Littoral Cell Angioma of Spleen: An Uncommon Presentation of a Rare Neoplasm
A 58-year-old female patient presented to her primary care physician with chronic non-specific bilateral lower rib pain. Her medical history included cholecystectomy for gall stones and gastroesophageal reflux disease. Her physical exam was normal at presentation. The chest radiographs showed a questionable opacity in the retrocardiac region near the diaphragm. Routine laboratory tests were normal including hemoglobin, hematocrit, white blood cell, and platelet count. A contrast-enhanced computed tomogram (CT) scan was performed during the portal venous phase, the retrocardiac opacity seen on the chest radiograph turned out to be hiatal hernia. The spleen was enlarged with a large 6.6 cm × 6.0 cm solitary mass []. There was diffuse, homogeneous enhancement on the lateral aspect of the mass and the medial aspect was hypoenhanced, probably due to a necrotic portion or a large nonenhanced vascular channel. To further characterize the mass, multiphasic magnetic resonance imaging (MRI) was performed. The MRI [] showed the mass to be both T1 and T2 isointense with mild peripheral nodular and internal septal enhancement during the arterial phase with complete, diffuse, and mild enhancement of the mass during the portal venous phase, which remained enhanced until delayed images. The differential diagnoses considered were primary vascular neoplasms including atypical hemangioma (as mass was not T2 hyperintense), hamartoma, and potential angiosarcoma. The patient underwent laparoscopic splenectomy with morselization. Histological examination of the fragments of mass revealed anastomosing and congested sinusoidal channels with fibrous interstitial tissue and absence of normal red and white pulp. The lining cells were immunoreactive for CD 31, factor VIII, and CD 68, and were negative with stains for CD8 and CD34 (markers that are normally present on red pulp sinusoidal endothelium), consistent with diagnosis of LCA.\nThe patient's postoperative course was uneventful. As 30% of LCA cases have been reported to be associated with other malignancies, she underwent further investigations including CT chest and colonoscopy, which were normal. Her clinical history has been uneventful over a 2-year follow-up period.