Hepatic splenosis: a report of a very rare case

Abstract

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).

Hepatic small vessel neoplasm: not totally benign, not yet malignant

“…Viable splenic tissue is autotransplanted in the abdominal cavity or more rarely in the thoracic cavity or brain. Hepatic splenosis is exceedingly rare and often asymptomatic with nonspecific imaging that can mimic other hepatic lesions [ 12 ]. CD8 stains a subset of T cells, and is useful for identifying splenic tissue because the endothelial cells lining the splenic sinuses are positive for CD8, a finding that is unique to those endothelial cells (littoral cells).…”

Splenosis in patient undergoing robotic assisted laparoscopic radical prostatectomy

“…It is reported to occur in nearly 67% of patients with history of splenic injury, with the number of nodules of ectopic tissue correlating to the severity of splenic injury. 1 The implantation is often multi-focal, with peritoneal cavity as the most frequently affected anatomical space.…”