Nonsurgical diagnosis and management of an inflammatory pseudotumor of the spleen in a child

Abstract

Primary splenic tumors in children are rare and usually benign. We report the case of a 7-year-old boy with a splenic mass that initially resembled an infectious process. Histopathologic examination of a specimen obtained using sonographically guided Tru-cut needle biopsy, performed after angiography, revealed an inflammatory pseudotumor of the spleen, an extremely rare benign lesion. The lesion has been managed conservatively with clinical and sonographic follow-up. This case shows that benign lesions of the spleen can easily be diagnosed using current radiologic and histopathologic techniques without the need for surgery, thus allowing total or even partial splenectomy to be reserved for patients in whom a mass cannot be diagnosed or in whom clinical progression is evident.

Inflammatory pseudotumor of the spleen: report of a case with emphasis on contrast-enhanced ultrasound findings

“…Although US is the primary diagnostic tool for observing the spleen, there is a distinct paucity of information on US findings for splenic inflammatory pseudotumor in the literature. 5,8,11 The lesion is imaged as a hypoechoic solid mass (B-mode) without vascularity (color Doppler US). Our case showed this tendency, but, like the radiologic findings, these findings are nonspecific.…”

“…However, they are relatively rare in the spleen, and the English-language literature includes only about 70 cases. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Although various theories have been advanced to explain the pathomechanism of this lesion (inflammation process, focal parenchymal necrosis with hemorrhage, disturbance of blood supply or bacterial or viral infection), 6 it remains undetermined. Like inflammatory pseudotumors arising from other organs, a splenic inflammatory pseudotumor is composed of foci of inflammatory cells, fibroblastic changes and granulomatous tissues.…”

“…Although the histologic patterns vary according to the predominant histologic component, the distinctive microscopic attributes of this lesion present no diagnostic difficulties for experienced pathologists. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] A review of the literature yielded information regarding the general tendencies of splenic inflammatory pseudotumors: (1) an asymptomatic splenic mass is the only clinical presentation; thus, the lesion is found incidentally by medical imaging performed during the workup for other diseases; (2) the tumor occurs most frequently in the fifth and sixth decades of life, and there is no sex predilection; and (3) it appears as a hypovascular or avascular solid mass. This tendency was seen in our case.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Furthermore, most previous reports of this tumor have dealt mainly with histologic studies. [1][2][3][4][5][6][7][8][9][10][11][12][13] As a result, although ultrasonography (US) is the initial diagnostic tool for splenic exploration, reports of US findings for this tumor are relatively scarce. 5,8,11 This may account for the paucity of detailed information in basic US texts.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] As a result, although ultrasonography (US) is the initial diagnostic tool for splenic exploration, reports of US findings for this tumor are relatively scarce. 5,8,11 This may account for the paucity of detailed information in basic US texts. 14,15 To our knowledge, contrast-enhanced US findings for inflammatory pseudotumor have not been previously reported.…”