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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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Kim N, Auerbach A, Manning MA. Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation. Radiographics 2022; 42:683-701. [PMID: 35302864 DOI: 10.1148/rg.210071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Splenic lesions are commonly discovered incidentally at imaging, without clinical signs or symptoms that may aid in diagnosis. As such, the differential diagnosis and subsequent management are based primarily on imaging characteristics. Much has been written about the myriad pathologic conditions that can occur in the spleen; however, there is little guidance on the approach to an incidental splenic mass. Applying an approach frequently used in imaging to the splenic mass-based on the number and consistency of lesions and refined by supplementary imaging features-allows formulation of a useful differential diagnosis. Solitary cystic masses include true cysts, pseudocysts, and parasitic cysts. When multiple cystic lesions are present, the differential diagnosis expands to include infectious lesions (abscess or microabscesses) and lymphangioma (a benign cystic neoplasm). Hemangioma is the most common solitary solid mass, although other vascular lesions (hamartoma, sclerosing angiomatoid nodular transformation) and nonvascular lesions (inflammatory pseudotumor, lymphoma) manifest as solitary and solid. When multiple solid masses are present, diffuse inflammatory disease (sarcoidosis), littoral cell angioma, and lymphoma should be considered. Malignancies, such as angiosarcoma or metastasis, can manifest as solitary or multiple and solid or cystic masses but are typically associated with symptoms or widespread primary malignancy. Careful assessment of the multimodality imaging characteristics of splenic lesions based on this approach aids the radiologist faced with the incidental splenic lesion. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- Nancy Kim
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, CCC Building Ground Floor, CG 201, Washington, DC 20007 (N.K., M.A.M.); the Joint Pathology Center, Silver Spring, Md (A.A.); and the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Aaron Auerbach
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, CCC Building Ground Floor, CG 201, Washington, DC 20007 (N.K., M.A.M.); the Joint Pathology Center, Silver Spring, Md (A.A.); and the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
| | - Maria A Manning
- From the Department of Radiology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, CCC Building Ground Floor, CG 201, Washington, DC 20007 (N.K., M.A.M.); the Joint Pathology Center, Silver Spring, Md (A.A.); and the American Institute for Radiologic Pathology, Silver Spring, Md (M.A.M.)
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Tregnago AC, Morbeck DL, D’Almeida Costa F, Campos AHJFM, Soares FA, Vassallo J. Inflammatory pseudotumor-like follicular dendritic cell tumor: an underdiagnosed neoplasia. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s41241-017-0051-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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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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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Ma ZH, Tian XF, Ma J, Zhao YF. Inflammatory pseudotumor of the spleen: A case report and review of published cases. Oncol Lett 2013; 5:1955-1957. [PMID: 23833674 PMCID: PMC3701001 DOI: 10.3892/ol.2013.1286] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/12/2013] [Indexed: 12/28/2022] Open
Abstract
Inflammatory pseudotumor of the spleen (IPTS) is an extremely rare condition. To the best of our knowledge, only ∼113 cases have been reported in the literature since the first 2 cases were reported in 1984. The present study reports the case of an IPTS in a 72-year-old male patient. The splenic tumor was identified incidentally 1 year prior to the patient being admitted to the Second Affiliated Hospital of Dalian Medical University (Dailan, China). There were no specific clinical symptoms. The initial diagnosis was of splenic lymphoma based on the pre-operative radiological findings. However, the patient underwent a splenectomy and the final pathological diagnosis of IPTS was declared. The present study also highlighted the difficulty of forming accurate pre-operative diagnoses, even when using modern imaging techniques. A partial resection of the spleen or splenectomy was considered to be the required treatment to form a definitive diagnosis and exclude malignancy. The prognosis of IPTS is generally considered to be favorable following splenectomy. The clinical and pathological features of previously reported cases are also briefly reviewed in the present study to aid in improving the accuracy of the diagnosis of this rare disease.
