Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Nov 24, 2016; 5(3): 93-96
Published online Nov 24, 2016. doi: 10.5410/wjcu.v5.i3.93
Splenunculi mimicking metastases in a patient with locally advanced prostate cancer
Darren Foreman, Sophie A Plagakis
Darren Foreman, Department of Urology, Flinders Medical Centre, Flinders University, Adelaide, SA 5042, Australia
Darren Foreman, Discipline of Surgery, Adelaide University, Adelaide, SA 5000, Australia
Sophie A Plagakis, Department of Urology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
Author contributions: This manuscript was drafted by both Foreman D and Plagakis SA, with the final revisions being made by Plagakis SA.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Flinders University.
Informed consent statement: The patient gave informed verbal consent for the use of his medical details in this publication.
Conflict-of-interest statement: There were no conflicts of interest in this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Darren Foreman, Consultant Urologist, Department of Urology, Flinders Medical Centre, Flinders University, Flinders Drive, Bedford Park, Adelaide, SA 5042, Australia. dforeman@sturology.com.au
Telephone: +61-08-82045511 Fax: +61-08-82045450
Received: July 19, 2016
Peer-review started: July 21, 2016
First decision: September 5, 2016
Revised: September 21, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: November 24, 2016
Processing time: 125 Days and 18.7 Hours
Abstract

A 61-year-old man with locally advanced prostate cancer was found to have multiple solid intra-abdominal solid lesions during staging investigations. While some were in the pelvis, they were not located in the common landing sites for prostate cancer metastases, and his prostate specific antigen was not significantly elevated to suggest a high burden of metastatic disease. He reported a history of a blunt abdominal trauma due to a motor vehicle accident more than forty years ago which had been conservatively managed. His staging imaging revealed a lack of a discrete spleen in his left upper abdomen and this raised the suspicion that these solid lesions may represent ectopic splenic tissue. Imaging with nuclear medicine scintigraphy confirmed the lesions in his upper abdomen and pelvis to be splenunculi. He proceeded with a combination of androgen deprivation therapy and external beam radiotherapy for locally advanced, non-metastatic prostate cancer. Although it has been described in patients with low risk prostate cancer, this is the first case report of splenunculi mimicking metastases in a patient with locally advanced prostate cancer.

Keywords: Prostate cancer; Splenosis; Metastasis; Locally advanced; Splenunculus

Core tip: The appearance of ectopic splenic tissue in the abdomen and other body cavities can mimic that of solid tissue tumours and metastases. Splenosis may occur following blunt abdominal trauma during which a splenic injury may or may not have been identified and is rarely symptomatic. Being aware of this unusual differential diagnosis may avoid anxiety for patients and allow early diagnosis. Nuclear medicine scintigraphy with Tc-99m is the imaging modality of choice to confirm splenunculi.