M S Peethambaran, Matthew Catherine, Rajendran Rajkamal R
Gastrointestinal Surgery, Avitis Institute of Medical Sciences, Palakkad, IND.
Pathology, Avitis Institute of Medical Sciences, Palakkad, IND.
Cureus. 2023 May 18;15(5):e39185. doi: 10.7759/cureus.39185. eCollection 2023 May.
Accessory spleen and splenosis are two types of ectopic spleen. An accessory spleen can be found in various sites in the abdomen, but an intrahepatic accessory spleen is very rare though many case reports of intrahepatic splenosis are available. This case report presents the incidental diagnosis of accessory spleen in the liver of a 57-year-old male while undergoing laparoscopic diaphragmatic repair. The patient had a history of splenectomy 27 years ago for hereditary spherocytosis, but his routine haemogram did not show any features of the ectopic splenic function. Intraoperatively, a mass was suspected in the liver and was resected. Histopathology revealed an accessory spleen with well-preserved red and white pulp architecture. Though a history of splenectomy suggested a diagnosis of splenosis, a well-encapsulated and preserved splenic architecture confirmed the diagnosis of accessory spleen. Accessory spleen or splenosis can be diagnosed radiologically using Tc-99m-labeled heat-denatured red blood cells (HRBC) and Tc-99m sulfur colloid scans, but the gold standard is histopathological examination. Ectopic spleen is mostly asymptomatic but usually results in unnecessary surgeries as it is difficult to differentiate from benign or malignant tumors. Thus, a high degree of suspicion and awareness is necessary for early and prompt diagnosis.
副脾和脾组织植入是两种类型的异位脾。副脾可在腹部的不同部位发现，但肝内副脾非常罕见，尽管有许多肝内脾组织植入的病例报告。本病例报告介绍了一名57岁男性在接受腹腔镜膈肌修复手术时，偶然诊断出肝脏中有副脾。该患者27年前因遗传性球形红细胞增多症行脾切除术，但他的常规血常规未显示异位脾功能的任何特征。术中，怀疑肝脏中有一个肿块并将其切除。组织病理学显示为一个副脾，红髓和白髓结构保存完好。虽然脾切除术史提示脾组织植入的诊断，但包膜完整且结构保存完好证实为副脾的诊断。副脾或脾组织植入可通过使用锝-99m标记的热变性红细胞（HRBC）和锝-99m硫胶体扫描进行放射学诊断，但金标准是组织病理学检查。异位脾大多无症状，但通常会导致不必要的手术，因为它很难与良性或恶性肿瘤区分开来。因此，高度的怀疑和意识对于早期和及时诊断是必要的。
