Imaging Findings of a Rare Intrahepatic Splenosis, Mimicking Hepatic Tumor

TL;DR

A rare case of intrahepatic splenosis was mistaken for a liver tumor, highlighting the importance of considering this condition in patients with a history of spleen injury or removal.

Contribution

This case report emphasizes the diagnostic challenges of intrahepatic splenosis and underscores the need for clinical awareness to avoid unnecessary interventions.

Findings

Intrahepatic splenosis was confirmed via biopsy in a patient with a history of splenectomy and trauma.

Imaging features of the lesion mimicked hepatocellular carcinoma, leading to diagnostic uncertainty.

The case highlights the importance of clinical history in differentiating splenosis from liver tumors.

Abstract

A young adult patient presented to the gastrointestinal outpatient department with a suspected hepatic tumor. The patient was in a traffic accident ten years ago and underwent splenectomy and distal pancreatectomy at another medical institution. The physical examination was unremarkable. The liver function tests and tumor markers were within normal limits, with the alpha-fetoprotein level at 1.38 ng/mL. Both hepatitis B surface antigen and anti-HCV were negative. Based on the clinical history, intrahepatic splenosis was suspected first. Dynamic computed tomography revealed a 2.3 cm lesion exhibiting suspicious early wash-in and early wash-out enhancement patterns. As previous studies have reported, this finding makes hepatocellular carcinoma and metastatic lesions the major differential diagnoses. For further evaluation, dynamic magnetic resonance imaging was performed, and similar enhancing features were observed, along with restricted diffusion. As hepatocellular carcinoma still could not be confidently ruled out, the patient underwent an ultrasound-guided biopsy. The diagnosis of intrahepatic splenosis was confirmed by the pathologic examination. Intrahepatic splenosis is a rare condition defined as an acquired autoimplantation of splenic tissue within the hepatic parenchyma. Diagnosis can be challenging due to its ability to mimic liver tumors in imaging studies. Therefore, in patients with a history of splenic trauma and/or splenectomy, a high index of suspicion and awareness is crucial for accurate diagnosis and for prevention of unnecessary surgeries or interventions.

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