J Korean Soc Radiol.  2019 Mar;80(2):359-364. 10.3348/jksr.2019.80.2.359.

Intrahepatic Splenosis Mimicking Hepatocellular Carcinoma: A Case Report

• Hwang E
• Min S
• Kim YC
• Choi JA

• KMID: 2442527
• DOI: http://doi.org/10.3348/jksr.2019.80.2.359

Abstract

Splenosis refers to autotransplantation of splenic tissue into intraabdominal, intrathoracic or even any other parts of body and occurs after splenic trauma or splenectomy. Hepatic splenosis is usually incidental found during imaging workup. It can mimic other hypervascular mass because it presents vivid and heterogeneous enhancement representing that of splenic tissue. So far, about 20 cases of intrahepatic splenosis have been described in the literature. Herein we report a case of intrahepatic splenosis mimicking hepatocellular carcinoma in a patient with liver cirrhosis. The patient was finally diagnosed on the basis of specific radionuclide imaging.

MeSH Terms

Autografts
Carcinoma, Hepatocellular*
Humans
Liver Cirrhosis
Radionuclide Imaging
Splenectomy
Splenosis*
Transplantation, Autologous

Figure

• 

  Fig. 1 A 43-year-old man with a hepatic mass and liver cirrhosis. A. Ultrasonography shows a homogeneous hypoechoic lesion located in the subcapsular region of the left hepatic lobe, measured 3.3 × 4.0 cm in dimension (arrow). B. Pre-contrast CT image shows a slightly low-attenuated mass (arrows). The lesion shows homogeneous strong enhancement, hyper-attenuation to the liver and well demarcation on arterial phase of multiphase contrast enhanced CT images. It shows persistent enhancement on portal phase and iso- to slightly low attenuation comparing to the liver on delayed phase. C. The lesion (arrows) shows mild high SI on T2WI and mild low SI on T1WI. On hepatocyte-specific contrast-enhanced dynamic MRI, the lesion shows homogeneous and intense enhancement on arterial phase and persistent enhancement on portal phase. It shows washout on 3-minute delayed phase and low SI on 20-minute delayed hepatobiliary phase image. The lesion shows intrahepatic location with surrounding thin hepatic parenchyma on 3-minute delayed coronal image. The lesions shows diffusion restriction. D. The heat damaged red blood cell scan with single photon emission computed tomography shows nodular and intense hot uptake at the corresponding area, suggesting intrahepatic splenosis. ADC = apparent diffusion coeffcient, DWI = diffusion-weighted imaging, SI = signal intensity, T1WI = T1-weighted image, T2WI = T2-weighted image

Reference

1. Wang WC, Li XF, Yan ZL, Wang Y, Ma JY, Shi LH, et al. Intrahepatic splenosis mimics hepatocellular carcinoma in a patient with chronic hepatitis B: a case report and literature review. Medicine (Baltimore). 2017; 96:e8680.

2. Choi GH, Ju MK, Kim JY, Kang CM, Kim KS, Choi JS, et al. Hepatic splenosis preoperatively diagnosed as hepatocellular carcinoma in a patient with chronic hepatitis B: a case report. J Korean Med Sci. 2008; 23:336–341.

3. Chung WJ. Splenosis mimicking hepatocellular carcinoma. Korean J Gastroenterol. 2014; 64:173–175.

4. Liu C, Liu J, Wang F. Intrahepatic splenosis mimicking liver cancer: report of a case and review of literature. Int J Clin Exp Pathol. 2015; 8:1031–1035.

5. Sato N, Abe T, Suzuki N, Waragai M, Teranishi Y, Takano Y, et al. Intrahepatic splenosis in a chronic hepatitis C patient with no history of splenic trauma mimicking hepatocellular carcinoma. Am J Case Rep. 2014; 15:416–420.

6. Pekkafali Z, Karsli AF, Silit E, Bas¸ekim CC, Narin Y, Mutlu H, et al. Intrahepatic splenosis: a case report. Eur Radiol. 2002; 12:Suppl 3. S62–S65.

7. Li T, Yang XY, Tang ZY. Intrahepatic and intraperitoneal splenosis mimicking hepatocellular carcinoma with abdominal wall metastasis in a patient with hepatitis C cirrhotic liver. Surgery. 2015; 157:954–956.