1
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Akasaka S, Tokunaga N, Sugawara Y, Mikuriya Y, Ohta K, Teramoto N. A case of EBV-associated inflammatory pseudotumor of the spleen. Radiol Case Rep 2024; 19:3907-3911. [PMID: 39040827 PMCID: PMC11261270 DOI: 10.1016/j.radcr.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 07/24/2024] Open
Abstract
Inflammatory pseudotumors (IPTs) of the spleen are rare and have often been reported to be associated with Epstein-Barr virus (EBV). Radiographically differentiating IPTs of the spleen from other malignant tumors is challenging, and splenectomy is often performed as a definitive treatment. We report a case of an EBV-associated splenic IPT in a male patient in his 70s. Contrast-enhanced computed tomography (CT) revealed a splenic mass that increased from 2.4 cm to 3.9 cm in diameter over one year. Magnetic resonance imaging (MRI) revealed that the mass showed a slightly high intensity on T1-weighted images and heterogeneous low intensity on T2-weighted images. On dynamic contrast-enhanced MRI, the mass showed weak and gradual inhomogeneous enhancement. A 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT demonstrated increased FDG uptake in the mass. Splenectomy was performed and the pathological diagnosis was EBV-associated IPT. EBV-associated splenic IPT can mimic malignant tumors on imaging, making it challenging to differentiate them from other splenic diseases.
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Affiliation(s)
- Sho Akasaka
- Department of Diagnostic Radiology, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Nobuko Tokunaga
- Department of Diagnostic Radiology, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Yoshifumi Sugawara
- Department of Diagnostic Radiology, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Yoshihiro Mikuriya
- Department of Gastroenterological Surgery, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Koji Ohta
- Department of Gastroenterological Surgery, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Norihiro Teramoto
- Department of Pathology, NHO Shikoku Cancer Center, Matsuyama, Japan
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2
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Prasad AS, Chua SS, Ramani NS, Shiralkar KG, Shanbhogue KP, Surabhi VR. Stroma-derived neoplasms and pseudoneoplastic lesions of the spleen: a select review of pathologic and CT/MRI findings. Abdom Radiol (NY) 2024:10.1007/s00261-024-04461-y. [PMID: 38937338 DOI: 10.1007/s00261-024-04461-y] [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: 04/07/2024] [Revised: 06/09/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
A wide spectrum of benign and malignant primary mesenchymal tumors and tumor-like lesions of the spleen has been recently included under the umbrella term 'stroma-derived' neoplasms and tumor-like lesions. These include dendritic cell neoplasms such as follicular dendritic cell sarcoma, EBV-positive inflammatory follicular dendritic cell sarcoma, and fibroblastic reticular cell tumor; smooth muscle and myofibroblastic lesions such as inflammatory pseudotumor, EBV-associated smooth muscle tumor and undifferentiated pleomorphic sarcoma as well as a diverse spectrum of vascular and vascular-stromal tumors and tumor-like lesions. While some tumor and tumor-like lesions are unique to the spleen, others may also occur in diverse extra-splenic viscera. These tumors and tumor-like lesions demonstrate characteristic histopathology, immunocytochemistry and biological behavior. While cross-sectional imaging studies allow detection, staging and limited characterization of these splenic lesions, histopathological confirmation permits optimal management and surveillance strategies.
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Affiliation(s)
- Aditya S Prasad
- Departments of Radiology, University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Nisha S Ramani
- Department of Pathology, Michael E DeBakey VA Medical Center, Houston, USA
| | | | | | - Venkateswar R Surabhi
- Departments of Radiology, University of Texas MD Anderson Cancer Center, Houston, USA.
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030, USA.
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3
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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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4
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Raza VF, Arshad D, Ahmad S, Khan KJ. Case report of an unexpected inflammatory myofibroblastic tumor. Ann Med Surg (Lond) 2021; 65:102316. [PMID: 33996052 PMCID: PMC8094897 DOI: 10.1016/j.amsu.2021.102316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Inflammatory myofibroblastic tumor is a benign entity that may present as a locally aggressive malignancy, predominantly in the lung. 500 cases have been reported in the literature, and an estimated prevalence ranges from 0.04% to 0.7%. Case presentation An eighteen-year old male presented to the surgical clinic with abdominal pain. The pain was recurring despite trials of analgesics and remained undiagnosed. Radiological imaging demonstrated a lesion in the spleen. An infectious cause was presumed due to their endemicity in South Asia, however pathology showed an inflammatory myofibroblastic tumor. Discussion Pre-operative imaging is yet to develop a set criterion that may identify this lesion, though clinicians may be clued in by the benign appearance despite the large size. Usual diagnosis is on pathology after complete surgical excision, which is the mainstay treatment advocated. Conclusion Reporting of the tumor in unusual sites such as the spleen is scarce, increase of which may help establish guidelines, understand tumor behavior and guide clinicians that may encounter it in surgical practice.
