S2801 Hepatic Splenosis Mimicking Hepatocellular Carcinoma

Introduction: Splenosis is defined as transplantation of splenic tissue in to surrounding structures like the peritoneal, intrathoracic surfaces and rarely in to the Liver. Most cases of hepatic splenosis (HS) are asymptomatic and usually found incidentally. Radiographic findings of HS are nonspecific and mimics other liver masses. We report a rare case of isolated HS in a 38-year-old male who presented with right upper quadrant (RUQ) pain and Liver mass mimicking Hepatoma. Case Description/Methods: A 38-year-old male with asplenia comes to the outpatient with complaint of worsening RUQ pain of 2 years duration. Pain was described as dull aching, non-radiating, 3/10, constant and without aggravating or remitting factors. He underwent splenectomy at the age of 4 for traumatic splenic rapture following a fall down accident from a stair. He denied fever, chills, night sweating, nausea, vomiting, diarrhea, constipation, melena, hematemesis, anorexia or weight loss. On exam; abdomen was soft, without direct or rebound tenderness. On work up- complete blood count, complete metabolic panel, liver function test including coagulation panel are all with in normal limits. Computed Tomography (CT) of the abdomen showed a lobular exophytic mass of the liver measuring 6.7cmx3.6cm (figure -1). Histopathology of the liver mass revealed hemorrhagic splenic parenchyma. Patient was treated conservatively and he is currently doing well. Discussion: Splenosis is the autoimplantation of splenic tissue to surrounding structures which was initially named by Buchbinder and Lipkoff in 1939. Even though splenosis is generally a common occurrence in patient who had history of splenic rapture or following elective splenectomy, hepatic splenosis (HS) is rare. Patients with HS are usually asymptomatic but some may present with nonspecific abdominal pain, nausea, vomiting or mechanical compression of surrounding structures. Imaging modalities are nonspecific because HS mimics liver adenomas, hepatocellular carcinoma or liver secondaries.Treatment is usually conservative for patients without compressive symptoms. Laparotomic removal of the spelonosis is only indicated in these with mechanical complications or if splenectomy was done for hematologic disorders.In Conclusion, isolated intrahepatic splenosis is a rare encountered but it should be strongly considered in the differential diagnosis of a liver lesion, especially if the patient has history of splenic trauma or splenectomy.Figure 1.: White arrows: CT scan of abdomen- a lobular exophytic mass of the liver measuring 6.7cmx3.6cm