Inflammatory Pseudotumor of the Spleen Managed Laparoscopically. Can Preoperative Imaging Establish the Diagnosis?

Abstract

A hypovascular solid splenic mass by Doppler ultrasound or CT scan suggests the diagnosis of inflammatory pseudotumor. Stellate central calcifications seen on CT scan make the diagnosis very likely. Laparoscopic splenectomy can be used for definitive diagnosis and symptomatic relief with minimal morbidity and mortality.

Splenic Inflammatory Pseudotumor (Inflammatory Myofibroblastic Tumor)

“…A substantial proportion of the inflammatory pseudotumors of the spleen are discovered incidentally upon screening 8 and symptoms roughly correlate with the lesion size. Symptomatic patients with splenic inflammatory pseudotumors most often manifest left upper quadrant pain, fever of unknown origin, weight loss, malaise, 8 and occasionally idiopathic thrombocytopenic purpura. 9,10 Laboratory findings are also non-specific in splenic inflammatory pseudotumors and include leukocytosis, anemia, thrombocytopenia, hypergammaglobulinemia, an elevated erythrocyte sedimentation rate, hypercalcemia, and/or elevated serum levels of soluble interleukin (IL)-2 receptor.…”

“…8 However, this gender predilection might be due to inflammatory pseudotumor-like follicular dendritic cell tumors of the spleen that are characterized by a striking female predominance. A substantial proportion of the inflammatory pseudotumors of the spleen are discovered incidentally upon screening 8 and symptoms roughly correlate with the lesion size.…”

“…8 However, this gender predilection might be due to inflammatory pseudotumor-like follicular dendritic cell tumors of the spleen that are characterized by a striking female predominance. A substantial proportion of the inflammatory pseudotumors of the spleen are discovered incidentally upon screening 8 and symptoms roughly correlate with the lesion size. Symptomatic patients with splenic inflammatory pseudotumors most often manifest left upper quadrant pain, fever of unknown origin, weight loss, malaise, 8 and occasionally idiopathic thrombocytopenic purpura.…”

Inflammatory Pseudotumour of the Spleen: A Diagnostic Dilemma

“…Pain in the left upper quadrant or in the epigastric region is the most common symptom. IPTs of the spleen have been detected almost exclusively in adults (4-87 years) and median age (49 years) [10] with a slight female preponderance (56.5 per cent) [11].…”

“…It was decided to therefore go in for a splenectomy. A splenectomy is both diagnostic and curative and it results in an excellent prognosis [11].…”