Inflammatory pseudotumour of the spleen

Inflammatory pseudotumor of the spleen: A case report and review of published cases

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.

[Inflammatory pseudotumours of spleen]

INTRODUCTION

Inflammatory pseudotumours are benign lesions of unknown aetiology that can appear almost in any organ, sometimes along with infectious agents like Epstein-Barr virus. They are very rare in the spleen, with about 80 cases described in the world literature. The tumour is a single, very rarely multinodal, lesion. Middle-aged patients are mostly affected. Symptoms are either absent or uncharacteristic so that the tumours are discovered by chance or during the investigations for other diseases. Although the tumour may be suspected before surgery, the exact diagnosis is established by the histological and immunohistochemical examination of the spleen removed as lymphoma or some other lymphoproliferative disorder because they cannot be ruled out.

OUTLINE OF CASES

The authors present 3 female patients 36, 48 and 56 years of age (average age 46.6 years) with the inflammatory pseudotumour of the spleen. Two patients complained of a mild pain in the epigastrium and below the left costal margin, while in the third patient the tumour of the spleen was discovered by chance during the examination after the traffic accident trauma. On examination, only slight epigastric tenderness was found in two patients. Except for the elevated white blood cells in one patient, laboratory data were within normal limits. All 3 patients were submitted to splenectomy as lymphoma of the spleen could not have been ruled out. Two patients developed transient postsplenectomy thrombocytosis which was treated with aspirin. The exact diagnosis of the tumours was established by the histological and immunohistochemical investigation.

CONCLUSION

Inflammatory pseudotumours of the spleen may not be so rare as it is believed. Thanks to the new diagnostic modalities (US, CT, MRI), an increasing number of reports of these tumours may be expected. They have to be taken into consideration in the differential diagnosis of solitary or multimodal lesions of the spleen. Splenectomy is a treatment of choice.

Inflammatory pseudotumor of the spleen managed laparoscopically. Can preoperative imaging establish the diagnosis? Case report and literature review

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.

[Inflammatory pseudotumor of the spleen]

BACKGROUND

Inflammatory pseudotumors are benign tumor lesions of an unknown etiology that can appear almost at any organ, sometimes along with infectious agens, like Epstein-Barr virus. They are extremely rare in the spleen, with less than 80 cases described in the world literature. It is a single, very rarely multinodal lesion. Middle aged patients are mostly affected. Symptoms are either absent or uncharacteristic, so that the tumors are discovered by chance or during investigations of other diseases.

CASE REPORT

We presented a 56-year-old woman in whom a nodal lesion of 2 cm in diameter had been discovered in the spleen during a routine check-up after a mild traffic accident. The lesion had grown up to 6 cm in diameter during a 5-year follow-up causing a mild pain over the upper left abdomen and left shoulder. Fine needle biopsy failed to show the exact nature of the lesion. Splenectomy was performed due to a suspected lymphoproliferative disorder. Histology and immunohistochemistry of the lesion of the upper pole of the spleen showed inflammatory pseudotumor. Epstein-Barr virus was not present. The patient developed postsplenectomy thrombocytosis (up to 850 x 10(9)/1) which settled down within 10 weeks.

CONCLUSION

. Inflammatory pseudotumors of the spleen are extremely rare. The exact diagnosis can be established only by histology and/or immunohistochemistry of the spleen removed for a suspected lymphoproliferative disorder, most frequently lymphoma. The patient was cured with splenectomy.

A case of inflammatory pseudotumor in the spleen

A case of an inflammatory pseudotumor of the spleen is presented. A 43-year-old woman was hospitalized for a detailed examination due to pancytopenia, which was diagnosed during an examination related to left upper quadrant abdominal pain. Physical examination revealed a 2 to 3 cm splenomegaly. Reticulocyte count was 4% and erythrocyte sedimentation rate was 55 mm/h. No other important findings were noted, except for an evident increase in myeloid series and megakaryocytes (more evident in erythroid series) on bone marrow aspiration and biopsy. Computed tomography (CT) scan revealed splenomegaly and a centrally located hypodense lesion with a 92 X 86 mm axial diameter in the spleen. With a hematologic malignancy prediagnosis, a splenectomy was performed on the patient because of pancytopenia and splenomegaly. An intrasplenic, centrally located, well-limited, capsulated lesion (9.5 x 11 x 10 cm in diameter) was discovered on macroscopic examination of the material. A cellular infiltration area was seen on microscopic examination. The spleen capsule was mildly fibrotically thickened. The lesion that separated from the spleen tissue consisted of diffusely proliferated fusiform fibroblasts, heterogenous inflammatory cells consisting mainly of plasma cells, lymphocytes, sparse neutrophils and vascular elements. No granuloma or multinuclear giant cells were detected. Pancytopenia improved on follow-up. The patient followed up for two years, is now healthy and has no complaints.

Clinical and pathologic considerations in a case of inflammatory myofibroblastic tumor of the spleen

Inflammatory myofibroblastic tumors, also called inflammatory pseudotumors, are rare pseudosarcomatous proliferations. Their behavior is generally not aggressive, but in most instances they can simulate malignant neoplasms, from which they are impossible to distinguish before excision. One case of myofibroblastic tumor of the spleen in a 5-year-old boy is described: the patient was treated with a partial splenectomy, which was found to be the best approach for diagnosis and treatment. The purpose of this report is to call attention to this entity with peculiar histologic and immunohistochemical characteristics, which has to be included in the differential diagnosis of splenic lesions and may be excised by a nonaggressive procedure.

Inflammatory pseudotumor of the spleen: report of a case

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.

[Inflammatory pseudotumor of the spleen]

Inflammatory pseudotumor of the spleen is a very rare benign lesion of unknown etiology. Splenectomy is recommended to obtain histological diagnosis and to eliminate a malignant tumor.