GI Radiography

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Imaging Findings

Study reveals a well defined enhancing mass lesion in the spleen. A faint central stellate area was noted at the center of the lesion

Diagnosis :

Patient was operated due to persistent pain.
Final Diagnosis on histopath: Acute splenitis with splenic pseudotumor.

Discussion:

Pseudotumors are rare mass lesions. They have been reported in various organs including the orbit, respiratory tract, gastrointestinal tract, lymph nodes, soft tissues, heart, and liver. Pseudotumors of the spleen are particularly uncommon with fewer than 70 cases reported in the medical literature.

The exact pathogenesis and etiology of splenic pseudotumor remains obscure. Various hypothesis have been proposed regarding its development and include autoimmune, infectious (especially with Epstein-Barr virus), vascular, inflammatory, and post-traumatic causes. The term inflammatory pseudotumor, however, is frequently applied to these lesions since they are composed primarily of plasma cells and lymphocytes in a fibroblastic stroma.

Splenic pseudotumor can occur over a large age range, but is most often seen in the middle and older age populations. Patients are typically asymptomatic, but may present with left flank pain or splenomegaly.

The imaging characteristics of splenic pseudotumor on CT, MRI, and US normally lack the specificity to differentiate this benign disorder from other benign and malignant neoplasms of the spleen. The presence of a central stellate area corresponding to a fibrous plaque on CT after contrast administration is strongly suggestive of an inflammatory pseudotumor, however, it may not be always seen.

Differential diagnosis: The differential considerations during the radiographic evaluation of splenic pseudotumor include lymphoma, hamartoma, hemangioma, lymphangioma, plasmocytoma, and splenic hydatid cyst. The definitive diagnosis of a splenic pseudotumor is made histopathologically.

Management: The prognosis of pseudotumor of the spleen is generally considered favorable. No reports of metastatic disease, local invasion, or recurrence following splenectomy have been reported in the literature in association with the disorder.

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