Inflammatory pseudotumor of spleen
A 63-year-old woman was admitted in our clinic with abdominal discomfort. She complained of upper left quadrant abdominal pain from 2 years ago. She had past history of nephrolithiasis that was treated by extracorporeal shock wave about 2 years ago; she was a known case of uncontrolled diabetes mellitus and had several resorts to cardiologists for transient chest and abdominal pain. Her paraclinical findings were as follow: Fasting blood sugar was 269 mg/dl, HbA1c was 9.1, T3, T4, Thyroid stimulating hormone, Aspartate transaminase, Alanine aminotransferase, Alkaline phosphatase, Creatinine and Blood urea nitrogen was normal and Hb was 11.9 g/dl. There was no any contributory finding in initial physical examination, so she referred to radiologist for abdominal ultrasonography.\nUltrasonographic investigation revealed hypoechogenic solid mass at inferiomedial pole of spleen that measured 83 mm × 82 mm × 70 mm and cortical cyst of right kidney, thus furthermore abdominal computed tomography (CT) scan was done for her. On CT-scan examination the hypodense mass was shown at central portion of spleen that induced marginal bulging []. There was no calcification and remarkable enhancement. Liver density was low due to fatty change. Other organs were normal there was no lymphadenopathy. With such findings the different diagnosis was primary tumor of spleen, hamartoma and single metastasis, so splenectomy was advised.\nOn surgical operation the spleen with peripheral lymph nodes were removed and send to pathologist.\nOn macroscopic examination, spleen measured 13 × 9 × 7 cm and weighted 370 g. After sectioning a well circumscribed bulging brown colored mass, 8 cm in greatest diameter was identified with softer consistency than splenic tissue [].\nOn microscopic examination, the mass showed diffuse infiltration of fibroblasts and inflammatory cells mainly composed of lymphocytes, significant number of plasma cells, some histiocytes and neutrophils []. Lymph nodes showed follicular hyperplasia with some hemosiderin pigment deposition. This feature was consistent with IPT. For rule out the Hodgkin's lymphoma immunohistochemical study was recommended. The common panel for hodgkin's cells are cluster of differentiation 15 (CD 15) and CD30 positivity but in IPT the background CD3 and CD20 positive lymphocytes are only exist.\nIn immunohistochemical staining the CD15, CD30 and anaplastic lymphoma kinase (ALK1) were negative, CD3 and CD20 were positive in few background inflammatory cells thus Hodgkin's lymphoma was ruled out [].