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Affiliation(s)
- Zhen-Hai Ma
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
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Tsutsumi N, Kawanaka H, Yamaguchi S, Sakai M, Momosaki S, Endo K, Ikejiri K. Huge inflammatory pseudotumor of the spleen with postoperative portal vein thrombosis: report of a case. Surg Today 2011; 42:382-5. [PMID: 22160356 DOI: 10.1007/s00595-011-0081-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 03/24/2011] [Indexed: 11/26/2022]
Abstract
We report the rare case of a splenic inflammatory pseudotumor associated with massive splenomegaly, diagnosed after surgery. A 51-year-old woman was admitted to our hospital for investigation of anemia. Physical examination revealed a palpable left upper quadrant mass. Computed tomography and magnetic resonance imaging showed a splenic mass, 20 cm in diameter. We performed splenectomy for both diagnosis and treatment. The spleen weighed 2400 g, and histologic examination of the mass confirmed an inflammatory pseudotumor. Portal vein thrombosis (PVT) developed the day after surgery, but resolved with anticoagulation therapy. This case highlights that there is a risk of PVT after splenectomy in patients with massive splenomegaly, and that anticoagulant therapy should be initiated promptly.
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Affiliation(s)
- Norifumi Tsutsumi
- Department of Surgery, Center for Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan.
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Granulomatous inflammatory pseudotumor of the spleen: association with Epstein-Barr virus. Appl Immunohistochem Mol Morphol 2009; 17:259-63. [PMID: 18987550 DOI: 10.1097/pai.0b013e318189f10f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 74-year-old woman with a clinical history of invasive ductal carcinoma of the breast was found to have a splenic mass during a routine radiographic survey. Splenectomy revealed a 3-cm well-demarcated lesion, which on histopathologic examination consisted of heterogeneous inflammatory cells. A striking feature of the lesion was the presence of innumerable well-formed non-necrotizing granulomas. Immunohistochemical studies confirmed the lesion to be composed mainly of mixed T and B lymphocytes, histiocytes, and plasma cells. No spindle cell component was evident on light microscopic examination or by immunohistochemical staining for smooth muscle actin, anaplastic lymphoma kinase, or follicular dendritic cell markers CD21 and CD35. Interestingly, Epstein-Barr virus-encoded RNA and latent membrane protein were detected by in situ hybridization and immunohistochemistry in numerous lymphohistiocytic cells within the lesion, but not in surrounding uninvolved splenic tissue. To our knowledge, this case represents a rare example of splenic inflammatory pseudotumor with exuberant granulomatous reaction in association with Epstein-Barr viral infection.
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Inflammatory pseudotumor of the liver successfully treated with nonsteroidal anti-inflammatory drugs: a challenge diagnosis for one not so rare entity. Eur J Gastroenterol Hepatol 2007; 19:1016-20. [PMID: 18049174 DOI: 10.1097/meg.0b013e32821acdd2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Inflammatory pseudotumor of the liver is a rare, benign lesion characterized by a well-circumscribed mass of chronic inflammatory cell infiltration and proliferating fibrous tissue. Its etiology remains unclear, although inflammatory processes have been proposed. It is often misdiagnosed as a malignant tumor, and the management has been traditionally surgical. We report the case of a 16-year-old boy who was referred from another hospital with a fever of >38 degrees C with rigor and right upper quadrant pain which he had suffered from for 5 days. The ultrasonographic computed tomography and MRI findings were not diagnostic, and we performed a needle biopsy from the lesion that was consistent with inflammatory pseudotumor (of liver, mixed fibrous tissue and chronic inflammatory cell infiltration). The patient was treated with nonsteroidal anti-inflammatory drugs and had an uneventful clinical course. During follow-up, the lesion subsequently shrank to completely vanish 1 year later.
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10
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Akatsu T, Kameyama K, Tanabe M, Endo T, Kitajima M. Epstein-Barr virus-positive inflammatory pseudotumor of the spleen with concomitant rectal cancer: a case report and review of the literature. Dig Dis Sci 2007; 52:2806-12. [PMID: 17406818 DOI: 10.1007/s10620-007-9773-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 01/18/2007] [Indexed: 12/09/2022]
Affiliation(s)
- Tomotaka Akatsu
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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11
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Martínez Celada M, Rivas Carmenado M, García Pravia C, Fresno Forcelledo M. [37 Year old woman with abdominal discomfort and splenic focal lesion]. Rev Clin Esp 2007; 207:135-7. [PMID: 17397636 DOI: 10.1157/13100228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- M Martínez Celada
- Servicios de Medicina Interna I, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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12
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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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