Z Gastroenterol 2013; 51(02): 209-212
DOI: 10.1055/s-0032-1325556
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Littoral Cell Angioma of the Spleen

Littoralzellangiom der Milz
X. W. Cui
,
A. Ignee
,
C. De Molo
,
D. Schreiber-Dietrich
,
M. Woenckhaus
,
C. F. Dietrich
Further Information

Publication History

07 August 2012

12 October 2012

Publication Date:
15 February 2013 (online)

Abstract

We report for the first time on the contrast-enhanced ultrasound (CEUS) features of littoral cell angioma of the spleen (LCA). A patient presented with the incidental finding of splenomegaly which was investigated using modern ultrasound techniques. B-mode technique revealed heterogenous splenic parenchyma and small hypoechoic lesions up to 30 mm in size. Colour Doppler imaging revealed no specific vascularity. CEUS showed arterial hyper- and hypoenhancement with pronounced demarcation in the late phase. In an assumption of malignancy the lesions were biopsied using ultrasound guidance. Histology showed LCA. In this case report we discuss LCA in the light of new ultrasound techniques and present a review of the literature.

Zusammenfassung

Dies ist der erste Bericht über kontrastsonografische Eigenschaften eines Littoralzellangioms (LCA) der Milz. Ein Patient wurde mit zufällig detektierter asymptomatischer Splenomegalie vorgestellt und mit modernen Ultraschalltechniken untersucht. Im B-Bild fand sich ein heterogenes Milzparenchym mit hypoechogenen Milzläsionen bis zu 30 mm. Im Farbdoppler-Modus zeigte sich keine spezifische Vaskularisation. Im kontrastverstärkten Ultraschall konnten eine arterielle Mehr- und Minderanreicherung in der Spätphase nachgewiesen werden. Unter der Annahme einer malignen Läsion wurde diese sonografisch gezielt biopsiert. Die histologische Aufarbeitung zeigte ein Littoralzellangiom. Wir diskutieren das Litoralzellangiom im Hinblick auf moderne Ultraschalltechniken und analysieren die zur Verfügung stehende Literatur.

