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Mou Y, Yang L, Wang J, Chen Q, Zhang M, Zhang X, Tan R, Adam Mahamat D, Wu K. Case report and literature review: Asymptomatic littoral cell angioma in a 3-year-old girl. Front Pediatr 2024; 12:1383015. [PMID: 38699151 PMCID: PMC11064694 DOI: 10.3389/fped.2024.1383015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Background Littoral cell angioma (LCA) is an extremely uncommon benign vascular tumor of the spleen. Cases of LCA in infants are rarely reported, and due to the rarity of the tumor and non-specific symptoms, the diagnosis of LCA is often overlooked in clinical practice. Case report We present a 3-year-old girl with pulmonary inflammation who was admitted to the hospital due to the discovery of a space-occupying lesion in the spleen. Pathology after splenectomy confirmed LCA, and there was no recurrence observed at the 5-month follow-up examination. Conclusion LCA should be considered when a child shows asymptomatic splenomegaly, with antigen expression indicating dual positivity of endothelial and histiocytic markers. Laparoscopic splenectomy remains the primary method of treating LCA.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kai Wu
- Department of Pediatric Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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2
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Wang W, Qi G, Zhao X, Zhang Y, Zhu R, Liang R, Sun Y. Clinical Landscape of Littoral Cell Angioma in the Spleen Based on a Comprehensive Analysis. Front Oncol 2022; 12:790332. [PMID: 35211400 PMCID: PMC8861295 DOI: 10.3389/fonc.2022.790332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Littoral cell angioma (LCA) is currently considered to be a rare splenic tumor with malignant potential. As the epidemiology, pathogenesis, clinical manifestation, treatment, and prognosis remain unclear, the clinical diagnosis and treatment of LCA have not been standardized. Hence, we performed a comprehensive analysis of 189 observational studies comprising 435 patients to improve the current status of diagnosis and treatment. Methods PubMed, Embase, WanFang and CNKI were searched from inception to May 2021 to identify LCA studies that were published in English and Chinese. The clinical information of LCA patients were extracted and analyzed. Results The LCA has a male-to-female ratio of 0.90 and a solitary-to-multiple ratio of 0.31. In terms of clinical features, 69.7% of the patients showed splenomegaly, 49.7% were asymptomatic, and 39.2% experienced epigastric discomfort. As the imaging findings of patients with LCA were nonspecific, an image-guided biopsy (10/12) was a safe and effective method for diagnosing in this condition. Notably, results of the prognostic analysis indicated that LCA has a lower risk of recurrence and metastasis. The patient may develop a stable disease or the tumor will grow but will not metastasize. Besides, the novel immunohistochemical pattern of LCA was described as CD31+/ERG+/FVIII Antigen+/CD68+/CD163+/lysozyme+/CD8−/WT1−. Conclusion LCA should be reconsidered as a benign primary splenic vascular neoplasm, which is more like an intra-splenic manifestation of abnormal body function. Image-guided biopsy with follow-up might be a beneficial choice for LCA patients. For LCA patients with abdominal discomfort, pathological uncertainty or continuous tumor enlargement, splenectomy remains the preferred treatment.
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Affiliation(s)
- Weijie Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guangzhao Qi
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangtian Zhao
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanping Zhang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rongtao Zhu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruopeng Liang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuling Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Littoral cell angioma of the spleen in a child with Cornelia De Lange syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Di Serafino M, Verde F, Ferro F, Vezzali N, Rossi E, Acampora C, Valente I, Pelliccia P, Speca S, Vallone G. Ultrasonography of the pediatric spleen: a pictorial essay. J Ultrasound 2018; 22:503-512. [PMID: 30446947 DOI: 10.1007/s40477-018-0341-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/09/2018] [Indexed: 12/26/2022] Open
Abstract
In infants and children, the spleen is involved in many pathological processes, whether those processes are isolated or related to systemic diseases. Pathology of the pediatric spleen includes congenital anomalies, splenomegaly, trauma, focal lesions, infarction, and tumors. Ultrasonography (US) is a widely available, fast, noninvasive imaging technique to assess the size, shape, and position of the spleen, as well as to define splenic echotexture. US is capable of screening for splenic disorders without the risk of ionizing radiation; it is the initial imaging examination performed to evaluate suspected splenic pathology, providing clinicians with helpful decisional support. US plays an important role in the detection of even very small amounts of hemoperitoneum, a herald of significant abdominal organ injury, in pediatric blunt abdominal trauma. Moreover, contrast-enhanced US may allow early detection of splenic injuries, ideally minimizing children's risk from radiation exposure. This pictorial essay illustrates the normal ultrasound appearance of the pediatric spleen and the sonographic findings which may guide clinicians to a correct diagnosis of pathologic conditions.
