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

Hyeon Sik Kim; Tae Hyo Kim; Jae Min Lee; Hyun Jin Kim; Woon Tae Jung; Ok Jae Lee; Ji Eun Kim; Kyung Soo Bae

doi:10.4166/kjg.2014.64.6.380

Journal List > Korean J Gastroenterol > v.64(6) > 1007316

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Kim, Kim, Lee, Kim, Jung, Lee, Kim, and Bae: A Case of Splenic Hamartoma Diagnosed by Contrast-enhanced Ultrasonography and Magnetic Resonance Imaging

Case Report

Korean J Gastroenterol 2014;64(6):380-386.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.6.380

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

Hyeon Sik Kim¹, Tae Hyo Kim^1,³, Jae Min Lee¹, Hyun Jin Kim^1,³, Woon Tae Jung^1,³, Ok Jae Lee^1,³, Ji Eun Kim², Kyung Soo Bae²

¹Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea

²Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea

³Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea

Correspondence to: Tae Hyo Kim, Department of Internal Medicine, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 660-702, Korea. Tel: +82-55-750- 8726, Fax: +82-55-755-9078, E-mail: kimthy@medimail.co.kr

Received 29 April 201428 May 2014 Accepted 28 May 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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Keywords: Splenic hamartoma, Magnetic resonance imaging, Contrast-enhanced ultrasonography

References

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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.

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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).

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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).

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Table 1.

Dynamic Imaging Features of MRI and Contrast-enhanced Ultrasonography (CEUS) in the Splenic Lesion^7-15

Type of lesion	MRI				CEUS
Type of lesion	T1	AP	LP	T2	NC	AP	LP
Hamartoma	Iso or hyperintense	Diffuse heterogenous enhancing	More uniformly enhancing	Heterogenous hyperintense or hypointense ^b	Mild hyperechoic	Diffuse hyperenhancing	Prolonged hyperenhancing
Hemangioma ^a	Iso or hypointense	Early peripheral nodular enhancing	Homogenous enhancing	Homogenous, hyperintense	Homogenous hyperechoic	Peripheral nodular enhancing	Still hyperenhancing
Malignancy	Hypointense	Hypoenhancing	Hypoenhancing	Heterogenous hypointense	Mainly hypoechoic	Heterogenous hypoenhancing	Distinct hypoenhancing (rim-like, dotted)

AP, arterial phase; LP, late phase; NC, non-contrast.

^a Rare calcification and no fatty component;

^b fibrous type.

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