An Uncommon Cause of a Focal Liver Lesion

Röther, Mareike; Dufour, Jean–François; Schnüriger, Beat

doi:10.1053/j.gastro.2012.10.017

Cited by 9 publications

(6 citation statements)

References 2 publications

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“…The most likely mechanism underlying splenosis is the seeding of splenic fragments onto serosal surfaces during splenic trauma or splenectomy 7 and cell proliferation, promoted by local hypoxia of the liver. 8 Hepatic splenosis is rarely identified in the clinic, with no more than 41 cases published between 1993 and 2016 (Table 1), 1,8–44 and due to its low prevalence, knowledge of the clinical features and diagnosis of splenosis remains limited. Hepatic splenosis has no specific symptoms, although abdominal pain may arise due to heterotopic splenic infarction or compression, resulting in missed diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, pathological evidence was also required to confirm diagnosis according to the results of surgery or biopsy in 35 of the reported patients. 1,7,9–11,13,16–21,24–27,29,35,37–44 Based on current knowledge, the present authors propose the following criteria and process for diagnosing hepatic splenosis. Criteria: (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 SPIO-MRI or Tc-99m HDRS; and (4) histopathological findings (needle biopsy or surgical pathology).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…4 Hepatic splenosis rarely has clinical significance 4 and is usually asymptomatic, but complications have been reported, such as mass effect, acute abdominal pain due to obstruction caused by the lesion, bowel obstruction and invasion of the bowel wall, causing hemorrhage. 610,15,17 The differential diagnosis is essential, as it will completely change the approach, treatment and evolution. However, it is challenging and difficult and should encompass hepatic adenoma, haemangioma, focal nodular hyperplasia, lymphoma and hepatocellular carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Hepatic splenosis: a report of a very rare case

Kampa¹,

Guerra²,

Percicotte³

et al. 2019

GHOA

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Splenosis, one type of manifestation of ectopic spleen tissue, 1,2 is a heterotopic autotransplantation of splenic tissue after abdominal trauma or surgical intervention (Figures 1). Hepatic splenosis is very rare, usually asymptomatic and cannot be distinguished from hepatic malignancies because of lack of significant radiological features. 2,3 Therefore, suspicion is an important step for diagnosis and invasive procedures are usually necessary to establish a definitive diagnosis. An important differentiation is made with hepatic adenomas, which are generally benign and, if smaller than 5 cm and asymptomatic, do not require surgical treatment, but if they are larger, they should be resected, due to the risk of hemorrhage or malign transformation. 4 This was the initial suspicion in the presented clinical case and, therefore, the patient underwent surgical resection. Splenosis is a benign entity, but with several differential diagnoses and need for clinical correlation and images for correct definition .4-8 In patients with cirrhosis the most important differential diagnosis is with hepatocellular carcinoma and invasive procedures may be necessary for the definition. 4,9 In this article we describe a clinical case of hepatic splenosis, its differential diagnoses and review of imaging methods for diagnostic definition. Case presentation Male, 47 years old, with an incidental finding of hepatic lesion, during investigation of nephrolithiasis. Previous history of splenectomy after abdominal trauma due to automobile accident 20 years ago. Hypertensive in use Olmesartan, denied other pathologies and surgeries. On physical examination: good general condition, anicteric, painless abdomen, without palpable masses. Laboratory tests: Hb 14g/dL (13,5-17,5), Hct 44,4% (39-55), Platelets 268,000/ mm3 (150.000-400.000), creatine 0,9mg/dL (1,5), INR 0,8, CEA 1,33 ng/mL (<3,0), CA 19-9 20U/mL (<37), AFP 1,5ng/dl (<7,22), albumin 4,19g/dL (3,4-4,8), AST 20U/L (17-55), ALT 18U/L (21-71), GGT 54U/L (15/73), AP 48U/L (38-126), total bilirrubin 0,57mg/ dL (0,2-1,3). MRI showed nodular hepatic lesion, 42x41x28mm, slight hyperintense in T2, with contrast enhancement and washout in late phase, in segment II, without dilatation of biliary tract (Figures 2). The initial diagnosis was hepatic adenoma. Proceeded with hepatic segmentectomy, with good evolution. The surgical specimen referred to pathological anatomy and revealed hepatic splenosis (Figures 1).

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“…The auto-transplanted splenic cells derive their blood supply from adjacent structures and subsequently differentiate into mature splenic tissues. Although it is an uncommon condition, it affects approximately two-thirds of all patients with traumatic splenic rupture [1]. Herein, we present a case of a middle-aged male patient who presented with symptoms consistent with acute appendicitis; a subsequent computed tomography (CT) scan confirmed its diagnosis and further demonstrated multiple abdominal nodules, one of which was adjacent to the appendix.…”

Section: Introductionmentioning

confidence: 88%

Splenosis of the Mesoappendix with Acute Appendicitis: A Case Report

et al. 2020

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Rare co-existance of disease or pathology Background:Splenosis is a benign condition involving the auto-transplantation of splenic tissue at various locations, resulting from splenic injury or splenectomy. Case Report:A 40-year-old male, with a history of remote exploratory laparotomy with splenectomy secondary to blunt abdominal trauma, presented with symptoms consistent with acute appendicitis, which was subsequently confirmed by computed tomography scan of the abdomen that further demonstrated the presence of multiple abdominal nodules, one of which was adjacent to the appendix. A laparoscopic appendectomy was then performed along with resection of the nodule located in the mesoappendix, which was confirmed to be a splenic tissue based on histopathological examination. Conclusions:Abdominal splenosis is not an uncommon condition in patients with a history of splenic injury. However, the involvement of the mesoappendix, which may or may not contribute to acute inflammation of the appendix, is very rare.

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An Uncommon Cause of a Focal Liver Lesion

Cited by 9 publications

References 2 publications

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

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

Hepatic splenosis: a report of a very rare case

Splenosis of the Mesoappendix with Acute Appendicitis: A Case Report

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