GMT

[quote userid="6897" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29408/when-is-a-spleen-not-a-spleen/225911#225911"]Any previous surgery - a swab left behind?[/quote]

That was my first thought...from a previous splenectomy?

RE: When is a spleen not a spleen?

Beats — Wed, 14 Oct 2020 09:09:38 GMT

The lack of a spleen makes me think this must be/have been spleen.

Random incidental necrotic masses in abdomen otherwise have been from omentum in my experience - very satisfying cases!

RE: When is a spleen not a spleen?

bob lehner — Wed, 14 Oct 2020 08:57:51 GMT

Any previous surgery - a swab left behind?

RE: When is a spleen not a spleen?

Anthony Dennison — Wed, 14 Oct 2020 07:35:52 GMT

No, not second guessing anything. Just thought it was very weird, no one at work had seen anything like it before so thought I'd share.

I've removed a lymphoma from a spleen before, spleen looked horrible but prognosis was good post splenectomy. Dog is still going 2 years on

RE: When is a spleen not a spleen?

Michael Woodhouse — Wed, 14 Oct 2020 01:15:46 GMT

Lots of necrosis. Are we second guessing the histopath?

MCT secondary *shrug*

I removed a massive spleen in an older dog a couple of months ago - lymphoma.