Splenosis occurs after rupture of the spleen or splenectomy [8], and its essence is heterotopic autologous splenic tissue implantation [2,3,4]. Splenosis was first reported by Albrecht [9] in 1896, and Buchbinder and Lipkoff [10] named this disease in 1939. Splenosis occurs in 26%-67% of patients with a history of splenic rupture and splenectomy [4, 5, 11, 12]. In general, splenosis grows slowly and rarely causes invasion. Patients usually have no discomfort symptoms, and it is often accidentally found in physical examination, imaging examination, abdominal surgery and other cases [2, 4]. Spleen tissue or cells can be transplanted not only in various parts of the abdominal cavity [4, 6, 8, 13,14,15], but also in the retroperitoneal cavity, the chest and even the brain [1, 3, 6, 16,17,18]. There have been reported cases of spleen transplantation in the kidney and adrenal gland [17, 18]. Most asymptomatic spleen implants do not need the treatment. When obvious enlargement of the implanted spleen or special implant site causes hydronephrosis, intestinal obstruction, gastrointestinal bleeding and other corresponding symptoms, active treatment such as surgical resection is required [3, 6]. Splenosis lacks specificity in clinical imaging examinations such as ultrasound, CT and MRI, and is often confused with tumor [1, 3, 6]. TC-99M9DRBC and indium-111-labeled platelet are relatively specific imaging examinations for splenosis [1,2,3, 19, 20]. However, these diagnostic devices are not widely available and the cost of examination is very high, which will bring difficulties for accurate preoperative clinical diagnosis of splenosis. Therefore, for patients with a history of splenic rupture or splenectomy, especially in the case of abdominal and retroperitoneal masses, attention should be paid to the possibility of splenic implantation, and relevant preoperative preparations should be actively made.
Hemospermia is usually caused by inflammation, the most common is seminal vesiculitis, but can also be caused by other reasons such as obstruction or cysts, stones, tumors, etc. [21]. The reported patient presented with hemospermia and testicular pain. Multiple preoperative imaging examinations revealed a large pelvic mass closely associated with the seminal vesicle, which was located posterior to the upper part of the seminal vesicle. Endoscopy of seminal vesicle showed no obvious tumors and stones, and the ejaculatory ducts were unobstructed on both sides, but the right seminal vesicle showed chronic inflammatory changes. Therefore, it was considered that the clinical symptoms of the patient might be related to long-term pelvic mass compression of the seminal vesicle and secondary chronic infection. Combined with the patient's history of splenectomy for splenic rupture in childhood, the possibility of splenosis was not ruled out. The nature of the tumor could no longer be determined by routine preoperative imaging, and further pathological examination or expensive radionuclide scan was needed to determine the nature of the tumor. Considering that the large mass had caused obvious symptoms in the patient and there were clear indications for surgery, it was decided to conduct surgical exploration of the mass and submit the intraoperative frozen section for examination. The appropriate treatment was made according to the pathological results.
Based on this rare case, we made a series of advice, which are summarized as follows: First, the establishment of a good follow-up mechanism for patients after splenectomy or rupture of the spleen is not only helpful to observe the survival of the transplanted spleen, but also to monitor the growth and development of the ecotopic implanted spleen that may cause clinical symptoms [22]. Second, urology surgeons should pay attention to individualized plans and carefully consider various factors when treating patients, and do not ignore any small links. This case once again proves that a small detail may play a decisive role in accurate preoperative diagnosis. Attention should be paid to the information provided by the medical history. In this case, we assumed that this history might be forgotten by the patient due to the patient's young age at the time of splenectomy. We should be able to inquire about the history in detail and help the patient to recall the relevant history based on the scar of abdominal surgery at the time of physical examination or ask the relevant informed person about the relevant history(A case of a woman admitted to the hospital with "ovarian cysts and multiple peritoneal nodules" has been reported. The patient underwent splenectomy due to a traffic accident in childhood, and the surgical history was forgotten when the patient provided the medical history in hospital. The peritoneal nodules were suspected to be malignant nodules after examination, and the surgical resection of the nodules was confirmed by pathology as implantation of spleen [5]). When we have an important medical history, we should not simply write it down but think about the meaning behind it.
For patients with a history of splenic rupture or splenectomy, urologists should pay attention to the individualized plan and comprehensively consider all factors in the diagnosis and treatment of patients, and do not ignore any small link. Especially for patients with abdominal or retroperitoneal masses, attention should be paid to the possibility of splenosis, and we should carefully identify the tumor and avoid excessive treatment.
