Table 1.
Summary of 59 reported cases of intrahepatic splenosis from 1939 to 2019
| No. | Year | First author | Age/ Sex | Reason for splenectomy | Time* (years) | Risk factor for HCC | Clinical presentation | Laboratory investigations# | No. of lesions | Location | Size (cm) | Initial diagnosis | Confirmatory diagnosis |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 1993 | Yoshimitsu [8] | 51/F | Banti syndrome | 23 | Cirrhosis | Asymptomatic | ALP elevated | 1 | S3 | 2.5 | HCC | Surgery (liver resection) |
| 2 | 1997 | Gruen [9] | 38/F | Trauma | 20 | Fatty liver | Asymptomatic | ALT, AST, ALP, bilirubin elevated | 1 | S3, S4 | 3.9 | HCC/FNH | Surgery (liver resection) |
| 3 | 1998 | D’Angelica [10] | 38/F | Trauma | 20 | Alcohol | Asymptomatic | ALT, AST, ALP, GGT, bilirubin elevated | 1 | S3, S4 | 2.5 | Adenoma/FNH | Surgery (liver resection) |
| 4 | 1999 | Foroudi [11] | 59/F | NM | 47 | Nil | Upper abdominal pain and back pain | Normal | Multiple | Right lobe | NM | Liver metastasis | Tc-99m DRBC |
| 5 | 2000 | De Vuysere [12] | 50/M | Trauma | 34 | Nil | Epigastric pain | Normal | Multiple | S2 | 6 | Hepatic splenosis | Surgery (biopsy) |
| 6 | 2002 | Gamulin [13] | 49/M | Trauma | 37 | Nil | Asymptomatic | Normal | 1 | Left lobe | 6.6 × 4.2 | B-cell lymphoma | Surgery (explorative laparotomy) |
| 7 | 2002 | Lee [14] | 43/M | Trauma | 20 | HBV Cirrhosis | Asymptomatic | Normal, except for INR | 1 | S6 | 3.5 | HCC | Surgery (liver resection) |
| 8 | 2002 | Pekkafali [15] | 21/M | Trauma | 15 | Nil | Epigastric pain | Normal | 1 | Left lobe | 3.4 × 2.3 | Hepatic splenosis | Tc-99m DRBC |
| 9 | 2003 | Kim [16] | 43/M | Trauma | 21 | HBV Cirrhosis | Asymptomatic | Normal | 1 | S6 | 3 | HCC | Surgery (liver resection) |
| 10 | 2004 | Di Costanzo [17] | 58/M | Trauma | 46 | HBV Cirrhosis | Abdominal pain | AFP elevated | 1 | S2 | 4.8 | HCC | Needle biopsy, Tc-99m DRBC |
| 11 | 48/F | Trauma | 41 | HCV Cirrhosis | Asymptomatic | ALT, AST and AFP elevated | 1 | S3 | 3.1 | HCC | US-guided biopsy | ||
| 12 | 2004 | Kondo [18] | 55/M | Trauma | 31 | HCV | Asymptomatic | NM | 1 | S7 | 3.5 | HCC/FNH/ haemangioma | US-guided percutaneous biopsy |
| 13 | 2006 | Ferraioli [19] | 40/M | Trauma | 28 | HCV | Asymptomatic | Normal | 1 | S7 | 6 × 3.1 | Hepatic splenosis | US-guided biopsy |
| 14 | 2008 | Choi [20] | 32/M | Trauma | 26 | HBV carrier | Asymptomatic | AST elevated | Multiple | S4a, S6 | 1.0-3.0 | HCC | Surgery (explorative laparotomy) |
| 15 | 2008 | Grande [21] | 41/M | Trauma | 35 | Nil | Asymptomatic | Normal | Multiple | S7 | 0.5-4.5 | Hepatic splenosis | Tc-99m DRBC |
| 16 | 2008 | Imbriaco [22] | 39/M | Trauma | 24 | Nil | Abdominal pain | NM | Multiple | Left and right lobes, pancreatic tail, adjacent to upper pole of left | 3.0 | Neoplasm | Surgery (explorative laparotomy) |
| 17 | 2008 | Lu [23] | 59/M | Trauma | NM | HBV | Asymptomatic | Normal | Multiple | S7, left lobe | 1.2-2.2 | Hepatic splenosis | Tc-99m DRBC |
| 18 | 2008 | Nakajima [24] | 41/M | Trauma | 21 | Nil | Incidental finding on work-up for acute enteritis | NM | 1 | S6 | NM | Hepatic splenosis | US-guided biopsy |
| 19 | 2008 | Yeh [25] | 64/M | Trauma | 8 | HCV | Asymptomatic | ALT, AST elevated | 1 | S6 | 2.5 | HCC | Surgery (liver resection) |
| 20 | 2009 | Hilal [26] | 60/M | Trauma | 46 | Cirrhosis | Flu-like symptoms, loss of weight, loss of appetite | LFT deranged, AFP elevated | Multiple | S7 | 2 × 2.5 and 4.5 | HCC | Explorative laparoscopy |
