Splenic hamartoma

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient has a cystic pancreatic lesion which has been followed up with cross-sectional imaging for a number of years. He is asymptomatic.

Patient Data

Age: 65
Gender: Male
CT

CT Pancreas

There is a cystic mass in the pancreatic head, and there is mild dilatation of the pancreatic main duct as well as CBD.

There is a rounded, sharply circumscribed partially exophytic mass at the anterior inferior aspect of the spleen. It appears hyperenhancing on phase 1 of this pancreatic mass protocol CT (arterial), and mildly hyperenhancing on phase 2 (portal venous).

Compared to prior imaging, it was found that the splenic mass has been enlarging.

MRI

MRCP

This study was done for the cystic pancreatic head mass which it nicely depicts; note relationship with ductal system.

On this T2-only series, the splenic mass appears mildly hyperintense relative to splenic parenchyma.

In view of the enlarging splenic mass, the patient underwent splenectomy.

Pathology report:

Splenectomy specimen, 196g, 110 x 90 x 35mm, with attached perisplenic adipose tissue, 40mm. There is some poorly defined pallour, 10mm, located in the lower pole. The remaining splenic parenchyma appears normal. 

MICROSCOPY: Spleen, splenectomy: Non-encapsulated proliferation of anastomosing blood filled sinuses, with positive immunoreactivity for CD31 and CD8. CD68 is negative. The background spleen appears unremarkable. No atypical features seen.

The differential diagnosis lies between a benign hemangioma and hamartoma/splenoma, the latter being favoured in view of CD8 positivity.

CT

Postop CT

Just to prove it's out...

Post splenectomy. The cystic pancreatic head mass is unchanged.

Case Discussion

The reason for splenectomy was the interval enlargement of the splenic mass which initially had been identified incidentally during the cystic pancreatic mass workup and followup. 

Working diagnosis for the cystic pancreatic mass is an IPMN or mucinous cystadenoma.

Differentiantion between splenic hamartoma and haemangioma is not always clear cut - see pathology report - however the CD8 positivity is a very strong indicator against the differential diagnoses of splenic haemangioma, Littoral cell angioma, splenic lymphangioma, haemangioendothelioma, sclerosing angiomatoid nodular transformation, angiosarcoma.

See also:

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Case information

rID: 23221
Case created: 29th May 2013
Last edited: 25th Feb 2016
Inclusion in quiz mode: Included

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