Splenic hamartoma mimicking angiosarcoma: A case report.

Background: Primary splenic lesions are rare and often detected incidentally through imaging, biopsy, or autopsy, typically without distinct clinical symptoms. Although imaging can help differentiate benign from malignant lesions, splenic hamartomas, and angiosarcomas may exhibit overlapping features, making diagnosis challenging. This report presents a case of splenic hamartoma suspected to be an angiosarcoma based on preoperative imaging. Splenic hamartomas that mimic angiosarcomas are exceedingly rare.

Case summary: A 33-year-old male presented to the Department of Emergency with frank red blood hematemesis and a 1-week history of epigastric pain. On arrival, he was alert and hemodynamically stable. Contrast-enhanced abdominal computed tomography revealed splenomegaly with significant engorgement of the portal and splenic veins, along with a diffuse nodular splenic lesion measuring 8.2 cm × 6.2 cm. Following esophageal varix ligation, abdominal magnetic resonance imaging demonstrated iso- to high-signal intensity within the splenic mass and multiple hypervascular lesions in the right hepatic lobe, raising suspicion for splenic angiosarcoma with hepatic metastases. ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography showed diffusely mild increased metabolic activity in the spleen. The patient subsequently underwent splenectomy and liver biopsy. Histopathological examination revealed chronic inflammation in the liver, and the splenic lesion was confirmed to be a splenic hamartoma. The patient successfully returned to work and remains in good health.

Conclusion: This rare case of splenic hamartoma mimicking angiosarcoma highlights the importance of differential diagnosis in managing splenic tumors.