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Ouzzaouit H, Kaitouni BI, Zouaidia F, Hamza S, Hrora A, Raiss M. Pseudotumor inflammatory of the spleen: A rare entity with diagnostic and therapeutic challenges: A case report. Int J Surg Case Rep 2024; 115:109215. [PMID: 38280342 PMCID: PMC10839638 DOI: 10.1016/j.ijscr.2023.109215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Inflammatory pseudotumor (IPT) of the spleen is a rare entity that can be difficult distinguishing it from malignancies, both in clinical presentation and radiological imaging. CASE PRESENTATION We present the case of a 43-year-old female presented with 15-cm left hypochondrial mass, Initial imaging studies raised concerns of malignancy, leading to a splenectomy. However, the final pathological examination determined that the patient had IPT of the spleen with focal expression of Smooth Muscle Antibody (SMA). CLINICAL DISCUSSION This case highlights the importance of considering IPT as a potential diagnosis of splenic masses that was difficult to diagnose before surgery. CONCLUSION The uniqueness of the case under consideration lies in the rarity and the atypical localization of IPT of the spleen.
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Affiliation(s)
- Hamza Ouzzaouit
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco.
| | - Boubker Idrissi Kaitouni
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Fouad Zouaidia
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco; Anatomopathology department, Ibn Sina University Hospital, Rabat, Morocco
| | - Sekkat Hamza
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Abdelmalek Hrora
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
| | - Mohammed Raiss
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
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2
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Seijo L, Unger PD, Strauchen JA. Inflammatory Pseudotumor of the Spleen: A Case Report and Review of the Literature. Int J Surg Pathol 2016. [DOI: 10.1177/106689699604030410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors report the case of an inflammatory pseudotumor found incidentally in the spleen of a 53-year-old woman who had undergone splenectomy for the treatment of immune thrombocytopenic purpura. An ultrasound performed 2 months prior to the operation showed a spleen of normal size with no appreciable masses; however, gross examination of morselized splenic tissue removed by laparoscopic splenectomy revealed two small, well-circumscribed, white–tan nodules measuring 0.8 and 1.5 cm admixed with otherwise normal-appearing splenic parenchyma. Microscopically, these mass lesions were inflammatory pseudotumors composed of a variable mixture of polyclonal populations of mature lymphocytes and plasma cells with eosinophils, neutrophils, histiocytes, and fibrous tissue. This case represents a rare splenic lesion in our review of the world literature. Inflammatory pseudotumors of the spleen are usually solitary, often asymptomatic, rarely diagnosed prior to surgical removal, and characterized by a varied but uniformly benign histologic appearance. Recognition of this entity by clinicians and pathologists is important in definitively ruling out malignancy of the spleen.
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Affiliation(s)
- Laura Seijo
- From The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, New York
| | - Pamela D. Unger
- From The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, New York
| | - James A. Strauchen
- From The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, New York
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3
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Yagisawa H, Ishida H, Komatsuda T, Furukawa K, Yamada M, Ohno H, Kotanagi H, Miyauchi T. Inflammatory pseudotumor of the spleen: report of a case with emphasis on contrast-enhanced ultrasound findings. J Med Ultrason (2001) 2016; 33:177-80. [PMID: 27277856 DOI: 10.1007/s10396-006-0097-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 02/17/2006] [Indexed: 01/16/2023]
Abstract
Splenic inflammatory pseudotumor is a rare pathology, and the literature stresses the difficulty of preoperative diagnosis. There are no previous reports of contrast-enhanced ultrasound findings for this tumor in the literature. Our case appears to be the first to be examined using this technique. In our case, contrast-enhanced ultrasound showed the mass to be homogeneously and less enhanced than the surrounding parenchyma in all phases, and it included fine enhanced spots. We also briefly review the literature.