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Affiliation(s)
- Vishal Farid Raza
- Department of General Surgery, Sir Ganga Ram Hospital, Lahore, Fatima Jinnah Medical University, Queen's Road, Lahore, 54000, Pakistan
| | - Dawood Arshad
- Department of General Surgery, Sir Ganga Ram Hospital, Lahore, Fatima Jinnah Medical University, Queen's Road, Lahore, 54000, Pakistan
| | - Sajeel Ahmad
- Department of General Surgery, Sir Ganga Ram Hospital, Lahore, Fatima Jinnah Medical University, Queen's Road, Lahore, 54000, Pakistan
| | - Khalid Javeed Khan
- Department of General Surgery, Sir Ganga Ram Hospital, Lahore, Fatima Jinnah Medical University, Queen's Road, Lahore, 54000, Pakistan
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5
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Kwag MH, Park JY, Jeong HW, Han JY, Lim JH, Kim YS, Park JW. Overlooked and Challenging Encounters–Inflammatory Pseudotumors in the Abdomen and Pelvis: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1121-1133. [PMID: 36238032 PMCID: PMC9431880 DOI: 10.3348/jksr.2019.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 11/15/2022]
Abstract
Inflammatory pseudotumors (IPTs) are uncommon, mass-forming lesions, predominantly involving the lung and orbit. Although the incidence of IPTs is rare in the abdomen and pelvis, they can be encountered as enhancing, soft-tissue lesions, mimicking malignancy or fibrosclerosing disease. Generally, they exhibit a wide range of nonspecific imaging features in various organs. Preoperative imaging diagnosis of IPTs in appropriate clinical settings may help determine proper patient management. In this article, we review radiologic findings of IPTs in the abdominopelvic cavity, including the liver, spleen, kidney, gastrointestinal tract, mesentery, pelvis, and retroperitoneum.
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Affiliation(s)
- Min Ha Kwag
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jin Young Park
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hae Woong Jeong
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ji Yeon Han
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jong Heon Lim
- Department of Radiology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Seon Kim
- Department of Radiology, Yeungnam University Hospital, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jung Won Park
- Department of Radiology, Gimhaebokum Hospital, Gimhae, Korea
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6
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Torres US, Matsumoto C, Maia DR, de Souza LRMF, D'Ippolito G. Computed Tomography and Magnetic Resonance Imaging Findings of Inflammatory Pseudotumors in the Abdomen and Pelvis: Current Concepts and Pictorial Review. Semin Ultrasound CT MR 2018; 39:220-229. [PMID: 29571557 DOI: 10.1053/j.sult.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The group of inflammatory pseudotumors (IPTs) encompasses a variety of rare neoplastic and nonneoplastic entities described to occur in almost every location in the body and whose clinical features and aggressive imaging findings (varying from infiltrative to mass-forming lesions), frequently mimic those of malignant tumors. The radiologic features of IPTs are variable and nonspecific, the imaging findings depending on the body location and involved organ. Abdominopelvic IPTs are rare and the purposes of this review, therefore, are to familiarize the radiologist with the wide spectrum of computed tomography and magnetic resonance imaging findings of IPTs in various locations throughout the abdomen and pelvis, discussing the imaging features that allow consideration of IPTs in the differential diagnosis of soft-tissue masses within the pertinent clinical setting. Radiologists should be aware of this group of entities, as a preoperative histopathologic diagnosis upon radiological suspicion may help to differentiate IPTs from malignancy and to allow the most appropriate clinical work-up for these patients.
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Affiliation(s)
| | - Carlos Matsumoto
- Grupo Fleury, São Paulo, Brazil; Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Giuseppe D'Ippolito
- Grupo Fleury, São Paulo, Brazil; Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil
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7
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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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8
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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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9
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Abstract
With the exception of lymphoma involving the spleen, other primary and secondary neoplasms are rare and infrequently encountered. Primary malignant neoplasms involving the spleen are lymphoma and angiosarcoma. Primary benign neoplasms involving the spleen include hemangioma, lymphangioma, littoral cell angioma and splenic cyst and solid lesions such as hamartoma and inflammatory pseudotumor.
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Affiliation(s)
- R K Kaza
- Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI 48109-0030, USA.
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10
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Tc-99m labeled RBC scintigraphy of an inflammatory pseudotumor of the spleen. Clin Nucl Med 2009; 34:477-8. [PMID: 19542964 DOI: 10.1097/rlu.0b013e3181a7d1d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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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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12
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Computed tomographic and magnetic resonance features of inflammatory myofibroblastic tumor of the lung in children. ACTA ACUST UNITED AC 2009; 26:613-7. [DOI: 10.1007/s11604-008-0284-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 09/18/2008] [Indexed: 11/26/2022]
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13
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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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14
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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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15
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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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16
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Sarría Octavio de Toledo L, Cozcolluela Cabrejas R, García Asensio S, Martínez-Berganza T. [Wandering spleen associated to inflammatory pseudotumor]. RADIOLOGIA 2006; 48:173-6. [PMID: 17058642 DOI: 10.1016/s0033-8338(06)73149-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor.