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Affiliation(s)
| | - Francesco Verde
- Paediatric Radiology Department, "Federico II" University Hospital, Naples, Italy.
| | - Federica Ferro
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Norberto Vezzali
- Radiology Department, Regional Hospital of Bolzano, Bolzano, Italy
| | - Eugenio Rossi
- Radiology Department, "Santobono-Pausilipon" Children Hospital, Naples, Italy
| | - Ciro Acampora
- Radiology Department, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Iacopo Valente
- Radiology and Neuroradiology Imaging Diagnostic Department, Agostino Gemelli" University Hospital, IRCCS, Rome, Italy
| | | | - Stefania Speca
- Department of Radiology, Sacro Cuore" University Hospital, Rome, Italy
| | - Gianfranco Vallone
- Paediatric Radiology Department, "Federico II" University Hospital, Naples, Italy
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5
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Jasani M, Shah A, Shah A. Littoral Cell Angioma: A Rare Cause of Pediatric Thrombocytopenia. J Indian Assoc Pediatr Surg 2018; 23:156-157. [PMID: 30050266 PMCID: PMC6042161 DOI: 10.4103/jiaps.jiaps_214_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Littoral cell angioma is a rare primary splenic vascular tumor, originating from the littoral cells lining the red pulp sinuses of the spleen, with variable presentation. Here, we present the case of a 2-year-old male child presenting with chronic thrombocytopenia which resolved after splenectomy.
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Affiliation(s)
- Mitul Jasani
- Amardeep Multispeciality Children Hospital and Research Center, Ahmedabad, Gujarat, India
| | - Anirudh Shah
- Amardeep Multispeciality Children Hospital and Research Center, Ahmedabad, Gujarat, India
| | - Amar Shah
- Amardeep Multispeciality Children Hospital and Research Center, Ahmedabad, Gujarat, India
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Gakenheimer-Smith L, Mohlman J, VandenHeuvel K, Jackson WD, Thomsen W, Stevenson A, Cipriano F. A Novel Presentation of Littoral Cell Angioma and Lymphatic Malformations in a Neonate. Pediatrics 2018; 141:S520-S525. [PMID: 29610184 DOI: 10.1542/peds.2017-2782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/24/2022] Open
Abstract
This case report describes a novel presentation of littoral cell angioma (LCA) and lymphatic malformations involving the omentum and mesentery. To our knowledge, these 2 entities have not been reported in the same patient. A 1-month term infant male presented with chylous ascites. During his workup, imaging detected splenic nodules. Biopsies revealed that the nodules were LCA and the chylous ascites was secondary to microscopic mesenteric and omental lymphatic malformations. Evaluation for a secondary malignancy, an underlying immunologic defect, and genetic causes were unrevealing. The presence of LCA and lymphatic malformations in the same patient suggests a genetic link between these 2 rare vascular disorders and may help elucidate the etiopathogenesis of these 2 poorly understood anomalies.
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Bailey A, Vos J, Cardinal J. Littoral cell angioma: A case report. World J Clin Cases 2015; 3:894-899. [PMID: 26488026 PMCID: PMC4607808 DOI: 10.12998/wjcc.v3.i10.894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/21/2015] [Accepted: 08/07/2015] [Indexed: 02/05/2023] Open
Abstract
Primary splenic lesions are rare entities among which littoral cell angioma (LCA) is a recently described, uncommon vascular lesion that is unique to the spleen. It has heretofore been described primarily in pathologic series and has been found mostly to behave as a benign entity. A few reports of malignant variants have been reported. We present a case report of a solitary LCA discovered after splenectomy for an incidentally discovered splenic lesion, along with a literature review.
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YANG LING, ZHAO SHUANG, LIU RONGBO. Unicentric mesenteric Castleman's disease with littoral cell angioma, anemia, growth retardation and amenorrhea: A case report. Oncol Lett 2015; 9:1779-1781. [PMID: 25789041 PMCID: PMC4356425 DOI: 10.3892/ol.2015.2933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 01/08/2015] [Indexed: 02/05/2023] Open
Abstract
Castleman's disease (CD) is a rare lymphoproliferative disorder of unknown origin, and littoral cell angioma (LCA) is a rare vascular tumor of the spleen with an unknown etiology. The current study reports the case of a 28-year-old female who presented with anemia, growth retardation and amenorrhea. Physical examination revealed a mass in the mesentery, splenomegaly with multiple small nodules, hepatomegaly and an infantile uterus. Histopathological analysis of the resected mass and spleen confirmed the diagnosis of hyaline-vascular CD and LCA. The patient's anemia resolved, and menstruation and breast development also commenced following surgery. To the best of our knowledge, this is the first report of CD accompanied by littoral cell angioma, anemia, growth retardation and amenorrhea.
