Milzruptur: Klinisch-pathologische Zusammenhänge und Diagnostik

Zusammenfassung: Obwohl selten, stellen Milzrupturen die häufigste Splenektomieindikation dar. Bei der überwiegenden Mehrzahl der Fälle (traumatische Rupturen) lässt sich eine klare Kausalität mit Gewalteinwirkung feststellen, bei einem anderen Teil (pathologische Rupturen) liegt eine Vorerkrankung der Milz vor, bei einem kleinen Teil der Patienten (spontane Rupturen) lässt sich kein Zusammenhang mit Traumen oder anderen Grunderkrankungen eruieren. Bei etwa 10% der rupturierten Milzen ist mit Iatrogenie im weitestem Sinne (inklusive Medikamentennebenwirkungen) sowie mit relevanten pathologischen Befunden (die Hälfe davon unerwartet) zu rechnen. Kenntnisse der Pathophysiologie, die Erhebung einfacher makroskopischer Befunde wie Größen- und Gewichtsangaben und Angaben sichtbarer Läsionen sowie die sorgfältige histologische Analyse mit gezielter Suche nach wegweisenden Veränderungen, ggf. unter Anwendung histo- und immunhistochemischer Zusatzuntersuchungen am gut vorbereiteten Material, sind die Schlüssel zur adäquaten Diagnosti

Spontaneous splenic rupture mimicking pneumonia: a case report

A 74-year-old gentleman presented with a history of left-sided pleuritic chest and upper abdominal pain. Examination and chest x-ray findings were suggestive of pneumonia. An abdominal ultrasound was suggestive of spontaneous splenic rupture. An abdominal computed tomography scan showed a splenic laceration and large peri-splenic haematoma. The advice from the on-call surgical team was to treat conservatively but the patient's condition deteriorated suddenly and he died. Spontaneous splenic rupture is uncommon but probably under-diagnosed and should be considered in all patients presenting with non-specific abdominal pain. The optimal management strategy for the older patient with spontaneous ruptured spleen is unknown

Nuclear receptor NR2F6 inhibition potentiates responses to PD-L1/PD-1 cancer immune checkpoint blockade

Immune checkpoints blockade (ICB) is a viable anti-cancer strategy. Here the authors show that nuclear receptor NR2F6 acts as an immune checkpoint in T cells and, using mouse models and human T cells, they show NR2F6 inhibition might improve current ICB therapy or work as an alternative therapeutic strategy

[Rupture of the spleen. Clinicopathological correlations and diagnostic procedures]

Though rare, splenic rupture is the most common indication for splenectomy. In the vast majority of cases ruptures are clearly related to trauma (traumatic ruptures); in other cases there is a pre-existing disease affecting the spleen (pathologic ruptures); and in a minority of patients no obvious reason can be identified (spontaneous ruptures). In approximately 10% of cases an iatrogenic cause, in the broadest sense (including side effects of drugs), and relevant histological findings (approximately half of which will be unexpected) can be anticipated. Knowledge of pathophysiological aspects of splenic rupture and assessment of simple macroscopic findings such as splenic dimensions and weight, and information on macroscopically visible lesions are of key diagnostic importance, as is accurate microscopic examination with targeted histological pattern analysis, supplemented as appropriate by histo- and immunohistochemical studies on adequately prepared material