AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2690-8808/134
1 First Degree General Surgery Specialist. Auxiliary Professor
2 Second Degree General Surgery Specialist. Ph.D.
3 First Degree Orthopedics and Traumatology Specialist.
4 First Degree General Surgery Specialist Assistant Professor
*Corresponding Author: Juana Teresa Santiago Pérez, Second Degree General Surgery Specialist. Ph.D. e.mail: teresasp@infomed.sld.cu.
Citation: José Miguel González Bárcenas, Juana Teresa Santiago Pérez, Ernesto Miguel Rodríguez Santiago, José Rodríguez Santiago and Asunción Rodríguez Morris. (2022). Splenic peliosis. Presentation of a case. Journal of Clinical Case Reports and Studies 3(7); DOI: 10.31579/2690-8808/134
Copyright: © 2022 Jose Luis Turabian, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 21 May 2022 | Accepted: 03 June 2022 | Published: 28 June 2022
Keywords: peliosis; splenomegaly; rheumatoid arthritis
Peliosis is a very rare benign condition, characterized by sinusoidal lakes or cysts, filled with blood, with or without hyperplasia of the remaining tissue, presenting itself mainly in solid organs of the economy.
It has also been described in other organs such as lungs, pleura, kidneys, adrenal glands and stomach.
Its precise etiology is ignored until today, but associations have been made with other entities such as tumors, viral infections, systemic diseases where they are mentioned, lupus erythematosus, and rheumatoid arthritis, In addition, prolonged therapeutics are noted with Anabolics, Steroids, Erythropoietin, Acetyl-Salicylic Acid, Paracetamol and Vitamin A. among others.
The present case is a 51-year-old female, born of preterm birth and carrier of bronchial asthma, so it deliberately ingests steroids and Vitamin A.
Thus, she goes to the doctor for pain in left hypochondrium, which to the physical examination attracts attention the presence of splenomegaly of more than 4cm. It is also evident the deformity that presents in the third phalanx of both hands that makes you think of physical signs of arthritis rheumatoid.
Peliosis is a very rare benign entity, characterized by cavities filled with blood within solid organs, mainly in the reticuloendothelial system (mainly liver and spleen) [1-2]. Peliosis can also affect other organs such as lungs, pleura, kidneys, adrenal glands, and stomach. Lesions can be single or multiple and of variable size. The etiology is unknown, but it has been related to the ingestion or contact with drugs and various toxins such as steroids and oral contraceptives, being associated with hematological tumor diseases and infectious diseases, particularly tuberculosis; in some cases, it is idiopathic [1-3].
Wagner first described Peliosis in 1861 [4]. In 1916 Schoenlak et al. [5] introduced the term peliosis which means "purple" or "brown", due to the color observed in the tissue. In 1950, Zak [6] described this entity for the first time in the English literature. It took 103 years for Caroli et al [7]. Made the diagnosis in a living patient. In 1971, Drut and Pawlow [8] described the first case of hepatosplenic peliosis in Argentina.
A 51-year-old MML patient with a history of having been born prematurely, in addition to bronchial asthma from the first years of life and from the age of 35, debuted with rheumatoid arthritis; Due to these antecedents, in the course of life she is a high consumer of Vitamin A and D, without a medical prescription, also associated with the deliberate use of steroids due to bronchial asthma, which she still uses sporadically.
In June 2020, he went to the doctor for pain in the left hypochondrium, which he describes as dull, continuous pain without radiation. In addition, a feeling of early fullness. She refers to weakness and a slight loss of appetite. Denies other symptoms.
Physical Exam
Skin paleness - discreet mucosa and deformity of the third phalanx of all the fingers of both hands. (Figure 1)
Abdomen: voluminous, discreetly distended with splenomegaly of 4 cm, below the left costal margin, with regular borders, being painful on palpation.
