Recently, Prof. Tao Li from the Department of Hepatobiliary Surgery of Shandong Qilu Hospital reported a case of suspected liver cancer with abdominal wall metastasis, which was actually spleen tissue implanted in the liver, published in Surgery, a leading journal of surgery. The patient, a 67-year-old female, was admitted to our hospital for further treatment of a liver mass that was found one month ago during a physical examination at a local hospital. The patient had cirrhosis and a history of chronic hepatitis C for about 10 years and had undergone splenectomy in a car accident 5 years ago. Further enhancement scans showed uniform enhancement in the arterial phase and slight enhancement in the venous phase (Figure 1. A, B). Angiography showed that a branch of the hepatic artery supplied this round blood-rich mass (Figure 1. C). Figure 1. A: Enhanced CT scan shows a round hypointense solid lesion in the left lobe of the liver with homogeneous enhancement in the arterial phase; B: the lesion shows hypointensity in the portal phase; C: angiography shows that a branch of the hepatic artery (arrow) supplies the round blood-rich mass; D: after injection of enhancer, the MRI arterial phase of the lesion is high signal. One month later, the patient came to our hospital for evaluation of the lesion. The T1 and T2-weighted images of MRI showed a slightly high signal at the lesion site. After reinforcement injection, the signal was high in the arterial phase (Figure 1) and low in the portal phase. In addition, MRI showed a nodule in the abdominal wall with low signal on T2-weighted images and enhancement in the arterial phase. Laboratory findings were normal except for a slight disturbance in liver function and elevated alpha-fetoprotein (56.7 ng/mL, normal 0-20). Taken together, the patient was suspected of having hepatocellular carcinoma with abdominal wall metastases. Given that hepatic artery embolization chemotherapy had no effect on the tumor, surgical exploration was necessary to clarify the diagnosis and treatment. Intraoperatively, a mass was found to be completely embedded in the left lobe of the liver. The intrahepatic mass was dark red in color with distinct borders and an intact envelope, and the mass was excised completely. Pathological findings showed sinusoidal structures and lymphoid follicles clustered around the central artery, which were red and white, respectively, suggesting that the lesion was a splenic tissue implant containing some normal splenic tissue. Figure 2 clearly shows the envelope area separating the liver and spleen tissues. Figure 2. Histology shows splenic tissue implantation, sinusoidal structures and lymphoid follicles within the liver, with the envelope clearly separating liver and spleen tissue (HE stain, 200x). Thus, the preoperative suspicion of hepatocellular carcinoma with abdominal metastasis was finally confirmed as implantation of spleen tissue. The patient recovered well after surgery and showed no signs of recurrence at 3 years of follow-up. Splenic tissue implantation, also known as ectopic splenic implantation, is an ectopic implantation of autologous splenic tissue that occurs after splenic rupture or splenectomy in patients, mostly in the abdomen. Dr. Tao Li noted that the incidence of this condition is about 16%-67% in patients with traumatic splenic rupture. Implants in the liver, as in this case, are relatively rare.