Hamartoma lách được chẩn đoán và điều trị bằng phẫu thuật nội soi cắt lách kết hợp tiếp cận qua đường mổ tối thiểu trên xương mu

Ultrasonography findingsCollateral vessels were seen (A, purple arrows), and splenomegaly (143×65 mm) was observed (B). A hypoechoic splenic mass measuring 70×55 mm was detected incidentally (C, D, yellow arrows). This regularly shaped lesion involved a cystic component (C, blue arrow). The solid component showed hypervascularity with Doppler ultrasonography (E, F).

Tumor size during imaging performed 6 years prior to presentation at our hospitalThe splenic mass measured 13 mm 6 years prior to presentation at our hospital (yellow arrows). The blue arrow indicates the cystic lesion.

Contrast-enhanced computed tomography findingsThe splenic tumor consisted of a solid component (yellow arrows) and a cystic lesion (blue arrows). Imaging clearly shows homogeneous and strong enhancement in the early phase (A, B, D, E), with prolonged strong enhancement in later phases (C, F).

Three-dimensional magnetic resonance imaging findingsThe estimated splenic volume was 650.7 mL with computed tomography volumetry. Collateral vessels are visible around the splenic hilum (A, B, purple arrows). In T2-weighted imaging, the solid component (yellow arrows) and cystic lesion (blue arrow) both show relatively high intensity (C).

Magnetic resonance imaging findingsIn T2-weighted imaging, the solid component (yellow arrows) and cystic lesion (blue arrow) both show relatively high intensity (A, B). In T1-weighted imaging gradient-echo sequences, neither the opposed-phase (C, D) nor the in-phase (E, F) show the solid component.

T2-weighted and high b-factor diffusion-weighted magnetic resonance imaging findingsImages (b-values 0–800 s/mm2) demonstrate no positive enhancement in the solid component of the lesion (A–D, yellow arrows).The solid component also shows no signal suppression in the apparent diffusion coefficient map (E, F, yellow arrows).

Initial surgical proceduresAn incision was created in the umbilicus for the camera port, and 3 working ports were placed (A). A large splenic tumor is visible intraoperatively (B–E, yellow arrows). The splenic artery (SA) and splenic vein (SV) were both skeletonized distally (B, C). To control intraoperative bleeding from the spleen and to shrink the spleen for subsequent removal through the abdominal wall, the SA was ligated before the SV (D, E). The spleen was mobilized from the retroabdominal space by cutting the connective tissue (F, green dotted arrows).

Additional surgical proceduresThe spleen was caught in the containment bag (A). A transverse skin incision was made cranially at the pubic bone, and the mouth of the containment bag was introduced extraperitoneally through the abdominal wall. The containment bag was opened, and the stump of the splenic vein (SV) was cut within the bag (B). Blood in the resected spleen was then removed to further shrink the spleen, and an intraperitoneal drain was placed through the port incision (C).

Histopathological findingsThe splenic tumor (yellow arrows) consisted of a solid component and a cystic lesion (A, B). Histopathological findings are shown with hematoxylin and eosin staining at ×40 (C) and ×200 (D) magnification. A mixture of unorganized vascular channels and fibrotic cords of splenic red pulp-like area were clearly observed in hematoxylin and eosin stain (D).