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Hepatic splenosis mimicking hepatocellular carcinoma in metabolic associated fatty liver disease

      A 56-year-old patient in 6-month surveillance for metabolic associated fatty liver disease was referred to our centre following the detection of new hepatic nodule by abdominal ultrasound. His medical history included splenectomy due to schistosomiasis, diabetes, and arterial hypertension. Contrast-enhanced Magnetic Resonance Imaging (MRI) revealed a T1-hypointense, T2-hyperintense 16 mm subcapsular lesion in sixth segment with arterial phase wash-in but without venous/delayed phase wash-out and hypointensity in hepatospecific phase, while contrast-enhanced computed tomography (CT) showed the typical pattern of hepatocellular carcinoma (HCC), i.e. wash- in arterial and wash-out in portal/venous phases (Fig. 1). Following multidisciplinary meeting, the patient underwent videolaparoscopic nodulectomy, due to its favourable position and absence of portal hypertension. Histological exam revealed subcapsular intrahepatic splenosis (IHS, Fig. 2), a rare benign condition characterized by the implantation of the normal splenic tissue at ectopic sites. CT findings of IHS are nonspecific and may resemble those of HCC, while at MRI IHS mirrors the signal intensity of the spleen on all sequences and at diffusion-weighted sequence splenic tissue (Fig. 1). While definitive diagnosis is generally obtained by tissue sampling, IHS should be suspected in presence of typical imaging features in patients with previous history of abdominal trauma or splenectomy [
      • Toh W.S.
      • Chan K.S.
      • Ding C.S.L.
      • Tan C.H.
      • Shelat V.G.
      Intrahepatic splenosis: a world review.
      ].
      Fig 1
      Fig. 1Contrast-enhanced CT scan showed arterial phase wash-in (arrow in panel A) and portal phase wash-out (arrow in panel B) of the subcapsular hepatic lesion. Contrast-enhanced MRI revealed arterial phase hyperintensity (arrow in panel C), late phase isointensity (arrow in panel D) and hypointensity in hepatospecific phase of the hepatic nodule (arrow in panel E). At diffusion-weighted MRI the hepatic lesion (arrow in panel F) and the spleen have the most restricted diffusion as compared to other intra-abdominal organs (this MRI spleen image is for illutrative purpose only).
      Fig 2
      Fig. 2Subcapsular encapsulated liver nodule, focally hemorragic (panel A, H&E 5x), made up by normal splenic parenchyma with white pulp around a penicillary artery (panel B, right) and sinusoids of red pulp (panel B, left H&E 200x), demonstrating the typical immunoreactivity for both classic endothelial markers (panel C, CD34 100x) and CD8 (D, 100x).

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      Reference

        • Toh W.S.
        • Chan K.S.
        • Ding C.S.L.
        • Tan C.H.
        • Shelat V.G.
        Intrahepatic splenosis: a world review.
        Clin Exp Hepatol. 2020; 6: 185-198