PMC9716949_01
Imaging results of case 1. (A) Abdominal US imaging found a calcified heterogeneous vascularized central splenic mass (arrows) with a maximal diameter of 7 cm. (B) MRI showed a splenic vascular tissular lesion with a maximal diameter of 7 cm (arrows) that had an iso-intense signal on T2 sequence and a progressive signal enhancement of the central portion after injection. US, ultrasonography.
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F1
Abdominal US imaging found a calcified heterogeneous vascularized central splenic mass with a maximal diameter of 7 cm (figure 1A). T2 sequence and a progressive signal enhancement of the central portion after injection (figure 1B). Two weeks prior to surgery, she was vaccinated against Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.
The gross examination of the spleen extracted without morcellation in case 1. The spleen weighed 450 g and measured 12x9x5 cm.
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F2
On gross examination, the spleen weighed 450 g and measured 12x9x5 cm (figure 2).
Histopathological results of case 1. (A) Histological (HES x100). The histological examination showed a well-demarcated multinodular lesion respecting the surrounding borders of the splenic parenchyma. The lesion was surrounded by a reactive fibrous tissue. (B) Immunohistochemical (immunohistochemistry x100). The immunohistochemical staining showed that cells expressed SMA. HES, hematoxylin and eosin stain; hSMA, smooth muscle actin.
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F3
The lesion was surrounded by a reactive fibrous tissue and was mainly composed of proliferative fusiform cells without cytonuclear or mitotic anomalies (figure 3A). CD31 and smooth muscle actin (figure 3B), vessels most often expressed CD34 and/or CD31 whereas CD8 showed only rare sinuses trapped within these nodules. CD21, anaplastic lymphoma kinase (ALK) protein detection and in situ hybridization for the presence of Epstein-Barr virus-encoded small RNA were negative.
PMC9716949_02
Imaging results of case 2. Ultrasonography showed a heterogeneous tissular intrasplenic mass (arrows), located on the lower pole of the spleen and measured 3 cm of maximal diameter.
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F4
He was referred to our department after an incidental finding of a heterogeneous tissular intrasplenic mass (figure 4) found on ultrasound performed by pediatricians.
The gross examination of the resected spleen showed two fragments measuring respectively 6.5x4x3 cm and weighed 29 g with cystic architecture, 3x3x2 cm weighing 13 g with homogenous nodular aspect (arrows) in case 2.
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F5
The gross examination of the resected spleen showed two fragments measuring respectively 6.5x4x3 cm and weighed 29 g with cystic architecture, 3x3x2 cm weighing 13 g with homogenous nodular aspect (figure 5).
Histopathological results of case 2. (A) Histological (HES x200). The histological analysis showed many confluent fibrotic nodules centered by vessels, associated by plasma cells, lymphocytes and macrophages. (B) Immunohistochemical (immunohistochemistry x400). The immunohistochemical examination showed positive staining with CD31 and CD34 by these vessels, while macrophages stained positive with CD68 and CD163.
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F6
The histological analysis showed many confluent fibrotic nodules centered by vessels, associated with plasma cells, lymphocytes and macrophages (figure 6A). The immunohistochemical examination showed positive staining with CD31 and CD34 (figure 6B) by these vessels, while macrophages stained positive with CD68 and CD163.