Laparoscopic approach in the treatment of splenic angiolipomatous hamartoma: the first report of a case

Abstract

Angiolipomatous hamartoma is a benign mesenchymal proliferation of unknown aetiology. Only a few cases have been documented in the published literature. This current case report describes a 57-year-old female patient who was hospitalized for an assessment of a previously radiologically-verified splenic lesion and further treatment. The patient had been surgically treated 10 years previously; a lobectomy of the superior left pulmonary lobe had been performed in order to remove a verified tumour lesion. A complete radiological examination was undertaken, which verified a spleen of a size that was within the physiological range, with a centrally-located lobular tumour lesion. Given the risk of splenic rupture, as well as the fact that the lesion's aetiology was still undetermined, and finally the fact that differential diagnostics indicated the possibility of a metastasis, the patient was treated surgically. Laparoscopic splenectomy, in the treatment of splenic diseases, even rare ones such as this, is not a novelty. Indeed, it needs to be applied as the standard approach, with the well-known benefits that the minimalized approach offers.

Keywords: Spleen; angiolipoma; angliolipomatous hamartoma; laparoscopic splenectomy; splenic tumour.

Figure 1.

Preoperative radiological examination of a 57-year-old female patient who was hospitalized for an assessment of a previously radiologically-verified splenic lesion and further treatment: (a) an abdominal ultrasound examination showed a 6.5-cm splenic mass that was markedly hyperechoic relative to the parenchyma and accompanied by acoustic shadowing; (b) an axial multidetector computed tomography scan of the abdomen in the portal-venous phase of the examination clearly showed a hypodense, lobulated and clearly demarcated mass in the spleen. The measured density of –50.3 Hounsfield units corresponds to the fatty component of the lesion with well-enhancing vessels intralesionally; (c) an axial T2-weighted magnetic resonance (MR) image showed a hyperintense intraparenchymal lesion of the spleen due to the large amount of lipomatous content and (d) an axial fat-suppressed T2-weighted MR image clearly showed suppression of the fat.

Figure 2.

Laparoscopic splenectomy information for a 57-year-old female patient who was hospitalized for an assessment of a previously radiologically-verified splenic lesion and further treatment: (a) port sites for the laparoscopic splenectomy; (b) intraoperative presentation of the splenic tumour (arrow). Short gastric vessels were divided using a laparoscopic harmonic scalpel; (c) vessels were ligated with hem-o-lock clips and (d) splenic specimen placed into a nylon Endobag™.

Figure 3.

Pathohistological examination of a splenic tissue sample from a 57-year-old female patient who was hospitalized for an assessment of a previously radiologically-verified splenic lesion and further treatment: (a) non-circumscribed benign mesenchymal proliferation with vascular and fatty components, surrounded by residual splenic tissue (haematoxylin & eosin; scale bar 5000 µm); (b) mature adipose tissue was more predominant in some parts of lesion, with no necrosis, dense sclerosis, lipoblasts or marked cytologic atypia (haematoxylin & eosin; scale bar 2000 µm); (c) cluster of differentiation (CD)31 immunohistochemical staining of haphazard thick-walled muscular vessels (scale bar 500 µm) and (d) CD34 immunohistochemical staining of vessels of varying sizes inside the adipose tissue (scale bar 500 µm).