Laparoscopic splenectomy for histiocytic sarcoma of the spleen

Figure 1 Abdominal computed tomography. A: Just before the operation; B: 1 year before the operation. Arrows show the splenic tumor.

Figure 2 Technetium-99 m colloid scintiscanning. The broken line shows the splenic tumor. The tumor did not uptake technetium-99 m colloid, and the tumor was therefore shown as a defect.

Figure 3 Magnetic resonance imaging just before the operation. A: An iso-intense solid mass on T1-weighted images; B: A high-intensity multi-lobular mass on T2-weighted images.

Figure 4 Dynamic magnetic resonance imaging. The tumor was enhanced from 20 to 120 s after the injection of contrast medium. Contrast medium gradually pooled in the tumor. A: 20 s; B: 60 s; C: 120 s.

Figure 5 Clinical course of the patient. Transition of the platelet number and hemoglobin value from 1 year before the operation to 3 mo after the operation. The black arrow shows the operation time. The circle shows the platelet number. The triangle shows the hemoglobin value.

Figure 6 Macroscopic findings of the spleen. A: The raw specimen. Multiple nodules with different colors from normal splenic tissue; B: The specimen after formalin fixation. The arrows show the tumor.

Figure 7 Microscopic findings. A: Giemsa stain. Magnification is × 200; B: Giemsa stain. Magnification is × 400; C: MIB-1 labeling stain. The tumor consisted of cells with a foamy cytoplasm, hemosiderin-containing phagocytic cells (white arrow), and multilobular megakaryocytes. The MIB-1 labeling index was 8.1%.

Figure 8 Immunohistopathological staining. A: CD68; B: CD1a; C: S-100 protein; D: lysozyme CD68 stained positive. CD1a and S-100 protein were negative. Lysozyme was partially positive.