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Affiliation(s)
- Hitoshi Yagisawa
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Inashirozawa, Saruta Kamikitade, Akita, 010-1495, Japan.
| | - Hideaki Ishida
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Inashirozawa, Saruta Kamikitade, Akita, 010-1495, Japan
| | - Tomoya Komatsuda
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Inashirozawa, Saruta Kamikitade, Akita, 010-1495, Japan
| | - Kayoko Furukawa
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Inashirozawa, Saruta Kamikitade, Akita, 010-1495, Japan
| | - Mamiko Yamada
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Inashirozawa, Saruta Kamikitade, Akita, 010-1495, Japan
| | - Hideo Ohno
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, 222-1 Inashirozawa, Saruta Kamikitade, Akita, 010-1495, Japan
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4
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Computed tomographic and clinicopathological features of inflammatory pseudotumor of the spleen. J Comput Assist Tomogr 2015; 39:409-13. [PMID: 25626400 DOI: 10.1097/rct.0000000000000215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our goal was to elucidate the computed tomographic (CT) and clinicopathological features of inflammatory pseudotumor of the spleen. METHODS Computed tomographic findings and clinic materials of 4 patients with inflammatory pseudotumor of the spleen were reviewed and compared with pathologic findings. RESULTS Abdominal contrast-enhanced CT revealed a hypodense mass in the spleen with slight enhancement in the arterial phase in 3 cases. The enhancement persisted with venous phase and was moderate in the delayed phase. The remaining 1 case was a huge mass in the spleen with multiple areas of patchy necrosis and abundant tortuous vessels. CONCLUSIONS Inflammatory pseudotumor of the spleen is a rare benign process with nonspecific CT features. The mass was generally hypodense with delayed enhancement on CT.
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5
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Ugalde P, García Bernardo C, Granero P, Miyar A, González C, González-Pinto I, Barneo L, Vazquez L. Inflammatory pseudotumor of spleen: a case report. Int J Surg Case Rep 2015; 7C:145-8. [PMID: 25648471 PMCID: PMC4336391 DOI: 10.1016/j.ijscr.2015.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 11/22/2022] Open
Abstract
We present a case of nflammatory pseudotumor of spleen. It is an extremely rare condition of unknown etiology. It is considered as a benign lesion with multiple differential diagnoses. Splenectomy is indicated to confirm diagnosis.
Introduction Inflammatory pseudotumor of spleen is an extremely rare benign condition of uncertain etiology that presents with nonspecific symptoms or as an incidental finding in patients studied by other processes. Since the first description in 1984 by Cotelingam and Jaffe, only 114 cases have been reported. Presentation of case We present a case of a fifty-six years old woman with a splenic injury in ultrasound and computed tomography. The patient undergoes laparoscopic splenectomy and the histologic study of the specimen revealed findings consistent with inflammatory pseudotumor of spleen. Discussion This rare entity whose pathogenesis is still unknown, can present with nonspecific symptoms. Radiologic studies may lead the diagnosis being useful CT and MRI. The definitive diagnosis is established with the histological findings, characterized by the presence of inflammatory cells with areas of necrosis and fibrosis. There are multiple differentials diagnoses: metastasis, lymphoma, splenic infarction, hemangiomas, vascular malformations, lymphangioma, plasmacytoma, reactive lymphoid hyperplasia, abscess and infectious granulomatous processes; therefore suspicion of malignant neoplasm must be considered, being indicated splenectomy to confirm the diagnosis. Conclusion Inflammatory pseudotumor of spleen is a benign disease, in which diagnostic approach must bear in mind the possibility of a malignant lesion. For this reason, the surgical approach is appropriate to confirm the diagnosis and rule out malignancy with histology.
