# Hepatic Focal Lesion Suspicious for Hepatocellular Carcinoma in a Patient with a History of Post-Traumatic Splenectomy: The Challenge of Differential Diagnosis with Intrahepatic Splenosis—Literature Review and Case Report

## TL;DR

A rare case of liver lesion mistaken for cancer highlights the diagnostic challenge of hepatic splenosis in patients with a history of splenectomy.

## Contribution

This case report emphasizes the importance of considering hepatic splenosis in the differential diagnosis of liver lesions in post-splenectomy patients.

## Key findings

- Hepatic splenosis can mimic hepatocellular carcinoma on imaging, leading to potential misdiagnosis.
- Intrahepatic splenosis was confirmed in a patient with a suspicious liver lesion and a history of splenectomy.
- Awareness of hepatic splenosis can prevent unnecessary invasive procedures in at-risk patients.

## Abstract

Hepatic splenosis (HS) is a rare benign condition in which fragments of splenic tissue implant in the liver, typically following splenic trauma or splenectomy. Most patients are asymptomatic, and the condition is often incidentally detected. Radiologically, HS can closely mimic hepatocellular carcinoma (HCC), making preoperative diagnosis challenging, particularly in patients without classical HCC risk factors. Tc-99m heat-damaged red blood cell scintigraphy is a useful non-invasive diagnostic tool but is rarely performed. As a result, most cases are diagnosed through liver biopsy or surgical resection. Awareness of HS and careful consideration of patient history can prevent unnecessary interventions and guide appropriate management, highlighting the importance of including HS in the differential diagnosis of hepatic nodules.

Background: Hepatic splenosis (HS) is a rare para-physiological condition resulting from the ectopic implantation of splenic tissue, most commonly following traumatic or surgical splenectomy. Its radiological features can mimic those of hepatocellular carcinoma (HCC), potentially leading to misdiagnosis and unnecessary invasive procedures, such as biopsies or liver resection. Methods: A literature review was conducted using the PubMed database to identify all reported cases of HS. Case Presentation: We report the case of a 52-year-old male with an incidental finding of a liver lesion in segment V, initially suspected to be HCC, and a history of post-traumatic splenectomy. The patient had no history of underlying liver disease. Due to the lesion’s superficial location, a biopsy was not performed because of the risk of tumor rupture with subsequent bleeding or peritoneal seeding. Consequently, the patient underwent upfront laparoscopic anatomic segmentectomy of segment V. Final pathology revealed a diagnosis of intrahepatic splenosis. Conclusions: HS should be considered in the differential diagnosis of liver lesions in patients with a history of splenectomy but no underlying liver disease, particularly when imaging shows features suggestive of HCC, such as arterial phase hyperenhancement and portal venous washout. Awareness of this entity may prevent unnecessary invasive interventions and guide appropriate patient management.