Inflammatory pseudotumour of spleen

Inflammatory Pseudotumor of the Spleen: A Case Report and Review of the Literature

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.

Granulomatous inflammatory pseudotumor of the spleen: association with Epstein-Barr virus

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.

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.

Concomitant inflammatory pseudotumor of the liver and spleen

We report the case of a 53-year-old man with inflammatory pseudotumor (IPT) of the liver and spleen. This concomitant association has rarely been reported. The patient presented with a hypoechoic mass in the liver and a clinical picture of recurrent sepsis; hematochemical exams and imaging data were nonspecific. Antibiotic therapy improved the clinical course, but did not resolve it definitively. After 50 days of therapy, as the hepatic mass decreased a similar lesion appeared in the spleen. The final diagnosis was made on splenectomy and an intra-operative biopsy of the residual liver lesion. The diagnostic problems encountered in this very rare association of IPT of the liver and spleen were similar to those for isolated IPT in the respective single organ sites. After 15 months of follow-up, the patient is in good health and no recurrence of symptoms or masses has been observed.

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.

Inflamação pseudotumoral do baço em cão. Relato de caso

Descrevem-se pela primeira vez achados anátomo-histopatológicos da inflamação pseudotumoral do baço, caracterizados pela presença de células inflamatórias, neutrófilos, linfócitos, plasmócitos, macrófagos e células gigantes multinucleadas, em uma cadela sem raça definida, de 10 anos de idade.

[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.

Tc-99m colloid and Ga-67 imaging of splenic inflammatory pseudotumor correlation with ultrasound, CT, and MRI

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.

Dynamic MR imaging of splenic tumor

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.

Inflammatory pseudotumor of the spleen in a young child

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.

Clonal changes in inflammatory pseudotumor of the lung: a case report

BACKGROUND

Pulmonary inflammatory pseudotumor, also known as plasma cell granuloma among many other names, is widely believed to be an inflammatory or reactive lesion rather than a neoplasm, although its pathogenesis is still controversial.

METHODS

Cytogenetic analysis was performed on a lung mass that showed typical clinical and pathologic features of inflammatory pseudotumor. Ultrastructural and immunohistochemical studies were performed in addition to routine histologic examination.

RESULTS

Cytogenetic study of the lesion revealed clonal anomalies of t(1;2)(q21;p23) and del(4)(q27). The patient, a 30-year-old woman, presented with an asymptomatic but enlarging right lower lobe mass for which partial right lower lobectomy was performed. The lung mass was well circumscribed radiographically and grossly. Microscopically, it was characterized by a loosely arranged spindle cell proliferation with prominent plasma cell infiltration. Fibroblastic and myofibroblastic differentiation of the spindle cells was demonstrated by ultrastructural and immunohistochemical studies.

CONCLUSION

To the authors' knowledge, this is the first report of clonal cytogenetic changes in a clinically and pathologically typical case of inflammatory pseudotumor in the lung. This finding suggests that pulmonary inflammatory pseudotumor might be a true neoplasm rather than a purely inflammatory or reactive lesion.

Inflammatory pseudotumour of the liver: antecedent causes and clinical experience

We present a case in which inflammatory pseudotumour of the liver which appears to complicate Caroli's disease. We have reviewed the literature in hepatic inflammatory pseudotumour with particular emphasis on underlying causes. We were able to find 45 reported cases, with adequate clinical data in 42; in these only 7 showed a probable antecedent cause. There were gallstones in another 5, giving a prevalence not significantly different to that within the general population. Hepatic inflammatory pseudotumour typically presents with a history of fever, anorexia, loss of weight, hepatic pain, jaundice and a detectable liver mass (or masses). The diagnosis of inflammatory pseudotumour should be particularly considered when there is a history of previous inflammatory hepato-biliary disease. Preoperative or intra-operative diagnosis might then avoid major hepatic surgery.

Inflammatory pseudotumor of the spleen: report of a case

A case of an inflammatory pseudotumor arising in the spleen of a 60-year-old Japanese male is described herein. This benign lesion is extremely rare, with only 12 cases, including our own, having been reported in the world literature. We preoperatively diagnosed the splenic tumor as a metastasis, due to the coexistance of advanced stage carcinoma in the sigmoid colon. However, after splenectomy, histopathological examination of the mass revealed an inflammatory process. Inflammatory pseudotumors often pose diagnostic difficulties because the clinical and radiologic findings are suggestive of malignancy. The clinical and pathological features of cases previously reported are reviewed following the presentation of this case.

A case of splenic inflammatory pseudotumor

Inflammatory pseudotumor of the spleen in a 50-year-old man was encountered in our surgical clinic. This splenic tumor is very rare and in the ninth of the cases in the literature. The removed spleen, weighting 255g, revealed the presence of a firm, circumscribed mass, measuring 4.5 x 4.0 x 4.5 cm, and histologically presenting marked lamination of collagen fibers around the small vessels associated with granulomatous lesions. The implications of its pathogenesis was analyzed with a review of the literature.

Primary malignant lymphomas of the spleen. A morphologic and immunohistochemical analysis of 17 cases

Seventeen cases of primary malignant lymphoma of the spleen (PMLS) were identified among 500 splenectomy specimens showing involvement by Hodgkin's disease or non-Hodgkin's lymphoma. All PMLS represented non-Hodgkin's lymphoma and most of them were of B-cell origin. In two cases PMLS were associated with hamartomas of the spleen (splenomas). Histologic and immunohistochemical studies did not reveal any differences between PMLS and disseminated malignant lymphomas with splenic involvement with regard to morphologic features, immunophenotype, host cell infiltrates, or proliferation activity. The reasons for the infrequent occurrence of primary lymphomas in the spleen may not be sought in a special immunophenotype of PMLS, a vigorous host response in the spleen, or in a lower proliferation activity of splenic lymphomas.