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Correspondence
First case of spontaneous myospherulosis of the liver
  1. Veit Phillip1,
  2. Karen Becker2,
  3. Jochen Gaa3,
  4. Jörg Kleeff4,
  5. Roland M Schmid1,
  6. Monther Bajbouj1
  1. 1II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
  2. 2Institut für Allgemeine Pathologie und Pathologische Anatomie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
  3. 3Institut für Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
  4. 4Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
  1. Correspondence to Dr Veit Phillip, II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 85176 München, Germany; phillip{at}lrz.tum.de

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Introduction

Myospherulosis is a rare interaction of extravasated erythrocytes and lipids, resulting in the degeneration of erythrocytes, which are subsequently enclosed by a lipid membrane. Thus, histologically typical, saccular parent bodies containing variable numbers of approximately 6 µm spherules are formed.1 The lesions are usually small (few millimetres to few centimeters) and do not cause any symptoms except swelling at the involved site. Differential diagnoses include carcinomas, metastases, osteofibrosis or echinococcosis due to alikeness in radiographic imaging and morphology. In addition, myospherulosis can be misdiagnosed as infections by fungi or algae due to histopathological similarity.2 In most cases, myospherulosis is caused by iatrogenic exposure to petroleum-based material, however, rare cases without exogenic lipid exposure have been described, and only one case of hepatic myospherulosis following portal vein embolisation has been published.3–7 To the best of our knowledge, this is the first case of spontaneous myospherulosis of the liver parenchyma presenting with an exceptional size.

Case report

A 76-year-old female patient (height, 165 cm; weight, 78 kg; body mass index, 28.7 kg/m2) presented without any complaints at a rehabilitation centre. Eighteen months earlier, an invasive ductal mamma carcinoma (pT1c, pN0 (sn), R0, G2, L1, V0) was transmamillary resected, and an adjuvant radiochemotherapy (59.4 Gray, trastuzumab and letrozole) was applied. The clinical examination revealed a large liver tumour, and the patient was transferred to our university hospital. Abdominal ultrasound showed a 12×11×11 cm-sized, sharply demarcated tumour with a sponge-like content (figure 1) of unknown origin and dignity. Besides this tumour, at least two …

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