A Case of Splenic Sarcoidosis without Extrasplenic Lesions That Is Suffered from Differentiation with Malignant Disease

Kentaro Tasaki, Ikuya Ooshima, Takamitsu Ariga, Seiji Yoshimura, Koichi Shinoto, Yasushi Okazaki, Nobuhiro Morioka, Tetsutaro Sazuka, Masahiko Ozaki and Yukio Kakuta*

Department of Surgery and Department of Surgical Pathology*, Yokohama Rosai Hospital

A 36-year-old man consulted our hospital for abdominal discomfort and nausea. Abdominal US showed multiple hypo echoic lesions which were visualized on enhanced CT as low-density areas in the spleen. Laboratory data, including the serum sIL-2 (324 U/ml), were within normal limits. The SUV on FDG-PET imaging was 4.8, suggestive of malignancy, and we performed open splenectomy under the diagnosis of primary splenic malignant tumor. The removed spleen measured 11×9×4 cm in size, weighted 200 g, and showed multiple yellow-white colored nodules. Histopathologically, a large number of granulomas composed of Langerhans-type multinucleated giant cells and epithelioid cells, and collagen fibers were recognized in the specimen. No nests of caseation necrosis or Hodgkin's cells were recognized, and acid-fast bacterial fluorescent staining and Ziehl-Neelsen staining were negative. Finally, we made the diagnosis of splenic sarcoidosis. The postoperative course of the patient was uneventful, and he was discharged on the 13^th postoperative day. There were no lesions in any other organs, including the lungs, skin or eyes, until the time of writing (1year and 8months after the operation).

Key words
sarcoidosis, spleen, fluorine-18 fluorodeoxyglucose-Positron emission thomography

Reprint requests
Kentaro Tasaki Department of Surgery, Yokohama Rosai Hospital
3211 Kozukue, Kohoku-ku, Yokohama, 222-0036 JAPAN

Accepted
June 18, 2008

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