Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2020; 12(10): 435-441
Published online Oct 27, 2020. doi: 10.4240/wjgs.v12.i10.435
Gastric splenosis mimicking a gastrointestinal stromal tumor: A case report
Claudio Isopi, Giulia Vitali, Federica Pieri, Leonardo Solaini, Giorgio Ercolani
Claudio Isopi, Giulia Vitali, Leonardo Solaini, Giorgio Ercolani, Department of Surgery, Morgagni-Pierantoni Hospital, Forli 47121, Italy
Federica Pieri, Pathology Unit, Morgagni-Pierantoni Hospital, Forli 47121, Italy
Leonardo Solaini, Giorgio Ercolani, Department of Medical and Surgical Sciences, University of Bologna, Bologna 47100, Italy
Author contributions: Isopi C and Vitali G reviewed the literature and drafted the manuscript in consultation with Solaini L and Ercolani G; Isopi C and Vitali G are joint first authors; Pieri F performed the final pathology; Pieri F, Solaini L and Ercolani G critically revised the manuscript; All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Leonardo Solaini, MD, Assistant Professor, Department of Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, Forli 47121, Italy.
Received: June 30, 2020
Peer-review started: June 30, 2020
First decision: July 30, 2020
Revised: August 13, 2020
Accepted: September 14, 2020
Article in press: September 14, 2020
Published online: October 27, 2020
Processing time: 118 Days and 11.6 Hours

Mass lesions located in the wall of the stomach (and also of the bowel) are referred to as “intramural.” The differential diagnosis of such lesions can be challenging in some cases. As such, it may occur that an inconclusive fine needle aspiration (FNA) result give way to an unexpected diagnosis upon final surgical pathology. Herein, we present a case of an intramural gastric nodule mimicking a gastric gastrointestinal stromal tumor (GIST).


A 47-year-old Caucasian woman, who had undergone splenectomy for trauma at the age of 16, underwent gastroscopy for long-lasting epigastric pain and dyspepsia. It revealed a 15 mm submucosal nodule bulging into the gastric lumen with smooth margins and normal overlying mucosa. A thoraco-abdominal computed tomography scan showed in the gastric fundus a rounded mass (30 mm in diameter) with an exophytic growth and intense enhancement after administration of intravenous contrast. Endoscopic ultrasound scan showed a hypoechoic nodule, and fine needle FNA was inconclusive. Gastric GIST was considered the most probable diagnosis, and surgical resection was proposed due to symptoms. A laparoscopic gastric wedge resection was performed. The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. The final pathology report described a rounded encapsulated accumulation of lymphoid tissue of about 4 cm in diameter consistent with spleen parenchyma implanted during the previous splenectomy.


Splenosis is a rare condition that should always be considered as a possible diagnosis in splenectomized patients who present with an intramural gastric nodule.

Keywords: Splenosis, Intramural gastric mass, Gastric nodule, Laparoscopic gastric surgery, Gastrointestinal stromal tumor, Case report

Core Tip: Intramural gastric nodules are rare, but all differential diagnoses must always be considered. If feasible, a preoperative fine needle aspiration can help the surgeon in selecting the best treatment option. Splenosis is uncommon in the general population, but it must be considered in each patient with a history of splenectomy (especially after trauma). In this specific cluster it is reasonable to insist on ruling out splenosis even making a second histologic sampling after a first failure.