Letter to the editor: Laparoendoscopy in diagnostic and treatment of a rare case of pelveoperitoneal splenosis mimicking adnexal tumors

Splenosis is a benign condition that involves autotransplantation of the spleen following the abdominal trauma, but can also occur as a result of elective splenectomy or accidental injury of the spleen during abdominal surgery [ ]. Few papers have been published concerning rare findings of pelvic splenosis in clinical practice. This encouraged us to describe the case of pelveoperitoneal splenosis which mimicked the bilateral adnexal tumors in 54-year-old patient who was referred to gynecological examination due to the irregular pain in the lower abdomen. Ultrasound examination revealed hypoechogenic multi-cystic formations at the ovarian level; at the right ovary measuring 2.5×2.5×3 cm and 2.5×3×3.5 cm at the left side. Color doppler showed rich vascularization with low values of resistant index (RI 0,41–0,42). For further investigation of pelvic masses, pelvic computed tomography scan was performed that showed the similar formations as seen by ultrasound. The patient’s carbohydrate antigen (CA) 125 serum level was normal, like the others laboratory findings. In the personal history, the patient experienced abdominal trauma and open splenectomy 30 years ago, while her health condition was unremarkable since than. The patient had no family history of related malignant diseases. The patient was submitted for laparoscopic surgery that revealed multiple adhesions of the omentum and peritoneum of vesicouterine excavation with a bilateral brownish multiple soft tissue structures adjoined to both ovaries and of 2 to 3 cm in size. The masses were extirpated and intraoperatively sent for the urgent histopathological examination that diagnosed the ectopic splenic tissue (Fig. 1). Unlike the normal splenic tissue, this masses had distorted architecture with no hilus and a deficiently formed capsule. Other anatomic sites of pelvic and abdominal cavity were clear of splenosis. The patient underwent adhesiolysis with bilateral adnexectomy and complete extirpation of the ectopic splenic tissue. The definitive postoperative histopathological examination confirmed the diagnosis of splenosis. Although isolated ovarian splenosis has been described only few times in the literature, the patients are mostly asymptomatic with incidental findings of ovarian ectopic splenic masses [ , ]. Our case showed that ovarian splenosis could be associated with abdominal pains, although the contribution of the pelvic adhesions could not be neglected. Differential diagnosis includes a large variety of diseases such as endometriosis, ovarian malignancies, different metastatic disease, peritoneal carcinoma and lymphomas [ , ]. As in our case, the diagnosis has usually been established intraoperatively, by minimal invasive laparoendosopic approach, due to the rarity of the condition and the concern for malignancy, it would be advisable to consider it in splenectomised patients with ultrasound finding of echogenic ovarian masses.