Splenic hamartomas in two children

Abstract

Hamartomas are extremely rare splenic benign tumours in children. We present two cases, both in boys (6 and 8 years old), with left upper quadrant abdominal pain that were otherwise asymptomatic. Both patients showed a splenic mass on preoperative ultrasonography and magnetic resonance imaging (MRI). One patient had a focal splenic mass that was identified preoperatively with contrasted computed tomography (CT) scans. Both patients underwent a total splenectomy. Although multi-modality imaging findings were described preoperatively, the final diagnosis in each case was splenic hamartoma based on histology and immunohistochemistry. The postoperative courses were uneventful.

Splenic hamartoma–a rare finding

“…9 Preoperative diagnosis using a combination of multi-modality imaging exams may be possible. 4 Accurate preoperative diagnosis helps to avoid unnecessary surgery or biopsy and ultimately decrease the patient's overall morbidity. 10 Ultrasonography reveals splenic hamartoma as well-defined, homogeneous solid masses with variable echogenicity relative to the normal splenic parenchyma, but other masses may be heterogeneous with cystic changes or, in rare cases, have a gross calcification secondary to ischemia or hemorrhage.…”

“…2 The main differential diagnosis is a hemangioma, and MRI is the most appropriate technique to differentiate them. 2,4,12 Most lesions are isointense in T1-weighted images and heterogeneously hyperintense in T2-weighted images.12 In dynamic contrast sequences, it is typical to see low and heterogeneous enhancement in immediate post-contrast images. 12 These are the key features of the differentiation between hamartoma and hemangiomas.12 In delayed post-contrast imaging, the hamartoma is relatively uniformly and intensely reinforced and may reveal areas with poor central vascularization.…”

“…1 Splenic tumors are relatively rare and include malignancies such as lymphomas, angiosarcomas, plasmacytomas, primary malignant fibrous histiocytomas, and metastatic disease. [1][2][3][4] The most common benign splenic lesions include: 5 • Cysts.…”

“…Splenic hamartoma was first described in 1961 by Rokitansky. [3][4][5][6][7] Epidemiologically, splenic hamartoma can affect both sexes similarly, regardless of age, predominantly in older adults. 5 About 20% of hamartoma occurs in children.…”

Asymptomatic multinodular splenoma (splenic hamartoma) in a child with sickle cell anemia

“…Its reported surgical incidence reaches three cases out of 200,000 splenectomies. Incidence ranges from 0.024% to 0.13% at autopsy 3,4. Hamartoma means “scribal error or mistake”; it is a tumor-like disorderly proliferation of cells and tissues indigenous to the site in which the hamartoma is located.…”