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SDIAP SENEC 2010 case 374

SDIAP SENEC 2010 case 374. Ludmila Boudová Plzeń. Subcutis. Muž, 23 let. Mentální retardace, epilepsie Medikace 1. Mysoline (primidone) 2. Sodanton (diphenylhydantoine) 3. Apo-Haloperidol (butyrofenon. incis. neuroleptikum) 4. Rivotril (clonazepam) 5. Nitrazepam F

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SDIAP SENEC 2010 case 374

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  1. SDIAP SENEC 2010 case 374 Ludmila Boudová Plzeń

  2. Subcutis

  3. Muž, 23 let Mentální retardace, epilepsie Medikace 1. Mysoline (primidone) 2. Sodanton (diphenylhydantoine) 3. Apo-Haloperidol (butyrofenon. incis. neuroleptikum) 4. Rivotril (clonazepam) 5. Nitrazepam F 6. Apaurin (diazepam) při záchvatu 7. Topamax (topiramat) 8. Tisercin (levopromazin) Flavobion, Ascorutin, Pancreolan Vomitus, obstipace, zvětšení rezistence v levém podbřišku 4 dny

  4. Incarcerated inguinal hernia?4 cm mass • Blood count, CRP: normal • HBsAg positivity

  5. Diagnosis?

  6. A mass in the subcutis 8 x 7 x 5 cm

  7. Case history • Born 1982 • Children cerebral palsy, left sided hemiparesis • Epilepsy, mental retardation • 1992 - trauma - spleen laceration, renal contusion, brain commotion; splenectomy • 1993 – first operation of splenosis in the abdominal scar • corrective operations of lower extremities • 2005– suspected hernia in cicatrice; second operation for splenosis • 2010 - alive and well

  8. Splenosis Autotransplantation of splenic tissue following abdominal trauma or surgery Localization Common: peritoneum Rare: pericardium, pleura, retroperitoneum, subcutis May be cystic

  9. Splenosis • Diagnostic problem - clinical, imaging • Case history • Mostly: small, asymptomatic • Rarely: intestinal obstruction, mass effect on abdominal organs, pelvic pain, bleeding

  10. Splenosis - differential diagnosis • Splen accessorius = spleniculus Splenic hilus, lig. gastrosplenicum Tail of pancreas, mesentery Tumours, metastasis, endometriosis, incarcerated hernia…

  11. Splenosis Normally functioning splenic tissue Benefits and problems after splenectomy

  12. Subcutaneous splenosis of the abdominal wall Am J Dermatopathol. 2006 Jun;28(3):208-10. Boudová L, Kazakov DV, Hes O, Zahálka M, Mukensnabl P, Kocová J, Michal M.

  13. Splenóza jater u nemocného po operaci seminomu. Rozhl. Chir., 2005, 84, 9, s. 452-455. Třeška V., Skalický T., Chudáček Z., Boudová L., Hes. O

  14. Drug-induced abnormalities of lymph nodes and spleen Antiepileptic, ATB, NSAR, Phenytoin Spleen:T- cell hyperplasia Expansion of PALS by CD4 T-lymphocytes IOACHIM: Lymph node pathology

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