Diagnostic challenge of intrahepatic splenosis masquerading as hepatocellular carcinoma: A case report and review of literature

Figure 1 Magnetic resonance imaging findings of the patient. A and B: T2-weighted axial (A) and coronal (B) slices show a slightly hyperintense lobulated lesion measuring 25 mm × 37 mm in segment VIII of the liver (arrow); C: T1-weighted image with fat suppression shows a slightly hypointense lobulated lesion in segment VIII (arrow); D: Diffusion-weighted imaging demonstrates marked hyperintensity of the lesion (arrow); E: Apparent diffusion coefficient map shows low signal intensity (arrow); F: Arterial-phase T1-weighted axial slice shows mild hypervascularity of the lesion compared with the surrounding liver parenchyma (arrow); G-I: A prominent wash-out pattern is demonstrated on the portal-venous (G), 3-minute (H), and 10-minute (I) delayed phase (arrow).

Figure 2 Histopathological analysis and immunohistochemical findings of the resected specimen. A: Gross examination of the resected liver segment measuring 44 cm × 4.0 cm × 2.3 cm shows a dark red lesion (blue arrow) 1.6 cm in diameter, surrounded by a lighter rim; B and C: Hematoxylin and eosin staining [magnification × 10 (B) and × 20 (C)] demonstrates splenic tissue (triangle) surrounded by liver parenchyma (orange arrow); D: Immunohistochemical staining shows positivity for glycophorin C in erythroid cells (yellow arrow), magnification × 40.

Figure 3 Distribution of intrahepatic splenosis. A: Age and sex distribution of intrahepatic splenosis at the time of diagnosis. The majority of cases occurred in male patients, predominantly between 40 years and 60 years of age; B: Distribution of time from splenectomy to presentation of intrahepatic splenosis. Most cases were reported 20-30 years after splenectomy.

Figure 4 Suggested diagnostic algorithm for newly detected focal liver lesion in non-cirrhotic patients with suspicion of intrahepatic splenosis. A stepwise approach is presented based on clinical history, imaging findings, and confirmatory tests. 99mTc-DRBC: Technetium-99m-labeled heat-denatured red blood cells; CEUS: Contrast-enhanced ultrasound; MRI: Magnetic resonance imaging; US: Ultrasound.