Littoral Cell Splenic Angioma: Facts
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Littoral Cell Splenic Angioma: Facts The LCA can present as an incidental finding in an asymptomatic patient or as abdominal pain. The physical exam can reveal the presence of splenomegaly in some cases. Other less common clinical features include the presence of anemia, thrombocytopenia, hepatitis, cirrhosis, and portal hypertension. |
Littoral Cell Splenic Angioma: Facts The radiological imaging studies like magnetic resonance imaging (MRI) and computed tomography scan (CT scan) have not proven to be adequate in diagnosing littoral cell angioma, given that it is difficult to differentiate from other splenic neoplasms like angiosarcomas, lymphomas, metastatic tumors on imaging. Owing to the hemosiderin deposits in the tumor cells, hypodense lesions are visible on T1 and T2 weighted MRI images. Sonography evaluation is not helpful because of the variable findings of heterogeneous echotexture and no definite lesions. |
Littoral Cell Splenic Angioma: Facts The differential diagnosis includes other vascular neoplasms of the spleen, including splenic hemangioma, lymphangioma, hamartoma, angiosarcoma. The LCA can be differentiated from these lesions based on the histopathological and immunophenotyping findings, as detailed above. Imaging studies (MRI, CT scan, ultrasound) have not demonstrated usefulness in differentiating between these. |
Littoral Cell Angioma  |
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“Inflammatory pseudotumor of the spleen is a rare benign process with nonspecific CT features. The mass was generally hypodense with delayed enhancement on CT.” Computed tomographic and clinicopathological features of inflammatory pseudotumor of the spleen. Lu T, Yang C J Comput Assist Tomogr. 2015;39(3):409‐413. |
Inflammatory Pseudotumor of the Spleen  |
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”The definitive diagnosis is established with the histological findings, characterized by the presence of inflammatory cells with areas of necrosis and fibrosis. There are multiple differentials diagnoses: metastasis, lymphoma, splenic infarction, hemangiomas, vascular malformations, lymphangioma, plasmacytoma, reactive lymphoid hyperplasia, abscess and infectious granulomatous processes; therefore suspicion of malignant neoplasm must be considered, being indicated splenectomy to confirm the diagnosis.” Inflammatory pseudotumor of spleen: a case report. Ugalde P et al. Int J Surg Case Rep. 2015;7C:145‐148. |
Sclerosing Angiomatoid Nodular Transformation (SANT) of the Spleen
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Sclerosing Angiomatoid Nodular Transformation (SANT) of the Spleen
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“ While there are several imaging features of SANT which have been described in the literature, it is not routinely possible to make a prospective diagnosis based on the imaging features alone. Moreover, it may not be possible to exclude malignancy based on the imaging features, and needle biopsy or splenectomy may be required in certain cases.” Sclerosing Angiomatoid Nodular Transformation of the Spleen (SANT) – Multimodality Imaging Appearance of Five Cases with Radiology-Pathology Correlation Raman SP, Hruban RH, Singhi A, Horton KM, Fishman EK Abdom Imaging 2013 Aug;38(4):827-34 |
Splenic Malignancies Primary tumor
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Angiosarcoma Spleen and Liver  |
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"Primary angiosarcoma of the spleen is a rare and aggressive malignant neoplasm arising from splenic vascular endothelium and mesenchymal-derived elongated endothelial cells lining the spleen's spongy network of sinusoids. In general, angiosarcomas are rapidly proliferating, highly infiltrating anaplastic cells that tend to recur locally, spread widely, and have an increased rate of lymph node and systemic metastases.” Primary Splenic Angiosarcoma Kamran S. Hamid et al. JSLS. 2010 Jul-Sep; 14(3): 431–435. |
”On CT scans, the most common finding is an ill-defined heterogeneously enhancing splenic mass with areas of necrosis. In the event of acute rupture, hemorrhage will appear hyperattenuated on unenhanced images. There is no particular pattern of calcification associated with splenic angiosarcoma, but areas of hypervascular metastases to the liver, lungs, bones, and lymphatic system are well demonstrated on CT.” Primary Splenic Angiosarcoma Kamran S. Hamid et al. JSLS. 2010 Jul-Sep; 14(3): 431–435. |
“The most common CT finding, found in six (60%) patients, was an enlarged spleen that contained a large heterogeneous complex mass or masses that almost completely replaced the spleen. In two of these patients, there was substantial contrast enhancement, and in the other four patients, there was only minimal contrast enhancement, with areas of decreased attenuation suggesting necrosis.” Angiosarcoma of the Spleen: Imaging Characteristics in 12 Patients Thompson WM et al. Radiology 2005; 235:106-115 |
“CT shows an enlarged spleen with areas of low and high attenuation, due to acute hemor- rhage or hemosiderin deposits, and calci- fications can be seen. Contrast enhancement of angiosarcoma is variable depending on the degree of tumoral necrosis and can mimic that of a hepatic hemangioma by showing avid peripheral enhancement.” Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities Thipphavong S et al. AJR 2014;203: 315-322 |
Splenic Tumors: Metastatic Disease-Differential DX
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Splenic Metastases
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“ Splenic metastases can occur with widespread disease, and parenchymal disease is caused by hematogenous dissemination. The most common primary cancers with splenic metastases include melanoma and cancers of the breast, lung, ovary, stomach, and prostate.” Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities Thipphavong S et al. AJR 2014;203: 315-322 |
Metastatic Ovarian cancer to Spleen  |
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Splenic and Adrenal Metastases from RCC  |
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Metastatic Neuroendocrine Lung to Spleen  |
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Melanoma Metastatic to the Liver and Spleen  |
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The Spleen May be Involved By Adjacent Tumors
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Pancreatic Cancer Invades the Spleen  |
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