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Affiliation(s)
- Paúl Ugalde
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Carmen García Bernardo
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Granero
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alberto Miyar
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carmen González
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ignacio González-Pinto
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Barneo
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lino Vazquez
- Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
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6
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Bui PL, Vicens RA, Westin JR, Jensen CT. Multimodality imaging of Epstein-Barr virus-associated inflammatory pseudotumor-like follicular dendritic cell tumor of the spleen: case report and literature review. Clin Imaging 2015; 39:525-8. [PMID: 25725946 DOI: 10.1016/j.clinimag.2014.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 12/05/2014] [Accepted: 12/24/2014] [Indexed: 01/27/2023]
Abstract
Inflammatory pseudotumors (IPTs) are rare tumors of unknown etiology; however, there is a strong association with the Epstein-Barr virus (EBV). EBV-positive IPTs are typically found in the liver and spleen. While many EBV-positive splenic IPTs contain follicular dendritic cell (FDC) proliferations, they are not aggressive such as with conventional FDC tumors. EBV-positive splenic IPTs have been reported with low malignant potential. We present a case with multimodality imaging of an EBV-positive IPT-like tumor with FDC features.
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Affiliation(s)
- Pauline L Bui
- Department of Diagnostic Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.
| | - Rafael A Vicens
- Department of Diagnostic Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009.
| | - Jason R Westin
- Department of Lymphoma/Myeloma, Unit 0429, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009
| | - Corey T Jensen
- Department of Diagnostic Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009.
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7
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Sedlic T, Scali EP, Lee WK, Verma S, Chang SD. Inflammatory pseudotumours in the abdomen and pelvis: a pictorial essay. Can Assoc Radiol J 2013; 65:52-9. [PMID: 23830343 DOI: 10.1016/j.carj.2013.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 01/16/2013] [Accepted: 02/02/2013] [Indexed: 10/26/2022] Open
Abstract
Inflammatory pseudotumours are uncommonly encountered lesions in the abdomen and pelvis that often present with variable and nonspecific imaging features. They may mimic other more common lesions, including malignancy. Within the appropriate clinical context, inflammatory pseudotumours merit consideration in the differential diagnosis of soft-tissue masses within the abdomen and pelvis. A preoperative diagnosis of inflammatory pseudotumour, established through biopsy, may help to differentiate this benign entity from malignancy. In this article, we reviewed the imaging features of inflammatory pseudotumours of the abdomen and pelvis, including liver, spleen, bowel, retroperitoneum, kidney, bladder, uterus, and adnexa.
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Affiliation(s)
- Tony Sedlic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elena P Scali
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Wai-Kit Lee
- Department of Radiology, University of Melbourne, Victoria, Australia
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Kiryu S, Takeuchi K, Shibahara J, Uozaki H, Fukayama M, Tanaka H, Maeda E, Akahane M, Ohtomo K. Epstein-Barr virus-positive inflammatory pseudotumour and inflammatory pseudotumour-like follicular dendritic cell tumour. Br J Radiol 2009; 82:e67-71. [PMID: 19325041 DOI: 10.1259/bjr/66918927] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Various splenic inflammatory pseudotumours are reported to be infected with Epstein-Barr virus (EBV), which is thought to be associated with the pathogenesis of the lesion. The term "inflammatory pseudotumour (IPT)-like follicular dendritic cell tumour", all cases of which are also EBV positive, has recently been proposed. Here, we describe the imaging findings of these splenic tumours and present the cases of an IPT-like follicular dendritic cell tumour and two EBV-positive inflammatory pseudotumours in two female patients and one male patient. These splenic lesions were found incidentally on pre-operative or post-operative screening or at medical check-up. CT performed on all three patients revealed low-density solitary masses in the spleen. MRI was performed on one patient; the solitary mass demonstrated isointensity on T(1) weighted images and low intensity on T(2) weighted images relative to the surrounding splenic parenchyma. Dynamic MRI study revealed that the mass did not enhance on the early phase but enhanced to the same degree as the surrounding splenic parenchyma on the delayed phase. The imaging findings are almost identical to those found in conventional IPT because the morphology is similar in both cases; however, attention should be paid to this new entity in the diagnosis of splenic lesions because of its neoplastic nature. Longer follow-up is also necessary for these patients compared with those with conventional IPT.
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Affiliation(s)
- S Kiryu
- Department of Radiology, Graduate School and Faculty of Medicine, University of Tokyo, Japan.
