The wandering spleen
Wandering spleen is an unusual entity, occurring in both sexes and at any age, but is more frequent in women of reproductive age and in children. Wandering spleen is probably most often a result of congenital anomalies of development of the dorsal mesogastrium, but acquired factors may have a role in certain instances. Patients present most commonly with an asymptomatic mass, mass and subacute abdominal or gastrointestinal complaints or with acute abdominal findings. Clinical diagnosis can be difficult, but noninvasive imaging procedures, such as sonography, nuclear scintigraphy, computed tomography and magnetic resonance imaging are usually diagnostic. Laboratory tests are usually nonspecific, but may occasionally reveal evidence of hypersplenism or functional splenia. Symptoms may remain limited or absent for long periods of time, but complications related to torsion or compression of abdominal organs by the spleen or the pedicle are quite common. Splenomegaly is usually a result of torsion of the pedicle and splenic sequestration. Significant morbidity and mortality rates seem to be considerably less than described in 1933 and limited primarily to patients presenting initially with acute abdominal findings. Management recommendations have varied, but recognition of a significant risk of postsplenectomy sepsis supports a conservative approach. Patients with limited symptomatology may be medically managed until they exhibit worsening symptoms indicating progressive splenic torsion or gastrointestinal compression. Detorsion and splenopexy may be considered a reasonable surgical option even in patients presenting with acute abdomen, if there is no evidence of infarction, thrombosis or hypersplenism. Splenic preservation is especially recommended in extremely young patients who are at particular risk for postsplenectomy sepsis. However, it should be noted that follow-up evaluation data on splenopexy patients are notably lacking. Splenectomy is ideally reserved for patients presenting with acute abdomen and splenic infarction or thrombosis or with hypersplenism and patients in whom splenopexy is technically unfeasible. Subtotal splenectomy and splenic autotransplantation may be of limited value. Pneumococcal, Hemophilus and meningococcal vaccines are indicated before elective splenectomy and shortly after nonelective splenectomy. Antibiotic prophylaxis is recommended for those at particular risk. Prospective studies are unlikely, but extended follow-up information on patients already reported, particularly those managed expectantly or with conservative surgical measures, is needed. [1]
Innervation of the periarteriolar lymphatic sheath of the spleen
During the course of a neurohistochemical and two independent electron microscopic studies of the mouse spleen, unmyelinated adrenergic nerves containing numerous dense core and lucent vesicles and devoid of neurolemma were observed adjacent to reticular cells and lymphocytes in the white pulp. Some of these nerves formed an intimate relationship with these cells. Since adrenergic substances have been reported to modulate the cell cycle of lymphocytes in vitro, these findings are suggestive of a neural influence on the cell cycle of lymphocytes in vivo. [2]
Wandering spleen: a challenging diagnosis
Wandering spleen is rare, particularly in children, and diagnosis is difficult. It usually occurs at 20 to 40 years of age, and most cases are seen in women. Diagnosis is difficult because of lack of symptoms, unless splenic torsion has occurred. Patients usually have an asymptomatic abdominal mass, an acute abdomen, or, most commonly, a mass associated with pain. Laboratory data are nonspecific, but the diagnosis can be confirmed by imaging studies; computed tomography and duplex ultrasonography are preferred modalities. Treatment is operative because of complications of splenic infarction and possible splenectomy. Splenopexy is the treatment of choice for a noninfarcted wandering spleen. Splenectomy should be done only when there is no evidence of splenic blood flow after detorsion of the spleen. We review our experience with wandering spleen in two pediatric patients, one treated with splenopexy and the other with splenectomy. [3]
Pathological Overview and Antioxidant Status of Thyme on H2O2-induced Spleen Tissues Damage
Objectives: To study the preventive effect of Thymus algeriensis essential oil (TAS) against hydrogen peroxide (H2O2)-induced spleen toxicity in rats.
Materials and Methods: Rats were treated with Hydrophobic fractions of Thymus algeriensis (180 mg/kg body weight, n=6), H2O2 (0.1, 1 mmol/L body weight, n=6) and the exposure to both drugs orally for 15 days. Histological examination was performed and the levels of biochemical parameters and lipid peroxides were determined.
Results: In spleen tissue protein, catalase, superoxide dismutase, and glutathione (GST, GPx and GSH) levels were increased significantly (P<0.05) in the essential oil pretreated rats when compared to H2O2. TAS decreased the intracellular malondialdehyde (MDA) levels in spleen tissues. Vascular congestion was seen in spleen of high dose H2O2-treated rats and normal architecture of tissues was observed in other groups.
Conclusion: The biochemical parameters and histopathology examination support the cytoprotective effect of Thyme which could be attributed to terpenes. [4]
Effect of Passive Transfer of Spleen Cells from Immunized Mice with Hydatid Cyst Antigens on the Growth of Melanoma Cancer in C57/Black Mice
Background: Anticancer effect of hydatid has been shown in previous investigations. However the mechanism of anticancer effects of hydatid cyst has not been clarified. So in this work the effect of spleen cell transfer immunized by the hydatid cyst antigens on melanoma cancer growth in animal model has been investigated.
Methods: Spleen cells of mice immunized with hydatid cyst fluid, cyst wall and protoscoleces were transferred to different group of mice and subsequently challenged with melanoma cells. Then the tumor size, tumor growth rate and survival time of mice were compared with those of control groups.
Results: Tumor size, tumor growth rate and mice survival time were significantly lower than what observed in control mice.
Conclusion: Immune response to hydatid cyst antigens may be involved in Anti-cancer effect of this parasite. [5]
Reference
[1] Buehner, M. and Baker, M.S., 1992. The wandering spleen. Surgery, gynecology & obstetrics, 175(4), pp.373-387.
[2] Reilly, F.D., McCuskey, P.A., Miller, M.L., McCuskey, R.S. and Meineke, H.A., 1979. Innervation of the periarteriolar lymphatic sheath of the spleen. Tissue and Cell, 11(1), pp.121-126.
[3] Desai, D.C., Hebra, A., Davidoff, A.M. and Schnaufer, L., 1997. Wandering spleen: a challenging diagnosis. Southern medical journal, 90(4), pp.439-443.
[4] Fatma, G. and Ahmed, L. (2018) “Pathological Overview and Antioxidant Status of Thyme on H2O2-induced Spleen Tissues Damage”, Annual Research & Review in Biology, 27(6), pp. 1-7. doi: 10.9734/ARRB/2018/42443.
[5] Ramazninia, S., Sharafi, S., Bahadoran, M., Nodeh, F., Mahmoudzadeh, M. and Darani, H. (2016) “Effect of Passive Transfer of Spleen Cells from Immunized Mice with Hydatid Cyst Antigens on the Growth of Melanoma Cancer in C57/Black Mice”, Journal of Advances in Medicine and Medical Research, 16(7), pp. 1-6. doi: 10.9734/BJMMR/2016/26744.