Nhân một trường hợp lách lạc chỗ trong lồng ngực giả dạng u lympho: một thách thức trong chẩn đoán

Abstract

SUMMARY:

Ectopic splenosis is when splenic tissue is not located in its normal anatomical position but is present in various locations throughout the body. This is a rare entity in medical literature, particularly intrathoracic splenosis. Intrathoracic splenosis has nonspecific imaging features and can be easily confused with other diagnoses, posing significant diagnostic challenges. We report a rare case detected at the Quang Tri General Hospital with a confirmed diagnosis of intrathoracic splenosis that was initially misdiagnosed as left thoracic lymphoma.

CASE PRESENTATION:

A 70-year-old male patient was admitted to the hospital for cough and occasional left chest pain, with a history of splenectomy due to trauma. Physical examination revealed no abnormalities, complete blood count showed no signs of infection, tumor markers were not elevated, and a routine chest X-ray was ordered, which revealed a rather subtle lesion originating from the left upper lobe mediastinal pleura. The patient underwent a computed tomography scan for further evaluation, with an initial diagnosis of left pleural tumor. A biopsy of the lesion was performed for histopathology and immunohistochemistry simultaneously, and the results indicated lymphoma. The patient was treated with chemotherapy for over 3 months but did not respond to treatment; after two computed tomography scans, the lesion remained unchanged in morphology, characteristics, and size. The clinical physicians questioned the initial diagnosis and convened a multidisciplinary consultation with the pathologist and radiologist, repeated the immunohistochemistry, and the final result was a case of intrathoracic splenosis.

CONCLUSION: Intrathoracic splenosis is a rare entity in medical literature. Imaging features on routine X-ray, computed tomography, and magnetic resonance imaging are nonspecific and can be easily confused with other pathologies, creating significant challenges for radiologists. This diagnosis should be considered when a patient has a left intrathoracic lesion and a history of splenectomy due to prior trauma.