Hepatic splenosis: Rare yet important – A case report and literature review

Abstract

Hepatic splenosis is an uncommon condition that occurs following traumatic splenic rupture or splenectomy. The case of a 41-year-old male patient with multiple isolated liver masses indistinguishable from primary and metastatic liver tumours is reported. Following laparotomy, the liver lesions were resected and histopathology confirmed a diagnosis of hepatic splenosis. At an 18-month follow-up examination, no abnormalities in routine blood test, liver function, and liver computed tomography (CT) scanning were observed. After review of the literature, the following diagnostic criteria for hepatic splenosis are proposed: (1) a history of splenic trauma or splenectomy; (2) lesion(s) with a surrounding rim, particularly near the liver capsule identified by CT scanning; (3) findings on superparamagnetic iron oxide-enhanced magnetic resonance imaging or technetium-99m heat-damaged red cell scanning; and (4) histopathological findings (needle biopsy or surgical pathology). The following diagnostic process is also proposed: suspect diagnosis when criteria 1 and 2 are met; make diagnosis when criterion 3 is met; confirm diagnosis when criterion 4 is met. Laparotomy is recommended for either diagnosis or treatment when invasive procedures are necessary.

Intrahepatic splenosis: a world review

“…The search yielded 81 articles: 11 articles were not in English, 6 articles were not case reports or series, 5 articles included isolated extrahepatic splenosis, 1 article was on splenosis in animals, 1 article included an incidental finding of splenosis on autopsy, and the full text was not available for 1 article. The remaining 56 articles were included in the analyses, with a total of 59 reported cases ( Table 1 ) [ 4 - 59 ]. Year of study, age, sex, reason for splenectomy, time from splenectomy to presentation, presence of risk factors for HCC, clinical presentation, laboratory investigation results, imaging features, initial differential diagnoses and method of confirming diagnosis were extracted from the articles.…”

“…Intra-abdominal splenosis involving the serosal surface of the small or large bowel, parietal peritoneum and mesentery is relatively common [ 3 ]. However, intrahepatic splenosis (IHS) is rare, with many authors quoting fewer than 50 cases published to date [ 4 - 6 ]. Diagnosis of IHS is often challenging as patients are often asymptomatic or present with non-specific abdominal pain, and radiological imaging findings may resemble other hepatic lesions, particularly hepatocellular carcinoma (HCC), adenoma and focal nodular hyperplasia (FNH).…”

“…Hence it is important to understand this pathological condition and its clinical features. To date, there are two literature reviews on IHS which summarize reported cases [ 4 , 7 ]. However, these reviews do not include the clinical presentation, presence of risk factors for malignancy, laboratory investigations and imaging characteristics.…”

Splenosis masquerading as gastric stromal tumor: A case report

“…Less common are the liver, pancreas, stomach, bladder, gall bladder, kidney, ureter, and uterus. The pathogenesis of this disease includes: (1) Splenic pulp spreading to adjacent tissues, forming a planting metastasis[ 3 ]; (2) Entry of splenic pulp into other organs via circulation, including, rarely, the brain and liver[ 4 ]; and (3) A unique liver pathway where red blood cell progenitors are transferred from the spleen to the liver via the portal vein (Chinzei and Lenox LE[ 5 , 6 ] and others). Here the local hypoxic environment of the liver could stimulate the secretion of erythropoietin, activating BMAP/Madh5 signaling pathways, inducing the proliferation and differentiation of the transplanted splenic red blood cell progenitors, and leading to intra-hepatic splenosis.…”

Intrahepatic splenosis mimicking hepatocellular carcinoma

“…В мировой литературе опубликовано несколько обзорных работ, посвященных обсуждаемой теме -ВПС [3,[18][19][20], из которых наибольший интерес, на наш взгляд, представляет работа W.S. Toh и соавт., 2020 [3].…”