Management of Hepatic Splenosis Mimicking Liver Lesion: Tongji Experience

Introduction: Hepatic splenosis, splenic tissue implanted in the liver, mainly resulted from splenectomy or splenic trauma, is rarely seen in our clinical work. It is hardly discriminated from hepatic malignancies and benign tumors as no specific test or radiological features for this condition. Thus, we summarize five cases in our hospital, aiming to identify the common characteristics, which might help to the management of this situation. Method: Five hepatic splenosis cases were collected in our hospital. Clinical characteristics including age, gender, past history, physical examination, liver function as well as tumor markers, surgical findings, pathological examination and follow-ups were analyzed. Result: All the patients with good performance status were male, aging from 33 to 52 years. All of them experienced trauma and splenectomy, time interval of which was 16.4 years on average, and left surgical scars on abdomen. Child–Pugh was grading as A. No abnormality was found for tumor markers. Ultrasonography showed hypo or iso-echoic lesion with clear boundaries. The lesions were presented as hypodensity mass in plain CT scan, enhanced in arterial phase and decreased to iso-density in delayed phase for contrast-enhanced CT. MRI displayed long T1 and long T2, slight hyper-intensity or unchanged in DWI. PWI was similar to that of CT. The patients underwent surgical treatments, four of them received laparoscopic partial segmentectomies with sufficient surgical margin. Six lesions with intact capsules were discovered in segment 2, 4, 6 and 8, ranging from 1.5 to 5cm in diameter. Average operation time was 186.2 minutes, and blood loss was 100 ml. No transfusion, lesion rupture or hepatic blood occlusion appeared. The patients discharged uneventfully, 5 to 9 days after surgery. No recurrence was found during the follow-ups. Conclusion: History of splenic trauma or splenectomy is helpful for the diagnosis of hepatic splenosis. Laparoscopic exploration is recommended for uncertain cases.