Inflammatory Pseudotumor of Spleen

Abstract

The case of a 66-year-old man with pseudotumor of the spleen is presented. This rare entity can mimic malignant lymphoma clinically and radiographically. Splenectomy is diagnostic and curative. The etiology of pseudolymphoma is unknown, although a review of the literature suggests an association with prior systemic bacterial infection, as in the present case. Cancer 66:597-600,1990.NFLAMMATORY PSEUDOTUMOR (plasma cell granu-I loma) is a rare mass lesion with histologic features of inflammation and mesenchymal repair that has been observed in tissues of the respiratory tract,' gastrointestinal tract,2 orbit,3 soft tis~ues,~ lymph nodes,' and other organ^.^.^ When the lesion occurs as a primary splenic tumor, lymphoma is usually suspected clinically, and the true diagnosis is revealed only after the spleen is examined histologically. We recently observed a patient with this entity who has remained disease-free 24 months after the splenectomy. Case ReportA 66-year-old man was admitted to his community hospital in May 1988 with fever, pneumonia, hepatitis, and anemia. The liver was palpable two to three fingerbreadths below the costal margin but was not tender. A chest radiograph showed bilateral interstitial pneumonia involving all lobes except the right upper lobe, as well as small bilateral pleural effusions. An abdominal CT scan revealed mild splenomegaly and two right renal cysts.A diagnosis of Legionella pneumonia was made from sputum cultures and the patient responded to appropriate antibiotic therapy. However, hepatitis and malaise persisted and the patient was readmitted 1 month later for further evaluation. Significant physical findings were limited to jaundice and a nontender, palpable liver edge. The patient gave a history of jaundice that was treated medically at another hospital 10 years previously. He occasionally took indomethacin or ibuprofen for knee pain. Except for an appendectomy 40 years previously he had no other significant medical history. There was no history of blood donation or transfusion. The hematocrit was 30%, hemoglobin 9. gm/dl, and the platelet count was 377,OOO/pl. The leukocyte count was 12,9OO/p1 and a shift to the left was noted on a differential leukocyte count. The total serum bilirubin was 2.7 mg/ dl with a direct bilirubin of 1.4%. Serum alkaline phosphatase was 54 1 IU/l, SGOT 60 IU/l, SGPT 59 IU/l, and GGTP 52 1 IU/I. The blood urea nitrogen was 19 mg/dI and serum creatinine was I .2 mgdl. Hepatitis A antibody and hepatitis B surface antigen tests were negative. A bone marrow biopsy was hypercellular and an aspirate revealed mature granulocytic hyperplasia, moderately increased mature plasma cells, and decreased erythrocyte precursors.A repeat abdominal CT scan showed hepatosplenomegaly and a 10 cm focal solid splenic mass (Figs. 1 A and 1B). A comparison with the previous CT scan showed that the mass was barely perceptible on the previous scan. Furthermore, re-evaluation of a radionuclide bone scan done 6 months earlier for arthritic complaints revealed a suggestion of a...

Inflammatory pseudotumor of the spleen: Report of a case

“…Although inflammatory pseudotumors have been reported in several anatomic locations, 1-8 splenic involvement is extremely rare. Since the first two cases of inflammatory pseudotumor of the spleen were reported by Cotelingam and Jaffe in 1984, 11 24 cases in Japan 12-25 and 42 cases outside Japan 11,14,[26][27][28][29][30][31][32][33][34][35][36][37][38][39] have been reported. The clinical features of these cases, including the present case, are summarized in Table 1.…”

“…The granulomatous inflammation process, focal parenchymal necrosis with hemorrhage, disturbance of blood supply, or bacterial or viral infection have all been speculated to be initiators in the spleen. 11,21,29 Perrone et al 38 observed that most of the clinical and pathologic features of inflammatory pseudotumors may thus be related to the production of mediators in inflammation, and noted that interleukin-1 can produce local lesions and systemic manifestations with inflammatory pseudotumors.…”

Splenic Inflammatory Pseudotumor (Inflammatory Myofibroblastic Tumor)

“…8 In splenic inflammatory pseudotumors, the respiratory symptoms of chronic bronchitis and sleep apnea syndrome seen in our case have not been reported previously ; only one case with complications of interstitial pneumonia was reported. 13 Some investigators demonstrated that cytokines such as IL-1b, IL-6, IL-8, and monocyte chemotactic protein-1 were overexpressed in inflammatory pseutotumors. [14][15][16][17] These cytokines are not only associated with the histogenesis of inflammatory pseudotumors but also contribute to clinical manifestations of inflammatory disorders of the lung and sleep-related breathing disorders.…”

Inflammatory pseudotumor of the spleen

“…Further investigations are needed to shed more light on the etiology of this rare tumor. The long-term follow-up of patients with IP showed the benign nature of this lesion [3,16,17,19]. …”

“…It is more likely an exaggerated hypertrophic scar response to local tissue injury rather than manifestation of a systemic disorder. Splenectomy is diagnostic and curative [5,19]. Further investigations are needed to shed more light on the etiology of this rare tumor.…”