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9
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Sato M, Takasaka I, Okumura T, Shioyama Y, Asato Y, Yoshimi F, Imura J, Amemiya R. F-18 fluorodeoxyglucose accumulation in an inflammatory pseudotumor of the spleen. Ann Nucl Med 2007; 21:521-4. [DOI: 10.1007/s12149-007-0055-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 06/25/2007] [Indexed: 10/22/2022]
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10
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Hamdi I, Marzouk I, Toulali L, Amara H, Bellara I, Ridene I, Ben Abdelkader A, Khila M, Kraiem C. [Inflammatory pseudotumor of the spleen and radiopathologic correlation]. ACTA ACUST UNITED AC 2007; 87:1894-6. [PMID: 17213776 DOI: 10.1016/s0221-0363(06)74172-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Inflammatory pseudotumors of the spleen (IPTS) are rare. We report a case of an IPTS in a 48-year-old woman who was admitted for drug eruption. During her hospitalization, she complained of abdominal pain. Physical examination and laboratory investigations were unremarkable. The abdominal ultrasonography and hepatic MRI detected a heterogeneous mass in the spleen measuring approximately 5 cm in diameter. Partial splenectomy was performed. Histologically, the splenic mass was composed of an admixture of inflammatory cellular elements with hemorrhage and sclerosis, suggestive of an IPTS. The postoperative course was uneventful. The authors attempt to make a radiopathologic correlation of this rare tumor.
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Affiliation(s)
- I Hamdi
- Service d'imagerie médicale, CHU Farhat Hached, Avenue Ibn El Jazzar, Sousse 4000, Tunisie.
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11
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Abstract
Solitary splenic lesions are unusual. A differential diagnosis can be organized around their basic imaging appearance as either predominantly cystic or solid. Other imaging characteristics, including vascular enhancement and activity on Tc-99m sulfur colloid scan, as well as clinical history may narrow the diagnostic possibilities. Cystic lesions include post-traumatic, inflammatory and infectious pseudocysts, congenital cysts, lymphangiomas and cystic metastasis. Solid lesions include both nonneoplastic lesions such as splenic hamartoma, benign tumors such as hemangioma and malignant masses including lymphoma and angiosarcoma. Percutaneous biopsy may be used for histologic diagnosis when required.
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Affiliation(s)
- David M Warshauer
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7510, USA.
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12
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Shapiro AJ, Adams ED. Inflammatory pseudotumor of the spleen managed laparoscopically. Can preoperative imaging establish the diagnosis? Case report and literature review. Surg Laparosc Endosc Percutan Tech 2007; 16:357-61. [PMID: 17057583 DOI: 10.1097/01.sle.0000213738.77654.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inflammatory pseudotumor of the spleen, or inflammatory myofibroblastic tumor, is an uncommon condition easily mistaken for a malignant process. Patients may be asymptomatic or may present with nonspecific abdominal complaints. Mild constitutional symptoms have also been reported. The ability to diagnose this entity radiographically preoperatively may allow the uniform application of laparoscopy to manage this condition and spare patients open splenectomy. METHODS Chart review and literature review. RESULTS Inflammatory pseudotumor of the spleen was successfully managed laparoscopically. Preoperative evaluation suggested but could not confirm the diagnosis. CONCLUSIONS A hypovascular solid splenic mass by Doppler ultrasound or CT scan suggests the diagnosis of inflammatory pseudotumor. Stellate central calcifications seen on CT scan make the diagnosis very likely. Laparoscopic splenectomy can be used for definitive diagnosis and symptomatic relief with minimal morbidity and mortality.
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Affiliation(s)
- Andrew J Shapiro
- General Surgery Service, Bayne-Jones Army Community Hospital, Ft Polk, LA, USA.
