A Rare Case of Hepatic Splenosis; Initially Interpreted as Metastasis, in a Patient with a Gastrointestinal Stromal Tumor

Abstract

Splenosis refers to auto-transplantation of splenic tissue in heterotopic location usually seen after splenic injury or splenectomy. Very few cases of hepatic splenosis have been reported. Here we report an unusual case initially evaluated for submucosal gastric tumor subsequently diagnosed as gastrointestinal stromal tumor, with hepatic splenosis. Case Report: A 65-year-old male was evaluated for reflux symptoms. Past medical history was significant for hypertension, diabetes mellitus, non-ischemic cardiomyopathy and peripheral vascular disease. There was no history of any major trauma or abdominal surgery. Physical examination was normal. Laboratory results showed mild anemia. Liver function tests were normal. On upper gastrointestinal series a 6.5 × 4 cms, submucosal mass was seen in fundus and body of stomach. Subsequent EGD revealed an umbilicated, submucosal mass involving fundus and proximal body, which appeared to be a leiomyoma vs. leiomyosarcoma. CT scan of abdomen also showed a 7.2 × 6.2 cm submucosal mass. Liver appeared entirely normal. EUS was performed, which showed a gastric leiomyoma, with heterogenous signals consistent with sarcomatous transformation. On laparotomy, a large palpable gastric mass was seen which was close to gastroesophageal junction. Multiple millet-like lesions were also seen involving the left lobe of liver which were assumed to be metastases. Biopsies obtained from these liver lesions revealed benign splenic tissue. Gastric resection was subsequently performed with removal of tumor; pathology was confirmed as gastro intestinal stromal tumor. Hepatic splenosis is a very rare entity. In cases, reported earlier, various diagnoses considered on presentation included hepatocellular carcinoma, hepatic adenoma and metastases. Previously reported cases had a past history of either abdominal trauma, splenectomy or underlying hepatic cirrhosis. To our knowledge this is one of the first cases with hepatic splenosis with no underlying liver disease nor history of splenic trauma in a patient with concomitant gastrointestinal stromal tumor.