Inflammatory Myofibroblastic Tumor of the Spleen: A Report of Two Cases

Owing to the lack of typical clinical features and imaging characteristics, inflammatory myofibroblastic tumors (IMT) of spleen can cause diagnostic dilemmas. Here, we report two such cases of splenic IMT. Our first patient was a lady who was detected to have an incidentally splenic lesion characterized as angiosarcoma on CT scan. Splenectomy was done, Immunohistochemistry (IHC) was suggestive of IMT. After four years, follow-up imaging revealed a lesion in the liver, core biopsy was suggestive of metastasis from IMT. She was started on steroids and is on follow-up. Our second patient was an 83 year old gentleman who was detected to have adenocarcinoma sigmoid colon. CT scan revealed a splenic lesion, suggestive of lymphoma or metastasis. Anterior resection and splenectomy was done. IHC of splenic lesion was suggestive of IMT. He is asymptomatic at 9 months follow-up. The two cases of splenic IMT presented us with different challenges in management. In the first case, the patient developed a metachronous lesion in the liver four years after splenectomy, which is a rare occurrence as per literature. In the second case, the co-existence of splenic IMT with adenocarcinoma colon led to suspicion of metastatic disease, we could not find any similar case reported in literature. Thus, although splenic IMT is rare, it can cause significant diagnostic and therapeutic challenges. Surgery is mostly curative, but follow-up is essential in view of possibility of local recurrence and metastasis.