| 21 | 2009 | Kashgari [27] | 52/M | Trauma | 30 | HCV Cirrhosis | Asymptomatic | ALT, AST elevated | 1 | S7 | 2.1 × 1.5 | HCC | US-guided biopsy |
| 22 | 2009 | Menth [28] | 43/M | Trauma | 25 | HCV Cirrhosis | Asymptomatic | ALT, AST elevated | Multiple | S2 | 0.4-3.6 | HCC | Tc-99m DRBC |
| 23 | 2009 | Yu [29] | 54/M | Trauma | 20 | Nil | Asymptomatic | Normal | 1 | S2 | 4 | Uncertain | Surgery (liver resection) |
| 24 | 2010 | Mescoli [30] | 68/F | No splenectomy | NA | Cirrhosis | Abdominal pain | NM | Multiple | S3, S5, S7 | 6.2-11 | FNH/ haemangioma | Percutaneous biopsy |
| 25 | 54/M | Iatrogenic | 12 | Nil | Asymptomatic | NM | 1 | Left lobe | 3 | Liver metastasis | Surgery (explorative laparotomy) | ||
| 26 | 2010 | Tsitouridis [31] | 63/M | Trauma | 20 | Nil | RUQ pain | NM | 1 | Left lobe | 8 | Splenosis | CT-guided biopsy |
| 27 | 64/M | Gastric leiomyo-sarcoma | 1.5 | Nil | Asymptomatic | NM | 1 | NM | 5 | Peritoneal implantation | CT-guided biopsy | ||
| 28 | 2011 | Kang [32] | 54/M | Trauma | 15 | Nil | Asymptomatic | Normal | 2 | S2 | 0.7 × 0.6, 2.3 × 1.9 | Liver metastasis | Surgery (liver resection) |
| 29 | 2012 | Li [33] | 61/M | Trauma | NM | Nil | Asymptomatic | NM | Multiple | NM | NM | Hepatic splenosis | Needle biopsy |
| 30 | 2012 | Liu [7] | 38/M | Trauma | 14 | HBV | Asymptomatic | Normal | 1 | S2 | 3.3 × 2.7 | Liver tumour | Surgery (laparoscopic resection) |
| 31 | 2013 | Inchingolo [34] | 53/M | Trauma | 33 | NASH | Asymptomatic | GGT elevated | 1 | S3 | 3.5 | HCC/adenoma | Surgery (laparoscopic converted to open liver resection) |
| 32 | 2013 | Krawczyk [35] | 39/F | Trauma | NM | Nil | Abdominal pain | NM | 2 | S2, adjacent to major curvature of stomach | 3.2 × 2.0 | Adenoma | Tc-99m DRBC |
| 33 | 2013 | Leong [36] | 56/M | Trauma | NM | Nil | Chronic epigastric pain | NM | 1 | S3 | 3.7 × 4.6 × 3.1 | Carcinoid neuroendocrine tumour | Surgery (liver resection) |
| 34 | 2014 | Kandil [37] | 45/F | Haemolytic anaemia | 20 | HCV | Chronic abdominal pain | Normal | 1 | Left lobe | 5 × 4 | HCC | Surgery (explorative laparotomy) |
| 35 | 2014 | Sato [38] | 58/M | No splenectomy | NA | HCV Cirrhosis | Asymptomatic | ALT, AST, AFP elevated | 1 | Right lobe | 3.9 × 3 | HCC | Surgery (liver resection) |
| 36 | 2014 | Tinoco Gonzalez [39] | 60/M | Trauma | NM | HCV | Asymptomatic | NM | 1 | S3 | 4.8 | HCC/ Adenoma | Surgery (liver resection) |
| 37 | 2015 | Grambow [40] | 53/M | Trauma | 9 | Alcohol Cirrhosis | Incidental finding due to refractory ascites secondary to decompensated cirrhosis | Normal | 1 | S3, S4b | 3.5 | HCC | Surgery (laparotomy) |
| 38 | 2015 | Li [41] | 67/F | Trauma | 5 | HCV Cirrhosis | Asymptomatic | LFT deranged, AFP elevated | 1 | Left lobe | NM | HCC | Surgery (explorative laparotomy) |
| 39 | 2015 | Liu [6] | 33/M | Trauma | 30 | Nil | Asymptomatic | Normal | Multiple | Left and right lobes | 4.2 × 3.0 | HCC | FNA biopsy |
| 40 | 2015 | Tamm [42] | 43/M | Trauma | NM | Nil | RUQ pain | NM | 1 | S3 | 2.8 | Nil | Tc-99m DRBC |
| 41 | 2015 | Toktas [43] | 40/F | Idiopathic thrombocytopenic purpura | 7 | Nil | Asymptomatic, persistent low platelets | NM | 1 | S2/S3 | 7.0 × 3.0 | Nil | Surgery (liver resection) |
| 42 | 2015 | Wu [44] | 33/M | Trauma | 12 | Nil | Asymptomatic | Bilirubin elevated | 1 | S2 | 3.5 × 2.0 | HCC | Surgery (explorative laparotomy) |