 
  • References

  • 1 Sienz M, Ignee A, Dietrich CF. Reference values in abdominal ultrasound – biliopancreatic system and spleen. Z Gastroenterol 2011; 49: 845-870
  • 2 Piscaglia F, Nolsoe C, Dietrich CF et al. The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall in Med 2012; 33: 33-59
  • 3 von Herbay A, Barreiros AP, Ignee A et al. Contrast-enhanced ultrasonography with SonoVue: differentiation between benign and malignant lesions of the spleen. J Ultrasound Med 2009; 28: 421-434
  • 4 Dietrich CF, Nuernberg D. Lehratlas der Interventionellen Sonographie. Stuttgart: Thieme; 2011
  • 5 Gottschalk U, Ignee A, Dietrich CF. Ultrasound-guided interventions and description of the equipment. Z Gastroenterol 2010; 48: 1305-1316
  • 6 Falk S, Stutte HJ, Frizzera G. Littoral cell angioma. A novel splenic vascular lesion demonstrating histiocytic differentiation. Am J Surg Pathol 1991; 15: 1023-1033
  • 7 Hansen T, Habekost M, Flieger D et al. Littoral cell angioma of the spleen. Association with colon and hepatocellular carcinoma. Pathologe 2010; 31: 290-292
  • 8 Nagarajan P, Cai G, Padda MS et al. Littoral cell angioma of the spleen diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy. Diagn Cytopathol 2011; 39: 318-322
  • 9 Bisceglia M, Sickel JZ, Giangaspero F et al. Littoral cell angioma of the spleen: an additional report of four cases with emphasis on the association with visceral organ cancers. Tumori 1998; 84: 595-599
  • 10 Langer R, Dinges J, Dobritz M et al. Sclerosing angiomatoid nodular transformation of the spleen presenting as a rapidly growing tumour in a patient with rectal cancer. BMJ Case Rep 2009; DOI: 10.1136/bcr.11.2008.1191 .
  • 11 Steensma DP, Morice WG. Littoral cell angioma associated with portal hypertension and resected colon cancer. Acta Haematol 2000; 104: 131-134
  • 12 Collins GL, Morgan MB, Taylor III FM. Littoral cell angiomatosis with poorly differentiated adenocarcinoma of the lung. Ann Diagn Pathol 2003; 7: 54-59
  • 13 Bhavsar T, Wang C, Huang Y et al. Littoral cell angiomas of the spleen associated with solid pseudopapillary tumor of the pancreas. World J Gastrointest Pathophysiol 2011; 2: 53-56
  • 14 Floyd JD, Kaplan PA, Sauter ER et al. Patients with unusual bladder malignancies and a rare cause of splenomegaly. Case 3. Littoral cell angioma of the spleen in a patient with previous lymphoma. J Clin Oncol 2005; 23: 4460-4462
  • 15 Chen LW, Chien RN, Yen CL et al. Splenic tumour: a clinicopathological study. Int J Clin Pract 2004; 58: 924-927
  • 16 Melzer N, Barth PJ, Muller KM et al. Rapidly progressive B-cell dominated inflammatory neuropathy and littoral cell angioma of the spleen associated with plasmablastic B-cell lymphoma. Leuk Lymphoma 2012; 53: 1242-1244
  • 17 Ercin C, Gurbuz Y, Hacihanefioglu A et al. Multiple littoral cell angioma of the spleen in a case of myelodysplastic syndrome. Hematology 2005; 10: 141-144
  • 18 Kranzfelder M, Bauer M, Richter T et al. Littoral cell angioma and angiosarcoma of the spleen: report of two cases in siblings and review of the literature. J Gastrointest Surg 2012; 16: 863-867
  • 19 Schedelbeck U, Gattenlohner S, Hahn D et al. Splenomegaly with multiple unclear parenchymal lesions. Littoralzellangiom. Radiologe 2012; 52: 263-266
  • 20 Muhlfeld AS, Eitner F, Perez-Bouza A et al. Littoral cell angioma of the spleen mimicking posttransplantation lymphoma in a 63-year-old renal transplant patient. Am J Kidney Dis 2008; 52: e11-e14
  • 21 Pilz JB, Sperschneider T, Lutz T et al. Littoral cell angioma in main and accessory intrapancreatic spleen presenting as splenic rupture. Am J Surg 2011; 201: e15-e17
  • 22 Venkatanarasimha N, Hall S, Suresh P et al. Littoral cell angioma in a splenunculus: a case report. Br J Radiol 2011; 84: e11-e13
  • 23 Tholouli E, Roulson JA, Byers R et al. Littoral cell angioma of the spleen in a patient with severe aplastic anaemia. Haematologica 2003; 88: ECR33
  • 24 Maternini M, Misani M, Vanzati A et al. Extramedullary hemopoiesis and littoral cell angioma of the spleen: our experience and review. Hepatogastroenterology 2012; 59: 1789-1793
  • 25 Forest F, Duband S, Clemenson A et al. Traumatic subcapsular splenic hematoma revealing littoral cell angioma and Gaucher's disease. Ann Hematol 2010; 89: 1061-1062
  • 26 Gupta MK, Levin M, Aguilera NS et al. Littoral cell angioma of the spleen in a patient with Gaucher disease. Am J Hematol 2001; 68: 61-62
  • 27 Neesse A, Huth J, Kunsch S et al. Contrast-enhanced ultrasound pattern of splenic metastases – a retrospective study in 32 patients. Ultraschall in Med 2010; 31: 264-269
  • 28 Bert T, Tebbe J, Gorg C. What should be done with echoic splenic tumors incidentally found by ultrasound?. Z Gastroenterol 2010; 48: 465-471
  • 29 Berman E, Ikpatt F, Wang D et al. Rapid progression of littoral cell angioma of the spleen in a man with multiple infections. Rare Tumors 2010; 2: e17
  • 30 Fadare O, Hileeto D, Mariappan MR. Pathologic quiz case: multiple splenic lesions in a bacteremic patient. Littoral cell angioma of the spleen. Arch Pathol Lab Med 2004; 128: 1183-1185
  • 31 Ogembo JG, Milner Jr DA, Mansfield KG et al. SIRPalpha/CD172a and FHOD1 are unique markers of littoral cells, a recently evolved major cell population of red pulp of human spleen. J Immunol 2012; 188: 4496-4505
  • 32 Cappello M, Bravata I, Cocorullo G et al. Splenic littoral cell hemangioendothelioma in a patient with Crohn's disease previously treated with immunomodulators and anti-TNF agents: a rare tumor linked to deep immunosuppression. Am J Gastroenterol 2011; 106: 1863-1865
  • 33 Cordesmeyer S, Putzler M, Titze U et al. Littoral cell angioma of the spleen in a patient with previous pulmonary sarcoidosis: a TNF-alpha related pathogenesis?. World J Surg Oncol 2011; 9: 106
  • 34 Lindgren PG, Hagberg H, Eriksson B et al. Excision biopsy of the spleen by ultrasonic guidance. Br J Radiol 1985; 58: 853-857
  • 35 Civardi G, Vallisa D, Berte R et al. Ultrasound-guided fine needle biopsy of the spleen: high clinical efficacy and low risk in a multicenter Italian study. Am J Hematol 2001; 67: 93-99