Inflammatory Pseudotumor of the Spleen: Report of Two Cases with a Review of the Literature

Abstract

This study reports two cases of inflammatory pseudotumor of the spleen. The first case was a 57-year-old woman in whom the splenic mass was an incidental finding during evaluation for an acute abdomen due to a perforated, lithiasic gallbladder. The mass in the spleen measured 12.7 cm in greatest dimension. The second case was of a 46-year-old woman with a palpable, left upper quadrant mass. A computed tomography scan revealed a splenic mass and the spleen was removed. The mass measured 12 cm in greatest dimension. In a review of the literature, 13 examples of splenic inflammatory pseudotumor were reported. The age range was 19 to 75 years, with a median age of 50 years. The splenic lesions were either discovered incidentally or manifested by left upper quadrant discomfort and/or mass. Inflammatory pseudotumor of the spleen, although rare, is being increasingly recognized and should be considered in the differential diagnosis of mass lesions of the spleen.

Inflammatory pseudotumor of the spleen concomitant with renal cell carcinoma: case report

“…1 The published long-term follow-ups were uneventful and, to the best of our knowledge, no recurrence has been described in the literature. There have not been any cases of splenic inflammatory pseudotumors presenting or evolving with metastasis.…”

“…There is predominance of lymphocytes (mostly T cells), plasma cells, histiocytes and, to a lesser extent, neutrophils and eosinophils. 1,2 The features of the lymphocytes emphasize the benign nature of the tumor, with small, cytologically mature cells, absence of nuclear atypia and low mitotic activity. Centrally located areas of coagulative necrosis and areas of hemorrhage are often found.…”

“…Even in the absence of characteristic features such as nodal and bone marrow involvement, the most common preoperative diagnosis in splenic inflammatory pseudotumor cases is splenic lymphoma. 1 In addition to lymphomas, the lesions frequently included in the differential diagnosis for splenic inflammatory pseudotumors are: lymphoreticular malignancies other than lymphomas (e.g. solitary plasmacytoma), hemangioma, tumoral proliferation of follicular dendritic reticulum cells, splenic hamartoma, reactive lymphoid hyperplasia and malignant fibrous histiocytoma.…”

“…Histologically, it is characterized by nonspecific and reparative changes resembling granulation tissue. 1 Cases presenting with a concomitant neoplasm raise the suspicion of metastatic spread and are difficult to manage in the clinical setting, since accurate preoperative staging is, in most cases, impossible. We report on a case of splenic inflammatory pseudotumor presenting with concomitant renal cell carcinoma.…”

Inflammatory pseudotumor of the spleen: a case report and review of the literature

“…The remaining cases were diagnosed either incidentally, in the workup of another disease (two during staging laparotomy for Hodgkin's disease; three as part of the workup of idiopathic thrombocytopenic purpura; one during surgery for a ruptured gallbladder; three after gastric bleeding; one during follow-up for adrenal adenoma), or were found in a routine physical examination. Two cases were diagnosed during autopsy [22,29].…”