Intrahepatic Splenosis Mimicking Hepatocellular Carcinoma: A Case Series of Eleven Patients.

Abstract

Introduction: Intrahepatic splenosis is an extremely rare intrahepatic mass, which is easily misdiagnosed and mistreated. There are a few reports in the literature that intrahepatic splenosis mimicking hepatocellular carcinoma in a patient with elevated AFP. This study aims to analyze the diagnosis and treatment strategies of intrahepatic splenosis.

Materials and methods: The clinical data of eleven patients with intrahepatic splenosis, diagnosed and treated at Wuhan Asia General Hospital and Union Hospital (Wuhan, China) between March 2012 and November 2024, were retrospectively analyzed. Enhanced CT imaging and enhanced MRI were used for the screening and diagnosis of liver lesions.

Results: Of the eleven patients with intrahepatic splenosis, six cases were pure intrahepatic splenosis, and five cases included extrahepatic splenosis. Enhanced CT imaging or enhanced MRI showed intrahepatic splenosis lesions with uneven enhancement in the form of fast in and fast out. Two patients were misdiagnosed with hepatocellular carcinoma due to elevated AFP, but biopsy revealed intrahepatic splenosis, thus avoiding unnecessary resection. The size of the intrahepatic splenosis lesions ranged from 1.0 to 4.2 cm. None of the nine patients who underwent surgical resection had splenosis recurrences, and the patients with intrahepatic splenosis confirmed by liver biopsy did not show lesion progression during the active examination period.

Discussion: Splenosis refers to the autotransplantation of viable splenic tissue into different anatomic compartments following splenic injury. The enhanced CT or MRI features of intrahepatic splenosis are similar to those of HCC. Selective hepatic arteriography may help differentiate intrahepatic splenosis from HCC. Percutaneous liver biopsy helps diagnose intrahepatic splenosis.

Conclusion: In patients who have previously undergone splenectomy due to splenic trauma, it is important to consider the potential occurrence of intrahepatic splenosis upon the identification of intrahepatic lesions, and percutaneous liver biopsy is recommended. For individuals without clinical symptoms following a confirmed diagnosis of intrahepatic splenosis, no specific treatment is required.