Blood pressure: 130/80 mmHg. Heart rate: 84 bpm.Rest of the exam without alterations
Complementary Exams
Hemoglobin in 12.1 gr. / l Hematocrit in 39% Erythrosedimentation in 44 mm.,
Coagulation 7 min. Bleeding 1 min
Peripheral lamina: Adequate platelets, mild leukocytosis, neutrophilia.
Red blood cells: normochromic normocytic and reticulocyte count in 1.2%.
Rest of the rigorous exams, without alterations.
Abdominal Ultrasound: Occluded image in the region of the splenic pedicle, measuring around 10x10cms, in addition to verifying the splenomegaly found in the physical examination.
Contrast multisite helical tomography of the abdomen with MPR and MPI reconstruction, showing a liver of normal size and configuration. Spleen showing a hypo dense, septate image, with irregular contours, with low densities in its interior, said lesion slightly compresses and displaces the left kidney, downwards and backwards. The lesion did not capture contrast. (Figure 2)
After the studies carried out, it is discussed in the group of the Surgery Service and her surgical intervention is decided, performing total splenectomy, by conventional route, the patient evolves favorably and is discharged, one week later.
Anatomopathological study
The macroscopic study showed: Surgical specimen from total splenectomy, weighing 500gms. In addition, it measures 15x12x5 cm. presenting a smooth, shiny capsular surface, of a purplish brown color, that bulges and makes relief, in the pedicle region: of relentless consistency, corresponding to the cut, with a cystic, multinodular area, entirely occupied by abundant blood, and measuring 10x7cms. Rest of the splenic parenchyma of friable consistency, reddish in color, with a whitish stippling. Figure 3.
The microscopic study concluded: Splenic tissue with normal histological limits, which alternates with cystic and sinusoidal areas, with thick walls, which are occupied by blood. Figure 4,Histopathological diagnosis: Peliosis Splenica
The term peliosis refers to the histopathological appearance found in the affected organ and is given by the formation of cystic cavities filled with blood in the parenchyma of said organ, which may or may not coincide with the hyperplasia of the remaining tissue [9]. Hepatic localization is the most frequent, most of the time in immune deficient patients, chronically treated with steroids or in seropositive patients with bacterial infections. Cases of peliosis in the liver, spleen, lymph nodes, spinal cord, stomach, ileum and lung [9-11].
Splenic peliosis is an exceptional entity, with less than 100 cases published in the literature, most of the diagnoses being in post-mortem studies, because although it is a benign condition, its management is delayed due to its infrequent presentation. It is associated with tumors, infectious diseases, autoimmune disorders, drug use, transplants, radiation therapy, and splenic vein thrombosis [11].
Hemoperitoneum due to spontaneous splenic rupture or secondary to minimal trauma is a frequent complication [12]. The etiopathogenesis could be related to congenital, toxic factors, or immune complex deposits. Elevation of VEGF (endothelial growth factor) concentrations in patients with splenic peliosis has been argued [10,11].
Diagnosis is difficult, although this entity must be taken into account in cases of hypersplenism in which imaging tests show nodulations or cysts in the splenic parenchyma. In cases of suspected hemoperitoneum, abdominal tomography is the imaging technique of choice [12-14].
Peliosis is very little documented in the reviewed literature. Its identification requires a high index of suspicion, in patients with prolonged treatment with drugs or known toxins capable of producing the disease and who present persistent abdominal pain or suggestive images. The diagnosis is incidental and on other occasions of exclusion. Treatment depends on the underlying cause.
Splenic peliosis is an exceptional medical entity; therefore, the expertise for its diagnosis and subsequent treatment lies precisely in improving knowledge about the disease and medical performance in the consequent action.
The authors declare no conflict of interest
José Miguel González Bárcenas: Data collection, analysis, and statistical processing. Juana Teresa Santiago: She drafted the manuscript and participated in data collection. Ernesto Miguel Rodriguez Santiago: Participated in data collection. Asunción Rodríguez Morris: Participated in literature search. José Rodríguez Santiago: Participated in literature search.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
