Unexpected diagnosis at laparotomy: intrahepatic splenosis mimicking hepatocellular carcinoma – a case report

Introduction: Intrahepatic splenosis (IS) is a rare benign condition developing after splenic tissue autotransplantation, usually post-trauma or splenectomy. In HBV-infected patients, it can mimic hepatocellular carcinoma (HCC), leading to misdiagnosis and unnecessary surgery. Presentation of case: A 42-year-old man with chronic HBV infection and prior splenectomy had a 4-cm hepatic lesion with arterial enhancement and venous washout, consistent with HCC. Laparotomy revealed a dark-purple mass and diaphragmatic nodules; frozen and histopathology confirmed splenic tissue. The patient recovered well and remained recurrence-free after 1 year. Discussion: IS should be considered in patients with previous splenectomy and hepatic masses to avoid misdiagnosis. Noninvasive imaging such as Tc-99m-labeled RBC scintigraphy can prevent unnecessary resections. Conclusion: Increasing awareness of IS may help prevent unnecessary liver resections in similar cases.