Multiple focal liver lesions were incidentally detected in a patient screened by ultrasound for a recent diagnosis of lower limb deep vein thrombosis, for which anticoagulation had been initiated. Past medical history reported a post-traumatic splenectomy 15 years before. Magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) showed a subcapsular lesion in liver segment 5 consistent with focal nodular hyperplasia (FNH) and multiple other nodules, with a different pattern from the former, judged as probable hepatic adenomas by MRI but probable hemangiomas by CEUS (hyperenhancement in the late phase). Therefore, another MRI with gadoxetic acid was performed. The diagnosis of FNH was confirmed. The other lesions showed an hyperenhancing pattern in the arterial phase with progressive wash-out in the portal and late phase and marked hypointensity in the hepatobiliary phase. This pattern apparently confirmed the hypothesis of adenomas, with a potential risk of malignancy due to the hepatobiliary phase pattern and the recent occurrence of deep vein thrombosis. Due to the inherent risk of spontaneous bleeding from subcapsular adenomas increased by the ongoing anticoagulant therapy and the recommendation of international guidelines to resect adenomas in male subjects, the patient was directly offered surgery. Pathology of the resected specimens confirmed one FNH but demonstrated intrahepatic splenosis for all other lesions. This case suggests that in the setting of previous splenic trauma any discrepancy between MRI and CEUS findings should lead one to consider also the hypothesis of intrahepatic splenosis.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.15403/jgld-617 | DOI Listing |
Cureus
September 2024
Pathology, Fukuoka Seishukai Hospital, Fukuoka, JPN.
Intrahepatic splenosis is an uncommon condition that can present a significant diagnostic challenge, often masquerading as more sinister hepatic lesions. We report a perplexing case of a 56-year-old female with a history of splenectomy who presented with liver masses initially suspected to be hepatocellular carcinoma (HCC). Despite advanced imaging techniques, including ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI), the lesions convincingly mimicked HCC.
View Article and Find Full Text PDFAJR Am J Roentgenol
December 2024
Department of Radiology, First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), No. 61 Jiefang W Rd, Changsha, 410005 China.
United European Gastroenterol J
April 2024
Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy.
Indian J Cancer
April 2024
Department of General Surgery, The Second Affiliated Hospital, The Air Force Military Medical University, 1 Xinsi Road, Xi'an, China.
We present an extremely rare case of intrahepatic splenosis (IHS). On admission and examination, the patient was diagnosed with hepatocellular carcinoma and postoperative injury or inflammatory lesions of the pancreas, based on image analysis. Postoperative histopathology showed that the lesions of the liver and diaphragm were of splenic origin, and the pancreatic lesion was identified as a moderately differentiated adenocarcinoma.
View Article and Find Full Text PDFMol Clin Oncol
November 2023
Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Osaka 593-8304, Japan.
Intrahepatic splenosis (IHS) is a rare disease that is considered to result from heterotopic autotransplantation or implantation of splenic tissue after splenic trauma or surgery. A 46-year-old man with a treatment history of a left lateral liver segmentectomy and splenectomy for a road traffic injury 30 years earlier presented to Sakai City Medical Center (Sakai, Japan) with acute abdominal pain in November 2019. Physical examination showed no significant signs, and serum data were normal.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!