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Special Feature |

Image of the Month—Quiz Case FREE

Shankar R. Raman, MD, MRCS; Vellore S. Parithivel, MD; Masooma Niazi, MD
[+] Author Affiliations

Author Affiliations: Departments of Surgery and Pathology, Bronx-Lebanon Hospital Center, Bronx, New York.


Section Editor: Carl E. Bredenberg, MD


Arch Surg. 2010;145(2):205. doi:10.1001/archsurg.2009.279-a.
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Published online

A 50-year old-man presented to the clinic with pain in the left upper quadrant of the abdomen of approximately 4 months’ duration. His medical history included hypertension that was well controlled by medication. The patient denied any other symptoms. On physical examination there were no pertinent findings, specifically, no splenomegaly, hepatomegaly, or lymphadenopathy. Laboratory data were also within the reference limits.

A computed tomographic scan showed a 5.5 × 4.5-cm solid area in the spleen (Figure 1) that had grown in size over 3 months. The spleen showed decreased attenuation in the arterial phase. The lesion remained persistently photopenic on nuclear imaging. Despite intensive evaluation, the nature of the splenic neoplasm was not clear. As the patient was symptomatic and the lesion was increasing in size, the patient was scheduled for laparoscopic splenectomy after preoperative immunization.

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Figure 1

Splenic lesion on a computed tomographic scan.

Graphic Jump Location

The patient had a successful laparoscopic splenectomy with intact removal of the spleen. The lesion is shown in Figure 2.

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Figure 2

Cut surface of the spleen showing a bosselated mass with multiple dark brown nodules interspersed with stellate whitish fibrotic stroma.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Epithelioid hemangioendothelioma

B. Metastasis

C. Sclerosing angiomatoid nodular transformation

D. Kaposi sarcoma

Figures

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Figure 1

Splenic lesion on a computed tomographic scan.

Graphic Jump Location
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Figure 2

Cut surface of the spleen showing a bosselated mass with multiple dark brown nodules interspersed with stellate whitish fibrotic stroma.

Graphic Jump Location

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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