Epstein–Barr virus-associated inflammatory pseudotumor of the spleen: a case report

Introduction and importance: Epstein–Barr virus (EBV)-associated inflammatory pseudotumor (IPT) of the spleen is an uncommon lesion that can mimic splenic tumors on imaging, making preoperative diagnosis challenging. We report a case of splenic EBV-associated IPT successfully treated with splenectomy. Case presentation: A 74-year-old man was incidentally diagnosed with a splenic mass during routine follow-up computed tomography surveillance for a right lung hamartoma. Laboratory evaluation revealed markedly elevated soluble interleukin-2 receptor levels, and fluorodeoxyglucose positron-emission tomography demonstrated increased uptake within the lesion. As malignancy could not be excluded, splenectomy was performed. Postoperative histopathological examination confirmed an EBV-associated IPT in the spleen. The postoperative course was uneventful, and the patient remained recurrence-free during follow-up. Clinical discussion: Splenic EBV-associated IPT is exceedingly rare and lacks specific imaging findings. Elevated soluble interleukin-2 receptor levels and increased 18 F-fluorodeoxyglucose uptake may further complicate differentiation from malignant tumors. Consequently, definitive preoperative diagnosis is often difficult. Surgical resection is frequently required to establish the diagnosis and exclude malignancy. Although outcomes following complete resection are generally favorable, careful postoperative surveillance remains advisable because recurrence and metastasis have been reported in related EBV-associated lesions, particularly IPT-like follicular dendritic cell tumors. Conclusion: Splenic EBV-associated IPT should be considered in the differential diagnosis of splenic masses with indeterminate imaging findings. Because preoperative diagnosis is difficult, surgical resection may be warranted when malignancy cannot be excluded, as it can provide both a definitive diagnosis and treatment.