A case report: spleen Epstein-Barr virus-positive inflammatory follicular dendritic cell sarcoma

Background: Epstein-Barr virus-positive (EBV⁺) inflammatory follicular dendritic cell sarcoma (IFDCS) is a rare stroma-derived neoplasm of lymphoid tissues. It typically involves the spleen and liver, and is often associated with the presence of EBV. Because of its nonspecific clinical and imaging findings, making a correct diagnosis at the time of initial diagnosis is challenging. Therefore, we report this misdiagnosis case in order to help decrease the rate of making wrong diagnoses in the future.

Case description: We report a case of 71-year-old woman in whom a splenic space-occupying lesion was incidentally found during a chest computed tomography (CT) scan. After laparoscopic partial splenectomy and histopathological examination, the lesion was diagnosed as splenic EBV⁺ IFDCS.

Conclusions: EBV⁺ IFDCS is an extremely uncommon tumor. To date, there are no well-recognized imaging features for EBV⁺ IFDCS. We report a case of EBV⁺ IFDCS and focus on its imaging characteristics. The magnetic resonance imaging (MRI) of the lesion in this case report shows nodular enhancement in the arterial and portal phase and reversal enhancement in the delayed phase. This is a new enhancement pattern that has not been previously reported. Nonetheless, at present, the definitive diagnosis still relies on histopathological and immunohistochemical staining. By sharing this case, we aim to improve awareness of this rare entity and its imaging manifestations, which may aid in earlier and more accurate diagnosis.