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13
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Uchida H, Ohta M, Shibata K, Endo Y, Iwaki K, Tominaga M, Ishio T, Kitano S. Laparoscopic splenectomy in patients with inflammatory pseudotumor of the spleen: Report of 2 cases and review of the literature. Surg Laparosc Endosc Percutan Tech 2006; 16:182-6. [PMID: 16804466 DOI: 10.1097/00129689-200606000-00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report 2 cases of splenic inflammatory pseudotumor treated by laparoscopic splenectomy. The first patient was a 58-year-old woman who complained of constipation. Computed tomography (CT) showed a well-demarcated mass that measured 4 cm in diameter and was not enhanced. She underwent laparoscopic splenectomy under a preoperative diagnosis of hemangioma. The final histopathologic diagnosis was inflammatory pseudotumor. The second patient was a 29-year-old man who complained of abdominal pain. Computed tomography revealed a demarcated splenic tumor that measured 3 cm in diameter and was not enhanced. Laparoscopic splenectomy was performed. The pathologic and operative diagnoses were both inflammatory pseudotumor. In both cases, the postoperative course was uneventful, and the postoperative hospital stays were 10 and 11 days. Preoperative diagnosis of a splenic inflammatory pseudotumor is very difficult. However, laparoscopic splenectomy is safe and beneficial treatment for this tumor and should be performed in cases in which it is diagnosed.
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Affiliation(s)
- Hiroki Uchida
- Department of Surgery I, Oita University Faculty of Medicine, Oita, Japan.
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14
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Oz Puyan F, Bilgi S, Unlu E, Yalcin O, Altaner S, Demir M, Cakir B. Inflammatory pseudotumor of the spleen with EBV positivity: report of a case. Eur J Haematol 2004; 72:285-91. [PMID: 15089768 DOI: 10.1111/j.0902-4441.2003.00208.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Inflammatory pseudotumor (IPT) of the spleen is a rare benign tumor with unknown etiology. It causes problems in the diagnosis because of mimicking some hematopoetic malignancies. Here we report the case of a 36-yr-old woman complaining of nausea and insomnia. Laboratory investigations were limited to increase of leukocyte and thrombocyte count. Ultrasonography and magnetic resonance (MR) imaging showed circumscribed solid lobulated mass, measuring about 6.5 cm in diameter, located in the dorsal region of the spleen. Splenectomy was performed with the differential diagnosis including hamartoma and lymphoma of the spleen. Histological examination of the sharply demarcated splenic mass consisted of myofibroblasts and admixture of inflammatory cells. Immunohistochemistry and in situ hybridization were performed. IPT of the spleen was diagnosed. Epstein-Barr virus (EBV) was detected in the tumor by in situ hybridization. This rare entity is presented because of its clinical, radiological and pathological difficulties in the differential diagnosis.
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Affiliation(s)
- F Oz Puyan
- Department of Pathology, Trakya University Medical Faculty, Edirne, Turkey.
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15
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Yano H, Imasato M, Monden T, Okamoto S. Inflammatory pseudotumor of the spleen: report of two cases. Surgery 2003; 133:349-50. [PMID: 12660654 DOI: 10.1067/msy.2003.94] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Hiroshi Yano
- Department of Surgery and Pathology, NTT West Osaka Hospital, Osaka, Japan
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16
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Abstract
A case of a 45-year-old Japanese man with a splenic inflammatory pseudotumor is described. This benign lesion is rarely reported in the world literature. We preoperatively could not rule out the possibility of a malignant neoplasm, due to the fact that the tumor had grown in size after a 2-year observation. However, after performing a splenectomy, a histological examination of the mass revealed an inflammatory process. Inflammatory pseudotumors often pose diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The clinical and pathological features of such previously reported cases are also reviewed.