| 43 | 2016 | Fung [45] | 55/M | Trauma | 37 | Nil | Asymptomatic | Normal | 2 | S6, S7 | 2.27 × 3.04 and 1.15 × 1.21 | Nil | Surgery (liver resection) |
| 44 | 2016 | Chen [46] | 51/M | Trauma | 20 | Nil | Asymptomatic | NM | 2 | Left and right lobes | 2.1; 3.3 × 2.6 | HCC | US-guided biopsy |
| 45 | 2016 | Jereb [47] | 22/M | Trauma | 18 | Nil | Asymptomatic | Normal | Multiple | S2, S6, S7 | 2.6 | Liver metastases | Surgery (explorative laparoscopy) |
| 46 | 2017 | Keck [48] | 66/M | NM | NM | Chronic HCV | Asymptomatic | Normal | Multiple | S7, S8 | 5.3 | Nil | Needle biopsy |
| 47 | 2017 | Somsap [49] | 51/M | Thalassemia | 20 | Nil | Abdominal pain | ALT, AST, bilirubin elevated | 1 | Left lobe | NM | HCC | Surgery (liver resection) |
| 48 | 2017 | Wang [5] | 54/M | Trauma | 23 | Chronic HBV | RUQ pain | Normal | 1 | Right lobe | 3.9 × 3.6 | HCC | Surgery (liver resection) |
| 49 | 2017 | Wang [50] | 42/M | Trauma | 16 | HBV, HCV, fatty liver | Chronic low back pain | Normal | 1 | S4 | 2.3 × 1.8 | HCC | Surgery (liver resection) |
| 50 | 2018 | Aramoana [51] | 58/M | Trauma | 37 | Nil | RUQ pain | Normal | 1 | S6 | 4.6 × 3.4 | HCC | Surgery (liver resection) |
| 51 | 2018 | Budak [52] | 46/M | Trauma | 30 | Nil | NM | NM | 2 | S6, S7 | 3.6 | HCC/hepatic splenosis | Tc-99m DRBC |
| 52 | 2018 | Guzman [53] | 43/M | Trauma | 16 | Nil | Acute RUQ pain | ALT, AST elevated | 1 | S2 | 2.5 | Adenoma | Percutaneous needle biopsy |
| 53 | 2018 | Smolen [54] | 35/M | Trauma | 12 | Nil | Chronic abdominal pain | Normal | Multiple | Left and right lobes | 4.3 | Adenoma/FNH | Tc-99m DRBC |
| 54 | 2018 | Teles [55] | 73/M | NM | NM | Nil | Low back pain | CEA elevated | Multiple | Left and right lobes, lumbar spine | 4.9 | Primary or secondary neoplasia | Surgery (open liver resection) |
| 55 | 2018 | Varghese [56] | 50/M | Trauma | 40 | Nil | Asymptomatic | NM | 1 | Right lobe, multiple extrahepatic nodules | 3.0 | Nil | Contrasted CT scan resembling splenic enhancement and clinical judgement |
| 56 | 2018 | Vergara [57] | 69/M | Trauma | NM | Nil | RUQ pain, dyspnoea, lower limb oedema | Normal | Multiple | S6, near falciform ligament, left para-vesical space | 6.5 × 4.6 | Nil | Needle biopsy |
| 57 | 2018 | Xuan [58] | 54/M | Trauma | 5 | Nil | Asymptomatic | Normal | 1 | S4 | 4.5 × 3.3 | HCC | Surgery (liver resection) |
| 58 | 2019 | Guedes [59] | 68/M | Trauma | 44 | Nil | Chronic epigastric and right hypochondrium pain | Normal | 1 | S6 | 3.0 | HCC/Adenoma | Surgery (laparoscopic liver resection) |
| 59 | 2019 | Luo [4] | 41/M | Trauma | 21 | Nil | Asymptomatic | 1 | Right lobe | NM | HCC | Surgery (explorative la |
AFP – α-fetoprotein, ALP – alkaline phosphatase, ALT – alanine aminotransferase, AST – aspartate aminotransferase, CT – computed tomography, F – female; FNA – fine needle aspiration, FNH – focal nodular hyperplasia, GGT – γ-glutamyltransferase, HCC – hepatocellular carcinoma, INR – international normalized ratio, LFT – liver function test, M – male, NA – not applicable, NM – not mentioned, RUQ – right upper quadrant, S1-S7 – segments I to VII of the liver, Tc-99m DRBC – technetium-99m-tagged heatdamaged red blood cell scan, US – ultrasound
*
Time (years) refers to the interval after splenectomy to discovery of intrahepatic splenosis
#
Laboratory investigations refer to basic liver function test and tumour marker (AFP). Hepatitis B and C serology is not included