Symptomatic multinodular splenic hamartoma preoperatively suspected as metastatic tumor: a case report

Abstract

Splenic hamartoma (SH) is a rare benign tumor usually detected accidentally, which is composed of an aberrant mixture of normal splenic elements. Here, we report a case of 54-year-old man who presented with symptomatic multinodular SH and was admitted initially for thrombocytopenia and anemia. Physical examination revealed that the patients had an anemic appearance and palpable spleen, extending 10 cm below the costal margin. Preoperative ultrasound and computed tomography (CT) indicated splenomegaly with multinodular lesions. On enhanced CT scanning, during the arterial phase, the lesions demonstrated inhomogeneous enhancement, and in the portal phase the lesions were more hyperdense than the splenic parenchyma. The images were highly suggestive of a metastatic tumor. Splenectomy was performed 1 wk later. The tumor was eventually diagnosed as SH according to the morphological features and immunohistochemical detection, by which CD34 was positive in lining cells and some spindle cells, vimentin was positive in the tumor, factor-VIII-related antigen was positive multifocally in lining cells, and smooth muscle actin was positive in some spindle cells. Thrombocytopenia and anemia were cured after splenectomy.

Keywords: Diagnosis; Hamartoma; Splenectomy; Splenic; Symptoms.

Figure 1

Computed tomography imaging. A: Computed tomography plain scanning showing multiple hyperintense lesions in the spleen; B: During the arterial phase, the lesions showed heterogeneous enhancement; C: In the portal phase, the lesions were more hyperdense than the splenic parenchyma.

Figure 2

Resected specimen was 2130 g in weight and 24 cm × 19 cm × 11 cm in size. A: Resected specimen showed splenomegaly with multiple nodular lesions of various sizes; B: Histological section showing disappearance of normal splenic structure, and replacement by various sizes of nodular lesions, which were composed mainly of variably dilated, unorganized vascular channels (black arrow) (original magnification × 200); C: Proliferative spindle cells arranged in fascicular shape (black arrow) (original magnification × 200).

Figure 3

Immunohistochemical staining. A: CD34 immunostaining was positive in the lining cells (white arrow) and some spindle cells (white arrow) (original magnification × 100); B: Vimentin immunostaining was positive in the tumor (white arrow) (original magnification × 100); C: Factor-VIII-related antigen immunostaining was multifocally positive in the lining cells (black arrow) (original magnification × 100); D: Smooth muscle actin was positive in some spindle cells (black arrow) (original magnification × 100).