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Affiliation(s)
- S Moriyama
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto University School of Medicine, Japan
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17
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Matsubayashi H, Mizoue T, Mizuguchi Y, Shinohara Y, Magami Y, Horibe T, Seki T, Saito T, Serizawa H. A case of hemangioma accompanied by inflammatory pseudotumor of the spleen. J Clin Gastroenterol 2000; 31:258-61. [PMID: 11034012 DOI: 10.1097/00004836-200010000-00018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Both hemangioma and inflammatory pseudotumor (IPT) of the spleen are rare benign mass lesions. Moreover, a splenic hemangioma accompanied by IPT is extremely rare. A 61-year-old woman who suffered from liver cirrhosis had a splenic cavernous hemangioma surrounded by granuloma. The literature on IPT of the spleen has described several possibilities of its causes; however, it is still unknown. This case was accompanied by portal hypertension due to liver cirrhosis, which may cause microrupture of hemangioma resulting in an IPT.
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Affiliation(s)
- H Matsubayashi
- Fourth Department of Internal Medicine, Tokyo Medical University, Japan
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18
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19
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Suga K, Miura K, Kume N, Hara A, Matsunaga N, Tangoku A, Oka M. Tc-99m colloid and Ga-67 imaging of splenic inflammatory pseudotumor correlation with ultrasound, CT, and MRI. Clin Nucl Med 1999; 24:334-7. [PMID: 10232472 DOI: 10.1097/00003072-199905000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Splenic inflammatory pseudotumor is extremely rare and may mimic splenic neoplasms, such as lymphomas or hamartomas, clinically and radiologically. A case of a surgically proved splenic inflammatory pseudotumor is presented in which Tc-99m colloid SPECT and Ga-67 scintigraphy characterized the changes in the spleen, but the findings of ultrasound and unenhanced CT and MRI were nonspecific. This report indicates the utility of radionuclide imaging for diagnosing splenic inflammatory pseudotumor.
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Affiliation(s)
- K Suga
- Department of Radiology, Yamaguchi University School of Medicine, Ube, Japan
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20
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Abstract
Inflammatory pseudotumor and hemangioma of the spleen are rare benign tumors, and MRI findings of splenic diseases have been reported only rarely. We recently observed three patients with inflammatory pseudotumor and hemangioma of the spleen. Abdominal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography demonstrated within the enlarged spleen. MRI and dynamic MRI after administration of gadolinium DTPA provide the characterization of the splenic tumor.
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Affiliation(s)
- K Hayasaka
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
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21
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Abstract
We describe a case of an inflammatory pseudotumor of the spleen in a 5-year-old boy, found incidentally during a physical examination. The boy underwent a hemisplenectomy. The problems in differentiating this disease from lymphoma of the spleen before surgery and the advantages of hemisplenectomy are discussed. This rare disease has previously been described in the spleen in only 28 cases, the youngest being a 16-year-old patient.
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Affiliation(s)
- G M Aru
- Department of Pediatric Surgery, Egleston Children's Hospital, Emory University School fo Medicine, Atlanta, GA 30322, USA
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22
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Irie H, Honda H, Kaneko K, Kuroiwa T, Fukuya T, Yoshimitsu K, Aibe H, Hirakata R, Horie Y, Maeda T, Masuda K. Inflammatory pseudotumors of the spleen: CT and MRI findings. J Comput Assist Tomogr 1996; 20:244-8. [PMID: 8606231 DOI: 10.1097/00004728-199603000-00014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Our goal was to elucidate the CT and MRI findings of inflammatory pseudotumors of the spleen. METHODS The CT and MRI findings of three patients with inflammatory pseudotumors of the spleen were reviewed and compared with the pathologic findings. RESULTS On the early phase of CT, the masses were hypodense to the normal spleen, and on the delayed phase, they demonstrated delayed enhancement. On T1-weighted MR images, the masses were isointense to the normal spleen, and on T2-weighted images, the masses had heterogeneous low signal intensities. After administration of Gd-DTPA, the masses showed delayed enhancement. CONCLUSION Inflammatory pseudotumors of the spleen were characterized by low signal intensity on T2-weighted MR images and delayed enhancement after contrast material administration on CT and MRI. The fibrous stroma may contribute to these unusual findings.
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Affiliation(s)
- H Irie
- Department of Radiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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