Epstein-Barr virus-positive inflammatory pseudotumor of the spleen managed with laparoscopic splenectomy

Abstract

We report a case of Epstein-Barr virus (EBV)-positive splenic inflammatory pseudotumor treated by laparoscopic splenectomy. A 66-year-old female without symptoms was found to have a solitary, avascular, solid tumor of the spleen by contrast-enhanced computed tomography. The tumor was compatible with a primary tumor of the spleen. A benign splenic tumor was the most likely diagnosis, but malignant lymphoma could not be ruled out because the serum-soluble interleukin-2 receptor (sIL-2R) level was elevated. Laparoscopic splenectomy was performed to enable a definite diagnosis. Removal of the whole spleen without injury was possible. Possible contamination of the extirpation orifice by cancer cells was carefully prevented by enclosing the spleen in a plastic bag. Histopathological examination showed the tumor to be an EBV-positive inflammatory pseudotumor. To the best of our knowledge, this is only the second report of an EBV-positive splenic inflammatory pseudotumor with an increased serum sIL-2R level. Although EBV-positive inflammatory pseudotumors have been reported to recur, no sign of recurrence has been detected in the present case in the 17 months following splenectomy.

Inflammatory pseudotumor-like follicular dendritic cell tumor: an underdiagnosed neoplasia

“…EBV (in situ hybridization for EBER) has been found in spleen and liver IPT in higher frequency than in lymph node (66%, 50% and 20%, respectively [20,38,[47][48][49][50]. Tuberculosis should be included in differential diagnosis [51], as well as sclerosing angiomatoid transformation of the spleen [52][53][54].…”

Splenic Epstein-Barr Virus–Associated Inflammatory Pseudotumor

“…Splenic EBV-associated IPTs that do not stain for FDC markers form a more heterogeneous phenotypic subgroup. [1][2][3]7,[18][19][20][21][22][23] The spindle cells in this subgroup show expression of vimentin, SMA (Figure 1, E), and/or CD68, suggesting fibroblastic, myofibroblastic, or histiocytic differentiation. In 1 reported case, there was positivity for SMA and keratin, which could suggest an FBRC origin.…”

“…Fifteen well-documented cases have been reported in the spleen. [1][2][3]7,[18][19][20][21][22][23] The phenotype of the spindle cells in splenic EBV-associated IPT not expressing FDC markers is heterogeneous and controversial. Lesions with a presumed fibroblastic, 1 myofibroblastic (''splenic inflammatory myofibroblastic tumor''), 1,2,20,21 fibroblastic reticular cell (FBRC), 17 or ''fibrohistiocytic'' phenotype have been reported.…”

“…[1][2][3]7,[18][19][20][21][22][23] The phenotype of the spindle cells in splenic EBV-associated IPT not expressing FDC markers is heterogeneous and controversial. Lesions with a presumed fibroblastic, 1 myofibroblastic (''splenic inflammatory myofibroblastic tumor''), 1,2,20,21 fibroblastic reticular cell (FBRC), 17 or ''fibrohistiocytic'' phenotype have been reported. 2,3,18,19,23 However, given a close relationship between fibroblasts, myofibroblasts, FBRCs, and FDCs with regard to their origin, differentiation, and transformation, 3,9,17,24 it may well be possible that IPT-like FDC tumors and FDC markernegative EBV-associated IPTs represent phenotypic subgroups of the same entity.…”