Case Report

A Case of Inflammatory Pseudotumor in the Spleen

Authors: Aslan Çelebi, MD, Seyit Mehmet Kayacan, MD, Serkan Keskin, MD, Ela Temeloglu, MD, Deniz Koç, MD, Vildan Ercan, MD, Deniz Esin, MD, İsmail Ekizoglu, MD, Sezai Vatansever, MD, Mine G. Gulluoglu, MD, Osman Erk, MD

Abstract

A case of an inflammatory pseudotumor of the spleen is presented. A 43-year-old woman was hospitalized for a detailed examination due to pancytopenia, which was diagnosed during an examination related to left upper quadrant abdominal pain. Physical examination revealed a 2 to 3 cm splenomegaly. Reticulocyte count was 4% and erythrocyte sedimentation rate was 55 mm/h. No other important findings were noted, except for an evident increase in myeloid series and megakaryocytes (more evident in erythroid series) on bone marrow aspiration and biopsy. Computed tomography (CT) scan revealed splenomegaly and a centrally located hypodense lesion with a 92 × 86 mm axial diameter in the spleen. With a hematologic malignancy prediagnosis, a splenectomy was performed on the patient because of pancytopenia and splenomegaly. An intrasplenic, centrally located, well-limited, capsulated lesion (9.5 × 11 × 10 cm in diameter) was discovered on macroscopic examination of the material. A cellular infiltration area was seen on microscopic examination. The spleen capsule was mildly fibrotically thickened. The lesion that separated from the spleen tissue consisted of diffusely proliferated fusiform fibroblasts, heterogenous inflammatory cells consisting mainly of plasma cells, lymphocytes, sparse neutrophils and vascular elements. No granuloma or multinuclear giant cells were detected. Pancytopenia improved on follow-up. The patient followed up for two years, is now healthy and has no complaints.


Key Points


* Inflammatory pseudotumour is a benign lesion although it seems to be a malign lesion in clinical and radiological examinations.


* Although its reason is not clearly known, it is a reactive lesion developed due to vascular thrombosis, infectious (EBV, HIV, etc) or autoimmune reasons.


* It is generally encountered in the orbital, spinal meninges, gastrointestinal system, heart, soft tissues, mesothelial membranes and respiratory system but is rare in the spleen.


* Pathologically, they are confused with especially lymphoproliferative diseases, but are differentiated by proliferation of fusiform spindle cells and inflammatory cell infiltration with variable severities.


* Surgical excision is curative.

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