title: Laparoscopic splenectomy for isolated splenic sarcoidosis.
abstract: BACKGROUND
  Sarcoidosis is an inflammatory disease with an unknown etiology. The pulmonary interstitium is mainly involved, with noncaseating granulomas and lymphadenopathy. It is a multisystemic disease, and the differential diagnosis should include infectious, neoplastic, and autoimmune diseases to prevent inappropriate treatment and unnecessary surgery. Abdominal disease without evidence of pulmonary abnormalities on chest radiography in sarcoidosis can be found in approximately 25% to 38% of cases. The approach to isolated splenic nodules in a patient with nonspecific abdominal symptoms should be focused on exclusion of malignancies and infections, and may require computed tomography, magnetic resonance imaging, and positron emission tomography- computed tomography imaging; scintigraphy; bone marrow biopsy; breast and genital examinations; and endoscopies. This report documents a rare case of isolated granulomatous disease of the spleen that was diagnosed and treated laparoscopically.
  
  
  METHODS
  A 29-year-old woman presented with nonspecific complaints such as nausea, vomiting, and epigastric discomfort. Further laboratory test results were normal. Abdominal ultrasonography, computed tomography, and magnetic resonance imaging revealed multiple splenic lesions. Additional examination findings were negative for occult neoplasia or infectious disease. Laparoscopic splenectomy was performed as a diagnostic procedure, without complications, and the final diagnosis was sarcoidosis.
  
  
  CONCLUSIONS
  Isolated splenic sarcoidosis is a rare manifestation of extrapulmonary disease. The final diagnosis may be achieved only by histology, requiring biopsy or splenectomy. Minimally invasive surgery is a safe and efficient method for diseases of the spleen and should be the first option when feasible. The patient did well; however, further monitoring is required to diagnose recurrence.
authors.affiliation: Division of Digestive Surgery, Hospital de clinicas de Porto Alegre (HCPA), Division of General Surgery, Santa Casa de Porto Alegre, Brazil.
authors.forename: Marcelo Martins
authors.initials: MM
authors.lastname: Souto
authors.affiliation: Universidade Luterana do Brazil (ULBRA).
authors.forename: Bruna Cogo
authors.initials: BC
authors.lastname: Tempes
authors.affiliation: Universidade Luterana do Brazil (ULBRA).
authors.forename: Bruna Franco
authors.initials: BF
authors.lastname: Lambert
authors.affiliation: Division of Digestive Surgery, Hospital de Clinicas de Porto Alegre (HCPA), Brazil.
authors.forename: Eduardo Neubarth
authors.initials: EN
authors.lastname: Trindade
authors.affiliation: Division of Digestive Surgery, Hospital de clinicas de Porto Alegre (HCPA), Division of General Surgery, Santa Casa de Porto Alegre, Brazil, 1974 Santa Cecilia st, apt 402, Porto Alegre, RS, Brazil. soutocarlan@gmail.com.
authors.forename: Manoel Roberto Maciel
authors.initials: MR
authors.lastname: Trindade
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D012507:Sarcoidosis / Q000175:diagnosis / Q000601:surgery*; D013156:Splenectomy / Q000379:methods*; D013158:Splenic Diseases / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed