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Splenosis, a form of ectopic splenic tissue, is generally caused by heterotopic autotransplantation of splenic tissues after traumatic splenic rupture or splenectomy. The implants are often localized intraperitoneally, mostly in the left upper quadrant and splenic region. Hepatic foci are seen only on rare occasions. The differential diagnosis of splenosis foci from malignant masses can be challenging by conventional imaging and lead to unnecessary invasive procedures. This manuscript presents radiological and scintigraphic images of splenosis foci located in the peritoneal cavity and liver capsule of a 46-year-old man who underwent splenectomy due to traumatic splenic rupture 30 years ago.

Background: Splenosis is a benign and relatively uncommon condition caused by trauma or splenectomy or other procedures involving splenic tissue. It is usually asymptomatic, and often diagnosed accidentally, especially misdiagnosed as malignant tumor., Methods: A 54-year-old man with prior history of chronic hepatitis B virus infection and underwent splenectomy for traumatic splenic rupture following a traffic accident 23 years previously was admitted to our hospital and found a hepatic mass in the right upper quadrant during an imaging examination. The diagnosis of his was not clear and finally he agreed to receive a surgical treatment., Results: During the operation, we found a mass in the right posterior lobe of the liver and a hard nodule on the right side of the diaphragm, both were completely resected, and postoperative histopathologic examination revealed that all excised tissues were proved to have histological structure typical for the spleen., Conclusions: The occurrence of intrahepatic splenosis is rare with only few cases previously reported in the literature. It is a benign disease and sometimes difficult to distinguish from diseases of the liver. The need for positive surgical resection of splenosis is still controversial., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Hepatic splenosis, one type of manifestation of ectopic spleen tissue, is rarely reported. It cannot be distinguished from hepatic malignancies because of lack of significant radiological features. By means of this case report and 31 literature reviews, potential treatment modalities concerning clinical diagnostics, patient's management could be discussed.The report presents the case of a 33-year-old man with a liver lesion. Finally, after a mini-incision laparotomy, the lesion was resected and the diagnosis confirmed it as hepatic splenosis. A literature search for case reports published between January 1, 1900, and August 1, 2014, was performed on PubMed.Approximately 80% (27/34) of patients diagnosed with hepatic splenosis had a history of splenectomy. The mean time interval between splenectomy and hepatic splenosis detection was 25 (1.5-47) years. The median size of reported hepatic splenosis is 30  mm in diameter. Technetium-99m-labeled heat denatured red-blood-cells scintigraphy or superparamagnetic iron oxide-enhanced magnetic resonance imaging is now considered to be the optimal method of diagnosing splenosis.Hepatic splenosis requires no treatment in most cases. Operation should be performed if it is accompanied by hypersplenism in hematological diseases. When the diagnosis remains unclear, further biopsy or laparoscopy is recommended. If hepatic splenosis is confirmed, careful follow-up is beneficial.

When a 32-year-old man was 18 a traffic accident caused splenic rupture, for which he underwent splenectomy, complicated postoperatively by hepatitis. As part of routine follow-up with his family doctor for chronic hepatitis C, a hepatic tumor was detected on plain abdominal computed tomography (CT), and he was admitted to our hospital for further investigation and treatment. Based on the results of abdominal dynamic CT, abdominal magnetic resonance imaging(MRI), abdominal angiography, CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP), we performed a laparotomy for suspected hepatocellular carcinoma. The operative findings were a 40 mm dark purple-brown nodule on the surface of the S7 segment of the liver, as well as multiple nodules, less than 20 mm in size but otherwise of similar appearance, scattered over the abdominal viscera and peritoneum, in particular the greater omentum. A hepatectomy was not performed, as we considered this to be a case of intrahepatic splenosis, so the abdomen was closed after a liver biopsy was taken. Histopathological examination of this specimen confirmed the diagnosis. As there have been only 19 previous reported cases of intrahepatic splenosis, we hereby present this valuable case with a review of the literature.

Intrahepatic splenosis is a rare disorder of ectopic erythropoiesis in the liver. Although traumatic splenic rupture is the common factor in public cases, the mechanism of long latency is still unknown. The correlation between aging and hepatitis virus infection with the diagnosed occurrence was reported in a limited number of cases; nevertheless, it suggested that ectopic erythropoiesis in the liver could be induced by the hepatic disorder. Based on the susceptibility of the splenic erythropoiesis response to hypoxia and the inevitability of hypoxia caused by aging or pathological changes, we hypothesized that the two events caused the occurrence of the intrahepatic splenosis, the migration of the erythrocytic progenitor cells via the portal vein following traumatic splenic rupture, and the local induction of erythropoiesis by hypoxia.

Splenosis is characterized by a presence of islets of the splenic tissue in the abdominal and, rarely, also in the thoracic cavity, most frequently as a consequence of the splenic injury. The authors describe a case of splenosis in a patient followed-up after surgery and radiotherapy for the testicular seminoma and who, 42 years ago, had splenectomy for polytrauma. With respect to the location of the splenosis in the hepatic region, the differential diagnosis was difficult, bearing in mind a possibility of the malignancy relaps. Although splenosis was highly suspected, based on the results of the examinations conducted, with respect to the preexisting malignancy, the tumor was excised. The histopathologist confirmed the diagnosis of splenosis. This case is rare in the literature, considering the time gap between the diagnosis of splenosis and the trauma.