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      Pathological Rupture of the Spleen in Uncomplicated Myeloma

      case-report
      Author(s): 1 , 2 , 3
      Publication date (Electronic):
      Journal: Clinical Medicine. Case Reports
      Publisher: Libertas Academica
      Keywords: spleen, rupture, myeloma

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          Abstract

          Pathological rupture of the spleen in uncomplicated myeloma is extremely rare. We present a case of a splenic rupture which occurred in a 52 year old woman with uncomplicated multiple myeloma. The patient required an urgent splenectomy and had an uneventful recovery. Pathophysiological mechanisms leading to splenic rupture are discussed. Plasma cell leukaemias have been previously documented to present with splenic rupture. A subgroup of aggressive multiple myelomas such as in our case may have a similar tendency for splenic rupture.

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          Pathologic rupture of the spleen in hematologic malignancies: two additional cases.

          Marcus Koch, Laurel M. Burk, Robert Schneider … (1996)
          Pathologic rupture of the spleen in hematologic malignancies is rare. We present two cases of splenic rupture which occurred in a man with a secondary high-grade non-Hodgkin's lymphoma and a woman with chronic lymphocytic leukemia (CLL). In a review of the literature, we have been able to identify 136 cases of pathologic splenic rupture since 1861; 34% have occurred in acute leukemias, 34% in non-Hodgkin's lymphomas, and 18% in chronic myelogenous leukemia (CML). We find a male-to-female ratio of 3:1, with considerable differences for the specific diseases encountered. Pathologic rupture of the spleen has happened almost exclusively in adults and the ruptured spleens are generally moderately to severely enlarged. It seems that, apart from splenic infiltration by a hematologic disease, splenic infarcts and coagulation disorders (which have previously been advanced as the most important pathophysiologic factors leading to rupture), male sex, adulthood, severe splenomegaly, and cytoreductive chemotherapy may increase the risk for pathologic splenic rupture. We briefly discuss symptoms preceding the event, diagnostic possibilities, and the outcome with operative and conservative approaches.
          Article 0 comments Cited 29 times – based on 0 reviews     Review now
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            Spontaneous rupture of the spleen: ultrasound patterns, diagnosis and follow-up.

            H Prinz, G Zugmaier, C Görg … (2003)
            Spontaneous rupture of the spleen is an extremely rare complication usually of infectious diseases or disorders of the haematopoietic system and has been described mostly in case reports. The incidence, symptoms, causes, therapy, and prognosis are poorly defined. From July 1985 to January 2000 41 patients with spontaneous splenic rupture were diagnosed by abdominal ultrasound and confirmed by splenectomy (n=12), CT (n=15), and ultrasound follow up (n=26). An ultrasound grading system was retrospectively established based on the degree of splenic injury (grade 0-2=low grade injury, grade 3=high grade injury) and correlated with surgical procedures. 30 day mortality rate was studied in relation to underlying disorders, ultrasound grades and treatment decisions. 21 patients had underlying malignant disorders (group I) and 20 patients had benign diseases (group II). Between group I and II we observed a highly significant difference in 30 day mortality rates (n=7; 38.1% vs n=1; 5%, p<0.01), but no significant difference in high grade injury rate (n=3; 14.3% vs n=2; 10.0%; p=ns) and surgical treatment rate (n=5; 23.8% vs n=7; 35.0%; p=ns). Depending on ultrasound grades the surgical procedures were 0% for grade 0, 16.7% for grade 1, 30.4% for grade 2, and 60% for grade 3. There were no significant differences between patients, who died within the first 30 days (n=9) and those who survived more than 30 days (n=32) regarding high grade splenic injury rate (n=0; 0% vs n=5; 15.6%; p=ns), and surgical treatment rate (n=2; 22.2% vs n=10; 31.2%; p=ns). Spontaneous rupture of the spleen is an extremely rare event. It is associated with a high mortality rate within 30 days in patients with malignant disease. Sonomorphologic grading is helpful for treatment decisions. 30 day mortality rate is correlated with neither ultrasound grades, nor surgical treatment rates.
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              Spontaneous splenic rupture in uncomplicated multiple myeloma.

              G. Majumdar, M Shirfield, Joshua Sommers … (1996)
              We report a case of spontaneous splenic rupture due to myelomatous infiltration of the spleen without any evidence of amyloidosis or any other complicating factors. A computer search of Medline since 1966 did not reveal any previously reported case of spontaneous splenic rupture in uncomplicated myeloma.
              Article 0 comments Cited 5 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Med Case Rep
                Journal ID (iso-abbrev): Clin Med Case Rep
                Title: Clinical Medicine. Case Reports
                Publisher: Libertas Academica
                ISSN (Electronic): 1178-6450
                Publication date Collection: 2008
                Publication date (Electronic): 22 April 2008
                Volume: 1
                Pages: 19-23
                Affiliations
                [1 ]Clinical Senior Lecturer, School of Medicine, James Cook University, Cairns, Queensland, Australia.
                [2 ]Haematologist, Department of Medicine, Cairns Base Hospital, Cairns, Queensland, Australia.
                [3 ]Head Department of Pathology, Cairns Base Hospital, Cairns, Queensland, Australia.
                Author notes
                Correspondence: Vincent Ho, M.B.B.S., B.sc (Med), Clinical Senior Lecturer in Medicine, James Cook University School of Medicine, Level 4 Department of Medicine, Cairns Base Hospital, Cairns, Queensland, Australia 4870. Tel: 61-7-4050 6333; Fax: 61-7-4050 6777; Email: vincent_ho@ 123456health.qld.gov.au
                Article
                Publisher ID: ccrep-1-2008-019
                PMC ID: 3785339
                PubMed ID: 24179339
                SO-VID: 4b91c41f-6e94-4d1b-8b3e-f1f4ba871477
                Copyright © © 2008 by the authors
                License:

                This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                Categories
                Subject: Case Report

                Keywords: myeloma,rupture,spleen
                Data availability:
                Keywords: myeloma, rupture, spleen

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