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Littoral Cell Angioma of the Spleen: CT Features with Clinicopathologic Comparison¹

¹ From the Departments of Radiologic Pathology (A.D.L.) and Hematopathology Pathology (S.L.A.), Armed Forces Institute of Pathology, 6825 16th St NW, Washington, DC 20306-6000; Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (A.D.L., R.M.A.); and Department of Radiology, University of Maryland School of Medicine, Baltimore (R.M.A.). Received February 5, 2003; revision requested April 23; revision received May 1; accepted June 23. Address correspondence to A.D.L. (e-mail: levya@afip.osd.mil).

PURPOSE: To evaluate the clinical, pathologic, and computed tomographic (CT) features of littoral cell angioma of the spleen in eight patients.

MATERIALS AND METHODS: Two abdominal radiologists retrospectively reviewed the contrast material–enhanced CT images obtained in six, the contrast-enhanced and nonenhanced CT images obtained in two, and the photographs of gross pathologic specimens resected from seven patients. They also retrospectively reviewed clinical data (ie, demographic data, presenting signs and symptoms, physical findings, and medical histories). Histopathologic specimens from the eight patients were reviewed by a hematopathologist. The CT images were reviewed for the presence of splenomegaly. The number, size, and enhancement characteristics of the splenic masses at CT were compared with the histopathologic and gross pathologic specimen findings.

RESULTS: All patients had laboratory evidence of hypersplenism. Seven patients (88%) had splenomegaly and innumerable splenic masses ranging from 0.2 to 6.0 cm in diameter at CT. The single patient with a normal spleen size had four splenic masses. The splenic masses were hypoattenuating relative to the normal spleen at CT in all patients and correlated with blood-filled nodules at gross pathologic examination and with blood-filled vascular channels of littoral cell angioma at histopathologic examination. The early and late portal venous phase CT images that were available in one case demonstrated progressive homogeneous contrast enhancement of the masses such that they were indistinguishable from the normal splenic parenchyma.

CONCLUSION: Littoral cell angioma is a primary splenic neoplasm that most commonly manifests at CT as multiple hypoattenuating masses in an enlarged spleen. Histopathologically, these masses represent blood-filled vascular channels.

Index terms: Computed tomography (CT), contrast enhancement, 775.12112, 775.12114, 775.12115 • Spleen, CT, 775.12112, 775.12114, 775.12115 • Spleen, neoplasms, 775.3194

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