There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
We commend Kulkarni et al. (1) on their description of a rare case of aberrant splenic
artery aneurysm treated with a combination of stent graft and coil embolization. Indeed,
aneurysm of splenic artery is a protean disease as for the origin, location, size
and clinical manifestations. Furthermore, what appears to be initially a splenic aneurysm
can exceptionally turn out to be another vascular lesion as happened to us.
In fact, a 74-year-old man with a history of prostate cancer was recently diagnosed
as having an aneurysm of 1.7 × 2 cm arising from a short gastric artery on a surveillance
CT scan (Fig. 1). Superselective arteriography confirmed the aneurysmatic nature of
the lesion (Fig. 2): transcatheter angiographic embolization was attempted twice but
failed. At this point, the patient was referred for surgical repair: at laparoscopy,
a brown, well-encapsulated, hypervascular lesion was observed in the greater omentum
on the left side of the stomach and excised after ligation of its feeding pedicle.
Histological and immunochemical features revealed benign hemangiopericytoma of the
greater omentum (no mitosis or necrosis along with an immunoprofile positive for CD34
and bcl-2). At 14-month follow-up, the patient appears free from recurrent disease.
Hemangiopericytoma (HPC), also known as solitary fibrous tumor, is a rare form of
vascular tumor arising from the pericytes of Zimmermann and may develop virtually
anywhere in the whole body (2). Involvement of the greater omentum is outstandingly
rare as only 30 cases have been reported in the world literature so far: tumor size
ranges from 2 cm (as in our patient) to 28 cm and a malignant behavior was ascertained
in 10 patients (3). Diagnosis prior to surgery appears impossible given that clinical
and radiological findings are aspecific and biopsy is contraindicated for the risk
of related bleeding (4). In fact, it is obtained, most of the time, in the course
of emergency intervention performed for acute abdominal pain or hemoperitoneum; rarely,
a solid, well-encapsulated hypervascular mass with a feeder vascular pedicle and centripetal
opacification is seen early in the arterial phase on CT scan and it is more suggestive
of stromal tumors or arteriovenous malformations (3, 4). Selective arteriography has
been employed in only one previous case of omental HPC, while preoperative embolization,
even if advocated, has never been described (3). Our case represents the first instance
of omental HPC resembling aneurysm on CT scan and arteriography being initially managed
with attempted angiographic embolizations. Surgical excision is the sole curative
treatment for omental HPC; laparotomic resection is the most frequently performed
intervention, while laparoscopic removal has been conducted only in three cases including
ours (3, 4).
We report a rare case of aneurysm of splenic artery arising anomalously from the superior mesenteric artery (SMA). The aneurysm was treated successfully by coil embolization of the splenic artery distal to aneurysm and then deploying a stent graft in the SMA. A combination of stent graft and coil embolization for the treatment of aberrant splenic artery aneurysm has been reported only once. We describe the imaging findings and the endovascular procedure in this patient.
Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and
Psychology "Sapienza", St. Andrea Hospital, Rome 00189, Italy.
Author notes
Corresponding author: Edoardo Virgilio, MD, Medical and Surgical Sciences and Translational
Medicine, Faculty of Medicine and Psychology "Sapienza", St. Andrea Hospital, via
di Grottarossa 1035-39, Rome 00189, Italy. Tel: (39) 633775989, Fax: (39) 633775322,
aresedo1992@
123456yahoo.it
This is an Open Access article distributed under the terms of the Creative Commons
Attribution Non-Commercial License (
http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in
any medium, provided the original work is properly cited.