Abstract
症例は70歳代女性．X－33年に脾臓摘出術と輸血を受けた．HCV抗体陽性およびCTで肝S2に20 mm大の腫瘤を指摘され紹介となった．腫瘤は超音波検査で低エコーとなり，dynamic CTで早期濃染を示すが門脈相にて欠損像を認めず，EOB-MRIで肝細胞相は低信号を示した．画像所見は肝細胞癌としては非典型的であったが，HCV陽性のため肝細胞癌を否定できず腫瘤生検を施行した．病理組織では白脾髄，赤脾髄を認め脾臓組織に矛盾しない所見で，SPIO-MRIにてSPIOの取り込みによる信号低下を認め，肝内脾症（intrahepatic splenosis）と診断した．Splenosisは脾臓摘出や脾損傷後に生じる良性疾患だが，特に慢性肝炎や肝硬変など発癌リスクがある場合に肝細胞癌との鑑別が困難となる．脾臓摘出術や脾損傷の既往を持つ症例では本疾患を念頭に置く必要がある．
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