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17
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Gunny RS, Akhbar N, Connor SEJ. CT and MRI appearances of inflammatory pseudotumour of the cervical lymph nodes. Br J Radiol 2005; 78:651-4. [PMID: 15961851 DOI: 10.1259/bjr/78900851] [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: 11/05/2022] Open
Abstract
Inflammatory pseudotumour (IPT), also known as plasma cell granuloma and inflammatory myofibroblastic tumour, is a rare cause of benign cervical lymphadenopathy which mimics malignant causes of cervical lymphadenopathy. The imaging features of IPT affecting the cervical lymph nodes have not previously been described. We present cross sectional imaging in a case of IPT occurring in a 42-year-old African-Caribbean man, from his initial presentation to a subsequent spontaneous reduction in the extent of lymphadenopathy.
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Affiliation(s)
- R S Gunny
- Department of Neuroimaging, Kings College Hospital, London SE5 9RS, UK
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18
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Ko SW, Shin SS, Jeong YY. Mesenteric inflammatory myofibroblastic tumor mimicking a necrotized malignant mass in an adult: case report with MR findings. ACTA ACUST UNITED AC 2005; 30:616-9. [PMID: 15791485 DOI: 10.1007/s00261-004-0296-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Accepted: 03/10/2004] [Indexed: 11/29/2022]
Abstract
Inflammatory myofibroblastic tumors are lesions that usually affect young adults and children. Numerous extrapulmonary sites of these tumors have been found, but the mesentery is a very unusual location for an inflammatory myofibroblastic tumor and it is extremely rare in an older patient. Inflammatory myofibroblastic tumor of the mesentery is often demonstrated as a large and infiltrative lesion with heterogeneous enhancement. Its diagnosis is recognized as difficult and it often mimics malignant tumor. We report a case of mesenteric inflammatory myofibroblastic tumor mimicking a necrotized malignant mass in a 55-year-old man who was examined with magnetic resonance imaging. To our knowledge, this is the first report of magnetic resonance imaging of mesenteric inflammatory myofibroblastic tumor with extensive central necrosis in an older patient.
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Affiliation(s)
- S W Ko
- Department of Diagnostic Radiology, Chonbuk University Medical School, 634-18 Geumam 2 dong, Dukjin-gu, Jeonju City, Chonbuk 561-712, South Korea.
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19
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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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20
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Yesildag E, Sarimurat N, Ince U, Numan F, Buyukunal C. Nonsurgical diagnosis and management of an inflammatory pseudotumor of the spleen in a child. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:335-338. [PMID: 12811795 DOI: 10.1002/jcu.10176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Primary splenic tumors in children are rare and usually benign. We report the case of a 7-year-old boy with a splenic mass that initially resembled an infectious process. Histopathologic examination of a specimen obtained using sonographically guided Tru-cut needle biopsy, performed after angiography, revealed an inflammatory pseudotumor of the spleen, an extremely rare benign lesion. The lesion has been managed conservatively with clinical and sonographic follow-up. This case shows that benign lesions of the spleen can easily be diagnosed using current radiologic and histopathologic techniques without the need for surgery, thus allowing total or even partial splenectomy to be reserved for patients in whom a mass cannot be diagnosed or in whom clinical progression is evident.
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Affiliation(s)
- Ebru Yesildag
- Pediatric Surgery and Pediatric Urology Center of Istanbul, Valikonagi Caddesi Sonu, Yapi Kredi Vakif Binasi, No. 173, D:12/3 Nisantasi, Istanbul 80220, Turkey
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21
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Abstract
This short review is dedicated to a precise pathologic characterization of 2 uncommon and poorly defined lesions of the spleen and to their distinction from histologically similar processes. Splenic hamartoma represents an abnormally formed red pulp and is characterized by the presence of sinus-like structures lined by CD8(+) endothelia. The great variety of its morphologic appearances may result from the preponderant growth of one or another of the several components of the red pulp, ie, CD34(+) capillaries, myoid cells and macrophages. Therefore, it is proposed that "cord capillary hemangioma," myoid angio-endothelioma, and histiocyte-rich tumors are part of the spectrum of splenic hamartoma. Inflammatory pseudotumor (IPT) of the spleen is a reactive lesion, probably of multiple etiologies, characterized by a mixture of inflammatory cells and a minor, disorganized component of spindle cells. The latter include fibroblasts, SMA(+) myofibroblasts, and CD68(+) spindled histiocytes, establishing a close similarity with the IPT of the lymph node. This benign process needs to be distinguished from 2 others that have a predominant spindle cell component arranged in parallel bundles: the IPT-like follicular dendritic cell tumor, which is consistently associated with Epstein-Barr Virus; and the inflammatory myofibroblastic tumor, also often Epstein-Barr Virus-related and similar to those of the soft tissues, lung and other organs. These 2 lesions are neoplastic and therefore have a potentially worse prognosis than IPT.
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Affiliation(s)
- Jayashree Krishnan
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA
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