Published online Apr 27, 2013. doi: 10.4240/wjgs.v5.i4.129
Revised: February 19, 2013
Accepted: March 5, 2013
Published online: April 27, 2013
Primary histiocytic sarcoma of the spleen is a rare but potentially lethal condition. It can remain asymptomatic or only mildly symptomatic for a long time. An 81-year-old woman presented with an extremely enlarged spleen. She suffered from progressive anemia and required a red blood cell transfusion once a month. Although computed tomography, ultrasonography, and magnetic resonance imaging were performed for diagnosis, a confirmed diagnosis was not obtained. Her enlarged spleen compressed her stomach, and she suffered from gastritis and a sense of gastric fullness just after meals. She underwent laparoscopic splenectomy for therapeutic and diagnostic purposes. Her post-operative course was uneventful. After surgery, her red blood cell and platelet counts increased markedly. The tumor was diagnosed as splenic histiocytic sarcoma. Post-surgical chemotherapy was not performed, and the patient died of liver failure due to liver metastasis 5 mo after surgery. Laparoscopic splenectomy is minimally invasive and useful for the relief of symptoms related to hematological disorders. However, in cases of an enlarged spleen, optimal views and working space are limited. In such cases, splenic artery ligation can markedly reduce the size of the spleen, thus facilitating the procedure. The case reported herein suggests that laparoscopic splenectomy may be useful for the treatment of splenic malignancy.
Core tip: Surgeons usually avoid choosing laparoscopic surgery for splenic malignancy because an enlarged spleen disrupts optimal views. Some authors reported that initial ligation of the splenic artery led to shrinkage of the spleen; therefore, the operation was easier. We report a case of splenic malignancy that was diagnosed as histiocytic sarcoma and treated by laparoscopic splenectomy with initial ligation of the splenic artery. In this case, because the size of the spleen was reduced after splenic artery ligation, the laparoscopic operation was performed safely. The patient was discharged 12 d after the operation despite her old age.