[37 Year old woman with abdominal discomfort and splenic focal lesion]

Pseudotumor inflammatory of the spleen: A rare entity with diagnostic and therapeutic challenges: A case report

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.

Inflammatory pseudotumor of spleen: a case report

•

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.