Atuiri Clifford, Foster Dawson, Li Xiao, Hadidi Danny, Sokhn Joseph
Department of Internal Medicine, St. Luke's Hospital, Chesterfield, USA.
Department of Oncology, St. Luke's Hospital, Chesterfield, USA.
Eur J Case Rep Intern Med. 2024 Jul 29;11(8):004760. doi: 10.12890/2024_004760. eCollection 2024.
Heterotopic splenic tissue can occur following splenectomy and is typically asymptomatic, often discovered incidentally during imaging for other conditions. This benign condition may mimic malignant processes, posing diagnostic challenges especially in patients with a history of cancer or concurrent malignancy.
We report the case of a 60-year-old male with a history of well-controlled hypertension and a splenectomy following a traumatic injury at age 7. The patient underwent routine screening which revealed elevated prostate-specific antigen (PSA) levels. Subsequent magnetic resonance imaging (MRI) identified suspicious lesions in the prostate and a left lower quadrant mass. Prostate biopsy confirmed an adenocarcinoma with a Gleason score of 6, while biopsy of the abdominal mass revealed heterotopic splenic tissue. The management strategy included active surveillance for prostate cancer, considering the tumour's low aggressiveness and the benign nature of the splenic tissue.
This case highlights the importance of considering heterotopic splenic tissue in differential diagnosis when evaluating abdominal masses in patients with a history of splenectomy. Accurate diagnosis through careful imaging and biopsy is crucial to avoid misdiagnosis and unnecessary treatments, particularly in patients with concurrent malignancies.
In patients who have had a prior splenectomy for trauma, heterotopic splenic tissue may be mistaken for metastases on MRI.
脾切除术后可出现异位脾组织，通常无症状，常在因其他疾病进行影像学检查时偶然发现。这种良性情况可能会模仿恶性病变，尤其在有癌症病史或并发恶性肿瘤的患者中带来诊断挑战。
我们报告一例60岁男性，有高血压病史且血压控制良好，7岁时因外伤行脾切除术。患者接受常规筛查，结果显示前列腺特异性抗原（PSA）水平升高。随后的磁共振成像（MRI）检查发现前列腺有可疑病变及左下腹肿块。前列腺活检确诊为 Gleason 评分 6 分的腺癌，而腹部肿块活检显示为异位脾组织。鉴于肿瘤侵袭性低及脾组织的良性性质，治疗策略包括对前列腺癌进行积极监测。
该病例强调在评估有脾切除病史患者的腹部肿块时，鉴别诊断中考虑异位脾组织的重要性。通过仔细的影像学检查和活检进行准确诊断对于避免误诊和不必要的治疗至关重要，尤其是在并发恶性肿瘤的患者中。
对于既往因外伤行脾切除术的患者，MRI 上异位脾组织可能被误诊为转移瘤。
