Hepatic splenosis: Rare yet important - A case report and literature review

Abstract

Hepatic splenosis is an uncommon condition that occurs following traumatic splenic rupture or splenectomy. The case of a 41-year-old male patient with multiple isolated liver masses indistinguishable from primary and metastatic liver tumours is reported. Following laparotomy, the liver lesions were resected and histopathology confirmed a diagnosis of hepatic splenosis. At an 18-month follow-up examination, no abnormalities in routine blood test, liver function, and liver computed tomography (CT) scanning were observed. After review of the literature, the following diagnostic criteria for hepatic splenosis are proposed: (1) a history of splenic trauma or splenectomy; (2) lesion(s) with a surrounding rim, particularly near the liver capsule identified by CT scanning; (3) findings on superparamagnetic iron oxide-enhanced magnetic resonance imaging or technetium-99m heat-damaged red cell scanning; and (4) histopathological findings (needle biopsy or surgical pathology). The following diagnostic process is also proposed: suspect diagnosis when criteria 1 and 2 are met; make diagnosis when criterion 3 is met; confirm diagnosis when criterion 4 is met. Laparotomy is recommended for either diagnosis or treatment when invasive procedures are necessary.

Keywords: Hepatic splenosis; diagnosis; treatment.

Figure 1.

Abdominal computed tomography scan showing lesions in the liver located near the liver capsule (arrows) with a rim surrounding the lesion (triangle): (A) low density lesions located near the capsule in unenhanced phase; (B) lesions washed-in and enhanced during hepatic arterial phase revealing a rim surrounding the lesion (triangle); and (C) lesions washed-out in portal venous phase

Figure 2.

Representative photomicrographs of a liver lesion tissue section stained with haematoxylin and eosin showing hepatic splenosis and normal liver tissue: (A) fibrous tissue isolates the liver and spleen parenchyma (arrow) with liver tissue on the left and spleen tissue on the right including lymphoid follicular tissue (triangle), original magnification × 100; and (B) lymphoid follicular tissue (triangle), original magnification × 200.