Hepatic splenosis mimicking HCC in a patient with hepatitis C liver cirrhosis and mildly raised alpha feto protein; the important role of explorative laparoscopy

Abstract

Hepatic splenosis is not a rare event and should be suspected in patients with a history of splenic trauma or splenectomy. Correct diagnosis is essential and will determine subsequent management plans. In doubtful cases laparoscopic investigation can offere essential information and should be part of the standard protocol for investigating suspected splenosis.

Diffuse Abdominal Splenosis Mimicking Peritoneal Metastases in a 35-Year-Old Man with a Resectable Carcinoma of the Ampulla of Vater

“…Splenosis may be confused with abdominal lymphoma, endometriosis, simple lymphadenopathy, primary tumors (including renal, gastric or hepatic tumors) and secondary metastatic disease including carcinomatosis, peritoneal mesothelioma and liver metastases [6, 11, 12]. Clearly, the described concurrent diagnosis of splenosis and ampullary adenocarcinoma in our 35-year-old patient is exceptional, and, furthermore, the patient had numerous, widely scattered lesions, which is unusual.…”

Splenunculi mimicking metastases in a patient with locally advanced prostate cancer

“…It is reported to develop over an average of 10 years following the insult, and is more common following trauma than iatrogenic causes [3] . The cells can implant in any other location and take their blood supply from surrounding structures; splenosis has been reported as intrathoracic where there is a concomitant diaphragmatic injury or intrahepatic following an emergency splenectomy for trauma [4,5] . The pathogenesis is generally accepted to be mechanical implantation of cells, however there are case reports of intracranial splenic deposits from purported haematological spread [6] .…”

Splenosis and sepsis: The born-again spleen provides poor protection

“…Splenotic tissue has a decreased amount of white pulp, 51,52 and while it contains many elements of the normal spleen, the splenic nodules are smaller in mass with reduced individual compartments. 47 The reduced immune function of these ectopic implants may be partially related to the decreased amount of white pulp. 49 There is no regeneration of the delicate but efficient arterial and venous circulating beds that are also important in the spleen's immunologic role.…”

“…A trauma history and tumor markers may be useful in distinguishing between benign and more serious lesions. 47,59 While biopsy remains the gold standard for diagnosis, imaging in combination with a history of splenic trauma or splenectomy can avoid excessive intervention. Currently, the preferred imaging ©2 0 1 1 L a n d e s B i o s c i e n c e .…”

“…46 Intrahepatic splenosis, an extremely rare manifestation of this condition, is often found as a 2-4 cm nodule and not apparent for years following initial splenic trauma. 39,[47][48][49] Since an acute embolic splenic nodule of such diameter would be expected to result in severe compromise of the portal circulation, this suggests that tissue from the ruptured spleen expanded after deposition within the liver.…”