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Affiliation(s)
- LING YANG
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - SHUANG ZHAO
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - RONG-BO LIU
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
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Li G, Xu P, Pan X, Qin H, Chen Y. The effect of age on apparent diffusion coefficient values in normal spleen: A preliminary study. Clin Radiol 2014; 69:e165-7. [DOI: 10.1016/j.crad.2013.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/21/2013] [Accepted: 11/26/2013] [Indexed: 01/19/2023]
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Fasih N, Gulati A, Ryan J, Ramanathan S, Prasad Shanbhogue AK, McInnes M, Macdonald DB, Fraser-Hill MA, Walsh C, Kielar AZ, Bhagat K. The Mysterious Organ. Spectrum of Focal Lesions within the Splenic Parenchyma: Cross-Sectional Imaging with Emphasis on Magnetic Resonance Imaging. Can Assoc Radiol J 2014; 65:19-28. [DOI: 10.1016/j.carj.2012.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 02/12/2012] [Accepted: 03/07/2012] [Indexed: 12/19/2022] Open
Abstract
Incidental splenic lesions are frequently encountered at imaging performed for unrelated causes. Splenic cysts, hemangiomas, and lymphomatous involvement are the most frequently encountered entities. Computed tomography and sonography are commonly used for initial evaluation with magnetic resonance imaging reserved as a useful problem-solving tool for characterizing atypical and uncommon lesions. The value of magnetic resonance imaging lies in classifying these lesions as either benign or malignant by virtue of their signal-intensity characteristics on T1- and T2-weighted imaging and optimal depiction of internal hemorrhage. Dynamic contrast-enhanced sequences may improve the evaluation of focal splenic lesions and allow characterization of cysts, smaller hemangiomas, and hamartomas. Any atypical or unexplained imaging feature related to an incidental splenic lesion requires additional evaluation and/or follow-up. Occasionally, biopsy or splenectomy may be required for definitive assessment given that some of tumours may demonstrate uncertain biologic behavior.
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Affiliation(s)
- Najla Fasih
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Ajay Gulati
- PGIMER (Post Graduate Institute of Medical Education and Research), Chandigarh, India
| | - John Ryan
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - S. Ramanathan
- PGIMER (Post Graduate Institute of Medical Education and Research), Chandigarh, India
| | | | - Matthew McInnes
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - David B. Macdonald
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | | | - Cynthia Walsh
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Ania Z. Kielar
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
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11
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Zhang YH, Liu LM, Wang WP, Ding H, Wang XN, Xia HS. Littoral cell angioma of the spleen: sonographic-pathologic comparison. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:691-697. [PMID: 23525396 DOI: 10.7863/jum.2013.32.4.691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the sonographic and pathologic features of littoral cell angioma of the spleen in 7 patients. METHODS The sonographic appearance in 7 cases of littoral cell angioma confirmed by surgical pathologic examination was retrospectively reviewed. All underwent color Doppler imaging. Two underwent contrast-enhanced sonography. The sonographic appearance was compared with pathologic findings. RESULTS Splenic lesions were solitary in 5 cases and multiple in 2 cases. The masses ranged from 10 to 64 mm in maximum diameter. Five hypoechoic and 2 hyperechoic lesions on grayscale sonography corresponded to few and multiple blood-filled spaces on pathologic examination, respectively. Four hypovascular lesions, 1 hypervascular lesion, and the other 2 hypervascular lesions full of color flow signals on color Doppler imaging corresponded to few, several, and multiple arteries on pathologic examination. On contrast-enhanced sonography, 1 hypervascular lesion full of color flow signals showed homogeneous hyperenhancement for 8 minutes during the arterial and parenchymal phases. One hypovascular lesion showed inhomogeneous isoenhancement transiently during the arterial phase and became hypoechoic later. CONCLUSIONS Littoral cell angioma is a primary vascular splenic neoplasm with variable features on grayscale sonography and color Doppler imaging as well as contrast-enhanced sonography. The sonographic appearance of littoral cell angioma mainly depends on the type and number of tumor vessels.
