Two cases of splenic neoplasms with differing imaging findings that required laparoscopic resection for a definitive diagnosis

Abstract

Introduction and importance: Splenic tumors are rare and are sometimes found incidentally. In such cases, laboratory tests and imaging studies should be performed based on the diagnostic algorithm to determine whether the tumor is benign or malignant. However, we clinicians sometimes encounter challenging cases. Herein we experienced two challenging cases of splenic tumor which we could not correctly diagnosis preoperatively.

Case presentation: Case 1: A female in her 80s presented to our surgical department to undergo follow-up examinations for Stage IIIa ascending colon cancer. A follow-up CT scan showed marked enlargement of the splenic tumor which suggested metastatic cancer. We performed laparoscopic splenectomy. Case 2: A healthy female in her 50s presented to our internal medicine department to undergo a workup after multiple splenic tumors. A follow-up CT scan showed that the tumors had grown slightly. We could not completely rule out a malignant tumor. She rejected further follow-up study and chose splenectomy.

Clinical discussion: We experienced two cases of splenic hemangioma with different clinical presentations and imaging findings. Although some studies have reported that biopsying a splenic tumor is a safe and effective way of distinguishing among splenic tumors, in our country splenic biopsies are seldom performed due to fears of causing intraabdominal bleeding or tumor dissemination. Clinicians should consider whether it would be better to perform follow up with a biopsy or splenectomy as a definitive treatment on a case-by-case basis.

Conclusion: Laparoscopic splenectomy can be used for definitive management in cases involving malignancy or an uncertain etiology.

Keywords: Laparoscopic splenectomy; Splenic hemangioma; Splenic incidentaloma.

Fig. 1

Contrast-enhanced CT scans obtained in case 1 Initial visit: (a) arterial phase; (b) delayed phase A solitary splenic tumor (maximum diameter: 1.5 cm) was seen. Six months later: (c) arterial phase; (d) delayed phase The tumor had enlarged (maximum diameter: 3.0 cm) with two components; one (center lesion) is relatively high-intensity area, the other (peripheral area) is low-density area.

Fig. 2

Laparoscopic image of the tumor in case 1 A solitary, slightly hard tumor was seen (arrow).

Fig. 3

Resected spleen (case 1) A cystic nodule (3.0 × 3.0 cm) was found in the spleen.

Fig. 4

Histopathological findings of the resected spleen (case 1) The tumor consisted of proliferating blood vessels without any epithelial abnormalities. These findings were consistent with hemangioma.

Fig. 5

Contrast-enhanced computed tomography (CT) scans obtained in case 2 Initial visit: (a) arterial phase; (b) delayed phase Innumerable splenic tumors were seen. Six months later: (c) arterial phase; (d) delayed phase The tumors had enlarged.