Intrahepatic splenosis mimics hepatocellular carcinoma in a patient with chronic hepatitis B: A case report and literature review

Abstract

Background: Splenosis is a benign and relatively uncommon condition caused by trauma or splenectomy or other procedures involving splenic tissue. It is usually asymptomatic, and often diagnosed accidentally, especially misdiagnosed as malignant tumor.

Methods: A 54-year-old man with prior history of chronic hepatitis B virus infection and underwent splenectomy for traumatic splenic rupture following a traffic accident 23 years previously was admitted to our hospital and found a hepatic mass in the right upper quadrant during an imaging examination. The diagnosis of his was not clear and finally he agreed to receive a surgical treatment.

Results: During the operation, we found a mass in the right posterior lobe of the liver and a hard nodule on the right side of the diaphragm, both were completely resected, and postoperative histopathologic examination revealed that all excised tissues were proved to have histological structure typical for the spleen.

Conclusions: The occurrence of intrahepatic splenosis is rare with only few cases previously reported in the literature. It is a benign disease and sometimes difficult to distinguish from diseases of the liver. The need for positive surgical resection of splenosis is still controversial.

Figure 1

Abdominal ultrasound of intrahepatic splenosis (the arrow). It showed a round-like equal echo area approximately 3.0 × 2.8 cm between the liver and kidney.

Figure 2

Contrast-enhanced computed tomography scan of intrahepatic splenosis (black arrow). It revealed a round solid hypodense mass (A) approximately 3.9 × 3.6 cm in the right lobe of the liver with strong homogeneous enhancement in the arterial phase (B); the lesion was hypodense during the portal phase (C).

Figure 3

Magnetic resonance imaging scan of intrahepatic splenosis (black arrow). It showed a slight hypointense signal on T1WI (A) and high signal intensity on T2WI (B) as well as on DWI (C), an enhanced scan suggested uneven enhancement (E), and the signal decreased during the delay phase (F). DWI = diffusion weighted imaging, T1WI = T1 weighted imaging, T2WI = T2 weighted imaging.

Figure 4

Histopathologic findings. (A) View of the surgical specimen, showing that it was 12.1 × 4.6 × 4.0 cm in size, and the red mass specimen of approximately 3.1 × 2.7 cm (black arrow); (B) histopathologic examination showed abundant spleen trabeculae and splenic sinuses that confirmed the diagnosis of splenosis, with no evidence of malignancy (hematoxylin and eosin, ×100).