Korean J Gastroenterol.  2014 Dec;64(6):380-386. 10.4166/kjg.2014.64.6.380.

A Case of Splenic Hamartoma Diagnosed by Contrast-enhanced Ultrasonography and Magnetic Resonance Imaging

• Kim HS
• Kim TH
• Lee JM
• Kim HJ
• Jung WT
• Lee OJ
• Kim JE
• Bae KS

• KMID: 2160672
• DOI: http://doi.org/10.4166/kjg.2014.64.6.380

Abstract

Splenic hamartoma is a very rare benign tumor, which is usually found incidentally after splenectomy or autopsy. Although percutaneous needle biopsy can be performed, it carries a high risk of bleeding after the procedure. Therefore, diagnosis is usually made by surgical resection. Herein, we report a case of splenic hamartoma diagnosed by magnetic resonance imaging and contrast-enhanced ultrasonography, which enables visualization of the unique signals of microbubbles in the vessels in real time. Relevant literature is also reviewed.

Keyword

Splenic hamartoma; Magnetic resonance imaging; Contrast-enhanced ultrasonography

MeSH Terms

Adult
Antigens, CD31/metabolism
Antigens, CD34/metabolism
Contrast Media
Female
Hamartoma/*diagnosis/pathology/ultrasonography
Humans
Immunohistochemistry
Magnetic Resonance Imaging
Splenic Diseases/*diagnosis/pathology/ultrasonography
Tomography, X-Ray Computed
Antigens, CD31
Antigens, CD34
Contrast Media

Figure

• 

  Fig. 1. Abdominal computed tomography scan. (A) Non-enhanced CT scan shows a mass (arrow) that bulges the splenic contour. Contrast-enhanced CT scan shows (B) hetero-genously enhancing mass with several small low density areas (arrow-heads) on artery phase, (C) the density of which becomes similar to the surrounding normal splenic parenchyma on delayed phase. (D) A uterine myoma (arrow) is also seen.

• 

  Fig. 2. Magnetic resonance images. The mass shows iso-signal compared to the splenic parenchyma on transverse fat saturated T2-weighted (A) and T1-weighted (B) images (arrows). Within the mass, focal areas of low signal are seen on T2-weighted image (A). The mass shows heterogenous enhancement on arterial phase (C) and demonstrates relatively homogenous enhancement to the same degree as that of the splenic parenchyma on delayed phase (D). One of the focal low signal areas depicted in A (arrowheads) shows lesser degree of enhancement compared to that of the mass on arterial phase (C), and delayed peripheral enhancement on delayed phase (D). The mass (arrows) shows high signal to the same degree as that of the splenic parenchyma on diffusion-weighted image (E) with corresponding low apparent diffusion coefficient value (F). One of the focal areas depicted in A (arrowheads) shows low signal on diffusion-weighted image (E) with corresponding high apparent diffusion coefficient value (F).

• 

  Fig. 3. B-mode ultrasonography and contrast-enhanced ultrasonography. (A) In upper pole of the spleen, a bulging-contoured hyperechoic mass is seen (arrows) on the transabdominal grayscale ultrasound image. (B) The mass shows avid hyperenhancement (arrows), compared to that of the splenic parenchyma (S) on the arterial phase image obtained 24 seconds after contrast agent injection. (C) The mass demonstrates homogenous enhancement (arrows) to the same degree as that of the splenic parenchyma on the portal venous phase image obtained 70 seconds after contrast agent injection.

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  Fig. 4. Gross and pathological findings. (A) Gross pathologic examination reveals a 8.0×8.0×7.5 cm sized dark brownish mass in upper part of the spleen. (B) Histologic findings show disorganized vascular channels lined by plump endothelial cells (H&E, ×100), (C) which are surrounded by abundant uniform lymphocytes and macrophages (H&E, ×400).

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  Fig. 5. Immunohistochemical staining. The sinuses are positive for CD8 (A, ×200) and CD31 (B, ×200). (C) The capillaries are positive for CD34(×200). (D) The macrophages are positive for CD68 (×200).

Reference

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