Peritoneale Splenose 26 Jahre nach traumatischer Milzruptur – seltene Differenzialdiagnose eines submukösen Magentumors – Fallbericht und Literaturübersicht

Zusammenfassung

Die Differenzialdiagnose submuköser Raumforderungen des Magens umfasst benigne (Leiomyome, Lipome, Schwann-Zell- und Granularzelltumoren, Hämangiome, Lymphangiome und Glomustumoren) und maligne (Leiomyosarkome, gastrointestinale Kaposi-Sarkome, Metastasen) Neoplasien, gastrointestinale Stromatumoren (GIST) und Raumforderungen nicht neoplastischen Ursprungs (ektopes Pankreasgewebe, intramurale Pseudozysten, intramurale Hämatome). Gelegentlich liegen einem submukösen Magentumor jedoch auch extragastrale Raumforderungen zugrunde, die die Magenwand von außen pelottieren und endoskopisch und radiologisch dennoch nicht eindeutig von genuinen Magenwand-Raumforderungen abzugrenzen sind. Wir berichten über den Fall eines 77-jährigen Patienten, der unter dem Verdacht eines GIST der Magenwand laparoskopiert wurde. Der vermutete Tumor stellte sich als ektopes Milzgewebe auf dem parietalen Peritoneum im Sinne einer Splenose bei 26 Jahre zuvor erfolgter Splenektomie nach traumatischer Milzruptur heraus. Im Rahmen einer Literaturübersicht werden außerdem Epidemiologie, Pathogenese, Diagnostik und Therapie des Krankheitsbilds der Splenose diskutiert.

Abstract

Differential diagnoses of subepithelial gastric masses include benign (leiomyoma, lipoma, haemangioma, lymphangioma, neurogenic tumours, glomus tumour) and malignant (leiomyosarcoma, gastric Kaposi’s sarcoma, metastases) neoplastic lesions, gastrointestinal stromal tumours (GIST) and lesions of non-neoplastic origin (heterotopic pancreatic tissue, intramural pseudocysts, intramural haematoma). Occasionally, however, suspected gastric wall tumours are caused by extragastral lesions that are not always easily distinguished from genuine gastric wall lesions by endoscopy or radiological imaging. We report the case of a 77-year-old patient undergoing laparoscopy for suspected gastric GIST in our institution in whom splenectomy had been performed 26 years prior to presentation due to traumatic splenic rupture. The tumour revealed to be ectopic splenic tissue located at the parietal peritoneum of the ventral abdominal wall, thereby fulfilling the definition of splenosis. Epidemiology, pathogenesis, diagnostics and therapy of splenosis are discussed in the context of a review of the relevant literature.

Splenose - submuköser Magentumor - GIST - Literaturübersicht

splenosis - subepithelial gastric mass - GIST - literature review

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