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Affiliation(s)
- Yun-Hua Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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12
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Morani AC, Elsayes KM, Liu PS, Weadock WJ, Szklaruk J, Dillman JR, Khan A, Chenevert TL, Hussain HK. Abdominal applications of diffusion-weighted magnetic resonance imaging: Where do we stand. World J Radiol 2013; 5:68-80. [PMID: 23671743 PMCID: PMC3650207 DOI: 10.4329/wjr.v5.i3.68] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 10/21/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI) is one of the magnetic resonance imaging (MRI) sequences providing qualitative as well as quantitative information at a cellular level. It has been widely used for various applications in the central nervous system. Over the past decade, various extracranial applications of DWI have been increasingly explored, as it may detect changes even before signal alterations or morphological abnormalities become apparent on other pulse sequences. Initial results from abdominal MRI applications are promising, particularly in oncological settings and for the detection of abscesses. The purpose of this article is to describe the clinically relevant basic concepts of DWI, techniques to perform abdominal DWI, its analysis and applications in abdominal visceral MR imaging, in addition to a brief overview of whole body DWI MRI.
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Bonekamp S, Corona-Villalobos CP, Kamel IR. Oncologic applications of diffusion-weighted MRI in the body. J Magn Reson Imaging 2012; 35:257-79. [PMID: 22271274 DOI: 10.1002/jmri.22786] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Diffusion-weighted MRI (DWI) allows the detection of malignancies in the abdomen and pelvis. Lesion detection and characterization using DWI largely depends on the increased cellularity of solid or cystic lesions compared with the surrounding tissue. This increased cellularity leads results in restricted diffusion as indicated by reduction in the apparent diffusion coefficient (ADC). Low pretreatment ADC values of several malignancies have been shown to be predictive of better outcome. DWI can assess response to systemic or regional treatment of cancer at a cellular level and will therefore detect successful treatment earlier than anatomical measures. In this review, we provide a brief technical overview of DWI, discuss quantitative image analysis approaches, and review studies which have used DWI for the purpose of detection and characterization of malignancies as well as the early prediction of treatment response.
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Affiliation(s)
- Susanne Bonekamp
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland 21287, USA
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Nagarajan P, Cai G, Padda MS, Selbst M, Kowalski D, Proctor DD, Chhieng D, Aslanian HR, Harigopal M. Littoral cell angioma of the spleen diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy. Diagn Cytopathol 2011; 39:318-22. [PMID: 21488173 DOI: 10.1002/dc.21384] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Littoral cell angiomas are uncommon primary vascular neoplasms that arise from the sinusoidal lining or littoral cells of the splenic red pulp, and hence are unique to the spleen. We report a case of littoral cell angioma in 34-year-old woman, which was diagnosed by endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB). The cytologic features of littoral cell angiomas have been described only in three previous case reports, one of which was a bench-top aspirate. In our case, we have utilized the fine-needle aspiration samples obtained by a linear endoscopic ultrasound examination for establishing the diagnosis. The characteristic cytologic features identified on the smears along with immunohistochemical analysis performed on the compact cellblock prepared from the aspirate aided in the confirmation of the diagnosis. We suggest that EUS-FNAB is a safe and reliable method in the diagnosis of vascular lesions of the spleen.
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Affiliation(s)
- Priyadharsini Nagarajan
- Department of Pathology, Cytopathology, Yale University, School of Medicine, New Haven, CT, USA
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Bittencourt LK, Matos C, Coutinho AC. Diffusion-weighted magnetic resonance imaging in the upper abdomen: technical issues and clinical applications. Magn Reson Imaging Clin N Am 2011; 19:111-31. [PMID: 21129638 DOI: 10.1016/j.mric.2010.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent technological achievements have enabled the transposition of diffusion-weighted imaging (DWI) with good diagnostic quality into other body regions, especially the abdomen and pelvis. Many emerging and established applications are now being evaluated on the upper abdomen, the liver being the most studied organ. This article discusses imaging strategies for DWI on the upper abdomen, describes the clinical protocol, and reviews the most common clinical applications of DWI on solid abdominal organs.
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Affiliation(s)
- Leonardo K Bittencourt
- Clínica de Diagnóstico por Imagem, Carlos Bittencourt Diagnóstico por Imagem and Department of Radiology, Rio de Janeiro Federal University (UFRJ), Av. Das Américas, 4666, Centro Medico, Sala 325, Rio de Janeiro 22649-900, Brazil.
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Shah S, Wasnik A, Pandya A, Bude RO. Multimodality imaging findings in image-guided biopsy proven splenic littoral cell angioma: series of three cases. ACTA ACUST UNITED AC 2011; 36:735-8. [DOI: 10.1007/s00261-011-9697-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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