2019 Volume 44 Issue 4 Pages 828-836
A 65-year-old man with consulted a local hospital with a history of left upper abdominal discomfort. A plain chest X-ray and chest computed-tomographic (CT) examinations revealed abnormalities of the heart, lungs and mediastinum, and further medical workup revealed the cardiac disorder as mitral valve prolapse. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed faint FDG uptake in the pulmonary and mediastinal lesions and multiple areas of intense FDG uptake in the spleen. As it appeared that the splenic lesions had grown in size as compared to the lesions visualized on the abdominal ultrasonographic images obtained 5 years earlier, the patient was referred to the Department of Surgery at our hospital. Laparoscopic splenectomy was performed on account of the difficulty in diagnostic differentiation between malignant lymphoma of the spleen and other possible splenic disorders, and in view of the subjective symptom of pain in the left upper quadrant of the abdomen. Laparoscopy revealed a large number of discrete 1- to 3-cm, yellowish-white solid lesions in the spleen. Histopathologically, these lesions consisted of non-caseating epithelioid granulomas; based on this finding, the patient was diagnosed as having sarcoidosis. The lung and mediastinal lesions were also diagnosed postoperatively as sarcoidosis. Laparoscopic splenectomy proved to be a minimally invasive, highly esthetic procedure for the treatment of the splenic lesions, as preoperative definitive diagnosis proved impossible. However, it was a case that had problems of collaboration with other departments.
