Hepatosplenic sarcoidosis: A case report and literature review

Sarcoidosis is a multisystem granulomatous disease that primarily affects the lungs. Isolated or concurrent hepatosplenic involvement, although not uncommon pathologically, is a rare clinical presentation that poses a significant diagnostic challenge and often mimics malignancy on imaging.

A 55-year-old asymptomatic female was admitted after the incidental discovery of pulmonary nodules during a health checkup.

Preoperative imaging, including contrast-enhanced computed tomography (CT) and fluorodeoxyglucose positron emission tomography/CT, suggested a high likelihood of splenic malignancy. A definitive diagnosis of hepatosplenic sarcoidosis was established after histopathological examination of both the resected spleen and a concurrent liver biopsy, which revealed noncaseating epithelioid cell granulomas.

The patient underwent laparoscopic splenectomy and intraoperative liver biopsy.

The patient's postoperative course was uneventful. Given the absence of symptoms and organ dysfunction, the patient was discharged without specific pharmacotherapy and was regularly monitored. To date, follow-up results have been unremarkable.

This case underscores that hepatosplenic sarcoidosis can mimic malignancy on advanced imaging studies, such as fluorodeoxyglucose positron emission tomography/CT. Therefore, sarcoidosis should be considered in the differential diagnosis of patients with multifocal splenic lesions and concurrent pulmonary nodules. We hypothesize that earlier incorporation of image-guided lesion biopsy into the diagnostic algorithm may improve diagnostic accuracy and avoid more aggressive surgical procedures in patients with multisystem nodular lesions.