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Toh WS, Chan KS, Ding CSL, Tan CH, Shelat VG. Intrahepatic splenosis: a world review. Clin Exp Hepatol 2020; 6:185-198. [PMID: 33145425 PMCID: PMC7592095 DOI: 10.5114/ceh.2020.99509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023] Open
Abstract
Splenosis is defined as the autotransplantation of viable splenic tissue throughout various anatomic compartments. Intrahepatic splenosis (IHS) is rare and diagnosis is often challenging. This study aims to provide a comprehensive review on IHS. A literature review was performed on PubMed database. Fifty-six articles with 59 reported cases were included. The majority of the patients were male (n = 49, 83.1%). Median age was 51 years. Risk factors for hepatocellular carcinoma (HCC) included hepatitis B (n = 8, 13.6%) and cirrhosis (n = 12, 20.3%). The majority of the patients were asymptomatic (62.7%) and did not have risk factors for HCC (55.9%). We report a diagnostic triad for IHS: 1) previous history of abdominal trauma or splenectomy, 2) absence of risk factors for liver malignancy and 3) typical imaging features. Non-invasive diagnostic tests such as technetium-99m-tagged heat-damaged red blood cell scintigraphy are useful in diagnosis. Malignancy should be ruled out in the presence of risk factors for HCC.
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Affiliation(s)
| | - Kai Siang Chan
- MOH Holdings, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Address for correspondence: Dr. Kai Siang Chan, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, e-mail:
| | | | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Xuan Z, Chen J, Song P, Du Y, Wang L, Wan D, Zheng S. Management of intrahepatic splenosis:a case report and review of the literature. World J Surg Oncol 2018; 16:119. [PMID: 29954390 PMCID: PMC6022698 DOI: 10.1186/s12957-018-1419-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/22/2018] [Indexed: 12/12/2022] Open
Abstract
Background Splenosis is the heterotopic autotransplantation and implantation of splenic tissue after splenic trauma or splenectomy. Considering that splenosis often occurs in the mesentery, omentum, and peritoneum, intrahepatic splenosis has seldom been reported. We report a rare case of isolated intrahepatic splenosis in a 54-year-old man who presented with a liver mass thought to be hepatocellular carcinoma. Case presentation A 54-year-old man was referred to our hospital for further evaluation of a liver lesion. The patient was asymptomatic and had a history of emergent splenectomy after a high-altitude falling accident. Abdominal contrast-enhanced computed tomography revealed a 4.5 × 3.3 cm lesion that was located in segment IV of the left liver lobe. The lesion had an inhomogeneous enhancement during the arterial phase and diminished enhancement during the portal and equilibrium phases. Similar radiological features were also observed on a contrast magnetic resonance imaging scan. Partial hepatectomy was performed with the suspicion of hepatocellular carcinoma. Pathological examination of the liver specimen revealed intrahepatic splenosis. Conclusion Splenosis should be considered in differential diagnosis of a liver mass discovered years after splenic trauma or surgery. A proposed scoring system may be helpful in evaluating the suspicious degree of intrahepatic mass to be splenosis. Invasive treatments are not recommended for asymptomatic patients, since the splenosis can provide beneficial immunologic function.
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Affiliation(s)
- Zefeng Xuan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Jian Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Penghong Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Yehui Du
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Lijun Wang
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Dalong Wan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China. .,Collaborative innovation center for Diagnosis treatment of infectious diseases, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.
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