Littoral cell angioma of the spleen

Last revised by Joshua Yap on 7 Sep 2022

Littoral cell angioma of the spleen is a rare, benign primary vascular tumor of the spleen.

Littoral cell angiomas may occur at any age and have no gender predilection.

Littoral cell angiomas have been diagnosed in association with various malignancies outside the spleen 10,12. The condition has also been linked to Crohn disease 13,14.

The lesion is often detected incidentally in asymptomatic patients. Symptomatic patients may present with abdominal pain, splenomegaly on physical examination, and/or laboratory evidence of hypersplenism including anemia and thrombocytopenia.

Littoral cell tumors arise from the littoral cells lining the sinusoids of splenic red pulp. Littoral cell angiomas are the benign type, as opposed to the less common, low-grade malignant littoral cell hemangioendothelioma and the rare and aggressive littoral cell angiosarcoma 9.

The spleen is enlarged with multiple nodules, the color of which varies by age of blood products 7.

Histopathology demonstrates a proliferation of anastomosing vascular channels congested with blood and lined with tall endothelial cells that show hemophagocytosis 7,8.

The tumor cells express both vascular endothelial markers (such as CD31 and factor VIII) and histiocytic markers (such as CD68) 7,8.

Imaging usually demonstrates splenomegaly and multiple mass lesions.

There are multiple nodules or masses which are hypoattenuating compared to normal spleen 2-8. They demonstrate progressive homogeneous contrast enhancement, later than normal splenic parenchyma 2.

The masses are often low in T1 and T2 signal intensity due to hemosiderin 7.

As many patients are symptomatic and imaging findings are non-specific, splenectomy is usually performed for definitive histological diagnosis and treatment. Littoral cell angiomas are considered benign.

The imaging differential includes:

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