Thoracic splenosis masquerading as advanced lung cancer
A 38-year-old man presented with a history of influenza-like symptoms and a persistent dry cough. He had been previously fit and well, other than a road traffic collision 20 years ago, in which he sustained bilateral pneumothoraces, left hemidiaphragm injury with herniation of the stomach into the left hemithorax and splenic injury. He therefore had undergone an emergency laparotomy, splenectomy and repair of the left hemidiaphragm. He was a non-smoker and denied contact with TB or asbestos.
... TB or asbestos. Physical examination was unremarkable other than a laparotomy scar. Chest radiograph showed a large opacity behind the cardiac silhouette suspicious for primary lung cancer ( figure 1A) . CT of the thorax and abdomen confirmed a 41 mm soft tissue mass in the left lower lobe, closely related to the posterior aspect of the left ventricle with no clear fat plane, which was concerning for local invasion ( figure 1B ). There were multiple other pleural-based nodules in the lower left hemithorax, measuring up to 21 mm; no right-sided pulmonary lesions or mediastinal lymphadenopathy were seen. The spleen was absent but further nodules were noted posterior to Figure 1 Chest radiograph showing a large mass behind the cardiac silhouette (A) and CT demonstrating multiple soft tissue pleural nodules in the left hemithorax (B). Figure 2 Multiple pleural nodules were found during video-assisted thoracoscopic surgery surrounded by adhesions in the lower left hemithorax (A) and on microscopy, low power view of the excised lesions showed viable nodules of histologically normal encapsulated splenic tissue demonstrating red and white pulps (B).