Symptomatic splenoma in a child.

Abstract

To the Editor: Splenoma or splenic hamartoma, described in 1861 by Rokitansky, is a rare benign lesion of the spleen, with only 150 cases having been reported in the literature.1 They are mostly asymptomatic and are usually discovered incidentally during workup for other unrelated problems or at autopsy. The majority of the reported cases are adult patients; only 20% of cases are in children or adolescents. They have been rarely associated with hematological disorders.2 We describe splenoma in a 12-year-old female admitted to our department with symptomatic anemia for the past year in the form of easy fatigability, palpitations and exertional breathlessness. Physical examination revealed pallor and a palpable spleen 5 cm below the costal margin. There was no evidence of jaundice, peripheral lymphadenopathy or hepatomegaly. Contrast-enhanced CT of the abdomen revealed splenomegaly and a 5×6-cm minimal enhancing hypodense mass in the lower pole of the spleen (75-80 Hounsfield units) (Figure 1). CT-guided aspiration of the space-occupying mass lesion proved to be inconclusive. A hemogram showed hemoglobin of 6.8 g/dL (normal, 12-16 g/dL); the white blood cell count was 3.7×109/L (normal, 3.7-12.9×109/L) with a normal differential and platelets of 58×109/L (normal 140-440×109/L). Renal, hepatic and coagulation profiles were within normal limits. The reticulocyte count was 4% and the erythrocyte sedimentation rate was 10 mm/hr. The bone marrow showed hyperactivity suggestive of peripheral destruction of blood cellular elements consistent with hypersplenism. The chest x-ray was normal. The tuberculin test and ANA serology were noncontributory.