Abstract
Purpose: Splenosis is heterotropic implantation of splenic tissue after splenectomy or traumatic rupture of spleen. We report patient with alcoholic liver disease, who was found to have enhancing hepatic lesion during surveillance for HCC but was diagnosed as splenosis based on characteristic imaging, nuclear scintigraphic findings and associated multiple splenules. A 39-year-old man with alcoholic cirrhosis on routine surveillance for HCC was found to have small hypoechoic lesion on ultrasound, follow up MRI revealed a mass in right lobe of liver measuring 4.5 × 5.3 cm with enhancement in early phase and an isodense lesion on late phase (white arrow in Fig. 1). These findings suggested a diagnosis of hepatocellular carcinoma. There were also multiple enhancing lesions in mesentery and splenic bud suggestive of splenules (black arrow in Fig. 1). A Tc-99m sulfur colloid scan showed uptake in the area of hepatic mass and splenules (marked with black and white arrow respectively in Fig. 2). Patient had splenectomy in past after abdominal trauma. Laboratory data revealed Alpha-fetoprotein 3.5, AST 58, and ALT 45. Six months later repeat imaging showed no increase in size of mass. In our case, the presence of concurrent mesenteric splenosis, normal alpha-fetoprotein, no growth on subsequent imaging and radio isotope uptake in liver and splenic bed on Tc-99m scan established the correct diagnosis of splenosis and averted the need for biopsy. Majority of the time splenosis is an incidental finding at surgery or autopsy, and at times discovered during computed tomography (CT) or magnetic resonance imaging (MRI). Splenosis being highly vascular mimics other vascular hepatic neoplasia and presents a dilemma in diagnosis of Hepatocellular carcinoma (HCC).[figure1][figure2]FigureFigure
Published Version
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