Intra-hepatic splenosis as an unexpected cause of a focal liver lesion in a patient with hepatitis C and liver cirrhosis: a case report

Abstract

Introduction: Splenosis is the heterotopic autotransplantation of splenic tissue, mostly found after splenic trauma or surgery in the abdominal, pelvic or thoracic cavity. Here we report a patient with a history of splenectomy after polytrauma with chronic hepatitis C and liver cirrhosis presenting with an hepatic mass of unknown origin.

Case presentation: The lesion could not be exactly classified by ultrasound, computed tomography, angiography and biopsy, classical features of malignancy were not fulfilled, and on the other hand a neoplastic process could neither be excluded. After revision of a MRI performed in our centre it appeared that the liver mass contrasted in the same way as the remaining accessory spleens in the left upper quadrant. A selective Tc-99m-labelled heat-denatured autologous red blood cells scintigraphy of the spleen was performed and showed both the accessory spleens in the left upper quadrant and spleen-typical tissue in projection to the left liver lobe and confirmed the diagnosis of splenosis.

Conclusion: Although intrahepatic splenosis represents an extremely rare condition, this diagnosis should always be taken into consideration in patients with history of abdominal trauma with splenic involvement presenting with an indeterminate focal liver lesion. The diagnosis of splenosis may then be reliably confirmed by Tc-99m-DRBC scintigraphy.

Figure 1.

MRI of the liver. T2-weighted single-shot turbo spinecho imaging (HASTE) MRI of the liver shows slightly hyperintense polylobular lesion in the left lobe of the liver, segment II (A, arrows). Multiple nodular structures are identified in the splenic recess indicating recurrent splenic tissue after splenectomy (large arrow). After intravenous application of Gadolinium-DTPA (Magnevist, Schering, Berlin, Germany), these lesions exhibit marked contrast enhancement in the early arterial phase, as it may also be seen in the case of hepato-cellular carcinoma (B). With hepato-specific contrast agents (iron-oxide particles, Resovist^®, Schering, Berlin, Germany), the hepatic lesion lacks iron uptake, which is shown on axial and coronal T2*-weighted images (C, D) and is indicative of the presence of non-hepatic tissue. Especially the coronal images delineate the indenting nature of the space-occupying lesion into the hepatic tissue and the close relationship to the diaphragm, suggesting an extrahepatic location of the lesion (D).

Figure 2.

Tc-99m-DRBC scintigram. Heat-damaged and Tc-99 m-labeled autologous red blood cell scintigram shows uptake of the labeled cells in the left lobe of the liver (thick arrow) and in the vicinity of the removed spleen (thin arrow) in the planar scan (a) and the SPECT-images (b) corresponding to the masses seen in MRI and CT.