Splenic hamartomas in two children

Abstract

Hamartomas are extremely rare splenic benign tumours in children. We present two cases, both in boys (6 and 8 years old), with left upper quadrant abdominal pain that were otherwise asymptomatic. Both patients showed a splenic mass on preoperative ultrasonography and magnetic resonance imaging (MRI). One patient had a focal splenic mass that was identified preoperatively with contrasted computed tomography (CT) scans. Both patients underwent a total splenectomy. Although multi-modality imaging findings were described preoperatively, the final diagnosis in each case was splenic hamartoma based on histology and immunohistochemistry. The postoperative courses were uneventful.

Figure 1

Splenic hamartoma in an 8-year-old boy was found during examination. (A) Abdominal ultrasonography showed an isoechoic oval-shaped mass (arrow) in the mid-portion of the spleen; (B) Non-enhanced CT showed a slightly lower-density mass (arrow) in the spleen. (C) Contrast-enhanced CT scan shows mild diffuse heterogeneous enhancement in the arterial phase. Magnetic resonance imaging (MRI) showed a hypointense mass (arrow) on the T1WI image (D) and a slightly hyperintense mass in the T2WI image (E). (F) The lesion (arrow) shows moderate enhancement on gadolinium-enhanced MRI.

Figure 2

Splenic hamartoma in a 6-year-old boy with left upper quadrant abdominal pain. (A) Abdominal ultrasonography showed a hypoechoic mass (arrow) with well-defined borders in the lower pole of spleen. Magnetic resonance imaging (MRI) showed slightly hyperintense signal in the T1WI (B), T2WI images (C), and T2WI + Fatsat images (D), and a non-homogeneous signal within the lesion (arrow).

Figure 3

Pathology of splenic hamartoma. (A) Microscopic image of the splenic hamartoma showed the lesion containing a mixture of unorganised vascular channels and fibrotic cords of splenic red pulp-like area (hematoxylin-eosin, original magnification × 100). (B) Higher magnification of the lesion reveals no cytologic atypia and mitosis (hematoxylin-eosin, original magnification × 400). (C) CD8 immunostaining was positive in the lining cells and scattered lymphocytes (original magnification × 100). (D) Immunohistochemistry for CD31 is positive in vascular lining cells (original magnification × 100).