Sikiric M, Premec H, Mijic M, Sobocan N, Filipec Kanizaj T, Lovric E, Kavur L, Lalovac M. Diagnostic challenge of intrahepatic splenosis masquerading as hepatocellular carcinoma: A case report and review of literature. World J Gastroenterol 2026; 32(38): 120967 [DOI: 10.3748/wjg.120967]
Corresponding Author of This Article
Martin Sikiric, School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia. sikiric.martin@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
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case-report
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Sikiric M, Premec H, Mijic M, Sobocan N, Filipec Kanizaj T, Lovric E, Kavur L, Lalovac M. Diagnostic challenge of intrahepatic splenosis masquerading as hepatocellular carcinoma: A case report and review of literature. World J Gastroenterol 2026; 32(38): 120967 [DOI: 10.3748/wjg.120967]
World J Gastroenterol. Oct 14, 2026; 32(38): 120967 Published online Oct 14, 2026. doi: 10.3748/wjg.120967
Diagnostic challenge of intrahepatic splenosis masquerading as hepatocellular carcinoma: A case report and review of literature
Martin Sikiric, Hrvoje Premec, Maja Mijic, Nikola Sobocan, Tajana Filipec Kanizaj, Eva Lovric, Lovro Kavur, Milos Lalovac
Martin Sikiric, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Hrvoje Premec, Maja Mijic, Milos Lalovac, Department of Gastroenterology, University Hospital Merkur, Zagreb 10000, Croatia
Nikola Sobocan, Tajana Filipec Kanizaj, Department of Gastroenterology, University Hospital Merkur, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Eva Lovric, Department of Pathology, Clinical Department of Pathology and Cytology, School of Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb 10000, Croatia
Lovro Kavur, Department of Diagnostic and Interventional Radiology, University Hospital Merkur, Zagreb 10000, Croatia
Author contributions: Filipec Kanizaj T and Sobocan N collected the patient’s clinical data and designed the case report; Kavur L and Lovric E contributed to the clinical data collection and analysis; Sikiric M conducted the literature review; Sikiric M, Lalovac M, Mijic M, and Premec H analyzed the data presented in the table, and contributed to writing and editing of the manuscript. All authors have read and approved the final manuscript.
AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Corresponding author: Martin Sikiric, School of Medicine, University of Zagreb, Šalata 3, Zagreb 10000, Croatia. sikiric.martin@gmail.com
Received: March 23, 2026 Revised: May 13, 2026 Accepted: July 10, 2026 Published online: October 14, 2026 Processing time: 166 Days and 6.7 Hours
Abstract
BACKGROUND
Intrahepatic splenosis (HS) is a rare benign condition characterized by heterotopic autotransplantation of splenic tissue into the liver parenchyma following splenic trauma or splenectomy. Radiological findings on conventional imaging modalities, such as computed tomography and magnetic resonance imaging, are usually inconclusive and nonspecific, making differentiation between splenosis and other hepatic lesions challenging. Therefore, awareness of HS is important to avoid unnecessary surgical procedures or patient anxiety resulting from the misdiagnosis of primary or secondary liver malignancies.
CASE SUMMARY
We present the case of a 61-year-old male patient with a history of chronic alcohol use and childhood splenectomy. He was admitted to the Department of Gastroenterology for focal liver lesions discovered during the diagnostic workup for an ischemic cerebrovascular incident that had occurred 3 months earlier. Notably, the patient had no evidence of cirrhosis and had normal findings for tumor markers. Multislice computed tomography and subsequent magnetic resonance imaging revealed one lesion suggestive of hepatocellular carcinoma (HCC). Although guidelines for indeterminate lesions in non-cirrhotic livers recommend ultrasound-guided biopsy, percutaneous sampling could not be performed due to the lesion’s proximity to major blood vessels. Given the high clinical suspicion for HCC and low suspicion for HS, contrast-enhanced ultrasound (CEUS) and scintigraphy were not performed. Surgery was selected as a combined diagnostic and therapeutic approach, and histopathological analysis confirmed HS. The patient recovered well and was discharged 7 days postoperatively.
CONCLUSION
Suspecting HS allows the use of CEUS or scintigraphy, thereby avoiding unnecessary invasive interventions while ensuring an accurate diagnosis.
Core Tip: Intrahepatic splenosis (HS) is a rare benign condition that may mimic malignant liver lesions on conventional imaging. We report the case of a 61-year-old man with a prior splenectomy in whom a hepatic lesion suspicious for hepatocellular carcinoma led to surgical resection. Histopathological examination ultimately confirmed HS. This case emphasizes the diagnostic challenges and common pitfalls associated with this condition and underscores the importance of considering HS in the differential diagnosis of focal liver lesions.
