Intrahepatic splenosis mimicking liver metastasis in a patient with gastric cancer

Abstract

A 54 year old man was referred to our hospital with gastric cancer. The patient had a history of splenectomy and a left nephrectomy as a result of a traffic accident 15 years earlier. The endoscopic findings were advanced gastric cancer at the lower body of the stomach. Abdominal ultrasonography (USG) and magnetic resonance imaging demonstrated a metastatic nodule in the S2 segment of the liver. Eventually, the clinical stage was determined to be cT2cN1cM1 and a radical distal gastrectomy, lateral segmentectomy of the liver were performed. The histopathology findings confirmed the diagnosis of intrahepatic splenosis, omental splenosis. Hepatic splenosis is not rare in patients with a history of splenic trauma or splenectomy. Nevertheless, this is the first report describing a patient with gastric cancer and intrahepatic splenosis that was misinterpreted as a liver metastatic nodule. Intra-operative USG guided fine needle aspiration should be considered to avoid unnecessary liver resections in patients with a suspicious hepatic metastasis.

Keywords: Liver; Neoplasm metastasis; Splenosis; Stomach neoplasms.

Fig. 1

The axial intravenous contrast enhanced CT scan (the portal venous phase image). (A) Note the wall thickening of the anterior wall of the antrum in the stomach and the lymph node enlargement in the perigastric area. (B) Note the 3.5×1.5 cm sized splenic tissue in the left subdiaphragmatic area with no supplying splenic vessel. CT = computed tomography.

Fig. 2

Ultrasound revealed a 2.5×1.7 cm sized nodular heterogenous hypoechoic lesion with clear margins in segment two of the liver.

Fig. 3

Axial liver MRI. (A) there was a 2.0×1.5 cm sized nodule in segment two of the liver with slightly high signal intensity on the T2-weighted image and (B) low signal intensity on the T1-weighted image. This nodule still showed high signal intensity on the superparamagnetic iron oxide (SPIO) enhanced T2 weighted image (C). MRI = magnetic resonance imaging.

Fig. 4

On the multiple serial sections of the liver, there were two encapsulated red-blue nodules that measured 2.3×1.9 cm (A) and 0.7×0.6 cm (B), respectively. They were located near the liver capsule.

Fig. 5

The pathological examination of this lesion found a full component of red and white pulp of the spleen and this confirmed the diagnosis of splenosis, with no evidence of metastasis (H&E, ×20).