Splenic hamartoma associated with thrombocytopenia: A case report

Abstract

Introduction: Hamartomas are rare, benign tumors of the spleen. Few cases of splenic hamartomas associated with thrombocytopenia have been reported.

Presentation of case: An asymptomatic 64-year-old man with myelodysplastic syndrome was found to have a splenic tumor. Laboratory tests were significant for thrombocytopenia, with a platelet count of 7.8×10⁴/μL. Ultrasonography showed splenomegaly (10.8×6.6cm), and a hypoechoic splenic mass (8.0×7.0cm). Color doppler ultrasound revealed blood flow within the mass, and the mass density was homogeneous on abdominal computed tomography (CT). Contrast-enhanced CT showed heterogeneous enhancement of the splenic mass during the arterial phase. Positron emission tomography (PET)-CT showed no significant fludeoxyglucose (FDG) accumulation within the mass. The differential diagnosis included splenic hamartoma, splenic hemangioma, splenomegaly associated with extramedullary hematopoiesis, and malignant tumor, including solitary splenic metastasis. A laparoscopic splenectomy was performed due to the possibility of malignancy, the presence of thrombocytopenia, and the risk of splenic rupture. The resected specimen showed a localized, well-demarcated, 8.0×7.0cm splenic mass. Histological examination revealed abnormal red pulp proliferation and the absence of normal splenic structures. The patient's post-operative course was uneventful. His platelet count improved on post-operative day 1 and he was discharged on post-operative day 9. He remained in good health with a normal platelet count one month after surgery.

Discussion: Making definitive preoperative diagnosis is difficult in splenic hamartomas. Surgery is necessary for diagnosis when malignancy cannot be ruled out.

Conclusions: Surgery may also improve symptoms of hypersplenism, including thrombocytopenia.

Keywords: Case report; Splenic hamartoma; Thrombocytopenia.

Fig. 1

Ultrasonography showed splenomegaly (10.8 × 6.6 cm), with a solid, hypoechoic splenic mass (8.0 × 7.0 cm) (Fig. 1a, b). Color doppler ultrasound showed blood flow within the mass (Fig. 1c).

Fig. 2

Abdominal computed tomography (CT) revealed an isodense splenic mass (a). Contrast- enhanced CT showed heterogeneous enhancement of a solid splenic mass (8.0 cm) during the arterial phase (b). The mass was isodense compared to normal splenic parenchyma in the portal phase (c). PET-CT showed no significant FDG accumulation within the mass (d).

Fig. 3

The resected specimen showed a localized, well-demarcated splenic mass (8.0 × 7.0 cm) (Fig. 3a,b). Hematoxylin- eosin stain revealed abnormal red pulp proliferation and the absence of normal splenic structures. No extramedullary hematopoiesis was observed (Fig. 3c,d).