Successful chemotherapeutic treatment for metastatic littoral cell angioma: A case report

Case report and literature review: Asymptomatic littoral cell angioma in a 3-year-old girl

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.

Littoral cell angioma of the spleen: A study of 10 cases case series and literature review

BACKGROUND

Current study aimed to investigate the clinical characterization, differential diagnosis, and treatment of splenic littoral cell angioma (LCA).

METHODS

A retrospective analysis was performed for 10 LCA cases admitted to Huzhou Central Hospital from 2007 to 2023, for clinical manifestations, hematological tests, imaging features, pathological features, treatment methods, and prognosis along with the relevant literature was also reviewed.

RESULTS

During examinations, no specific clinical manifestations and hematological abnormalities were seen in all 10 cases of LCA. Imaging observations depicted single or even multiple spherical lesions in the spleen. Plains shown by computed tomography (CT) were found somewhat equal or slightly lower in density. On the other hand, magnetic resonance imaging (MRI) plain scans viz. T1 weighted image showed equal low and mixed signals while T2-weighted showed high and low mixed signals. Moreover, punctate low signals could be seen in high signals named "freckle sign" in MRI scans. On contrast-enhanced CT scans, the enhancement of the lesions was not obvious in the arterial phase, and some of the lesions showed edged ring-like enhancements and "filling lake" progressive enhancement during the venous phase and delayed phase. In multiple lesions, the number of enhanced scan lesions showed a variable changing pattern "less-more-less." MRI-enhanced scan showed the characteristics of "fast in and slow out." Microscopic examinations identified tumor tissue actually composed of sinus-like lacunae that anastomosed with each other in the form of a network. Furthermore, cystic expansion and pseudopapillary protrusions were also seen in the dilated sinus cavity which was lined with single-layer endothelial cells having conspicuous cytoplasmic hemosiderin. High immunophenotypic expressions of vascular endothelial cell phenotype (CD31, CD34, FVIII) and tissue cell phenotype (CD68) were also seen. Total and partial splenectomy were performed in 8 and 2 patients, respectively, and follow-up examinations showed survival in all patients with no recurrence.

CONCLUSION

LCA is a rare splenic benign lesion with atypical clinical manifestations. CT and MRI imaging are important tools in preoperative diagnosis based on pathomorphological and immunohistochemical examinations. Splenectomy is a superior therapeutic choice with significant impacts and prognosis.

Littoral Cell Angioma of the Spleen: A Case Report

Littoral cell angioma (LCA) is a rare, primary vascular tumor of the spleen that originates from the cells lining the venous sinuses of the spleen. Around 150 cases have been reported worldwide, with most reported cases of LCA being non-malignant but with unspecified malignant potential. As of 2022, three cases of malignant LCA have been reported. A 75-year-old male with a history of monoclonal gammopathy of uncertain significance presented with left upper outer quadrant abdominal pain. Ultrasound (US) scan showed a 10.5 cm round, circumscribed mass lesion, with hyperechoic foci, occupying the posterolateral aspect of the spleen. US-guided core needle biopsy of the mass revealed a diagnosis of "atypical cells present, suggestive of vascular neoplasm of the spleen," which was based on histologic and immunohistochemistry characteristics. Due to the size of the lesion, a malignant neoplasm was suspected, and a splenectomy was performed. Histological and immunohistochemical features of the splenic lesion returned a final diagnosis of benign LCA.

Littoral cell angiomas: Benign lesion with a penchant for visceral malignancies

Littoral cell angiomas are rare vascular tumors of the spleen. Because of their rarity, unclear etiopathogenesis, and association with other malignancies, these tumors can pose diagnostic and therapeutic challenges. Due to paucity of published literature on this entity often limited to case reports, relevant data on this topic were procured and synthesized with the aid of a comprehensive Medline search in addition to oncologic, pathologic, radiologic, and surgical literature review on littoral cell angiomas. This article provides an in-depth review into postulated etiopathogenesis, pathology, clinical manifestations, associated malignancies, and prognostic features of littoral cell angiomas.

Early postsurgical lethal outcome due to splenic littoral cell angioma: A case report

BACKGROUND

Littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen. Given its rarity, standard diagnostic and therapeutic recommendations have yet to be developed for reported cases. Splenectomy is the only method of obtaining a pathological diagnosis and providing treatment to obtain a favorable prognosis.

CASE SUMMARY

A 33-year-old female presented with abdominal pain for one month. Computed tomography and ultrasound revealed splenomegaly with multiple lesions and two accessory spleens. The patient underwent laparoscopic total splenectomy and accessory splenectomy, and splenic LCA was confirmed by pathology. Four months after surgery, the patient presented with acute liver failure, was readmitted, rapidly progressed to multiple organ dysfunction syndrome and died.

CONCLUSION

Preoperative diagnosis of LCA is challenging. We systematically reviewed online databases to identify the relevant literature and found a close relationship between malignancy and immunodysregulation. When a patient suffers from both splenic tumors and malignancy or immune-related disease, LCA is possible. Due to potential malignancy, total splenectomy (including accessory spleen) and regular follow-up after surgery are recommended. If LCA is diagnosed after surgery, a comprehensive postoperative examination is needed.

Littoral Cell Angioma of Spleen: A rare case report

Introduction

Spleen's Littoral Cell Angioma is a rare benign vascular tumor. The main clinical presentation is isolated splenomegaly.

Case presentation

we present the case of a 37 years old male patient who suffers from chronic pain in the left hypochondrium.The abdominal examination finds a painful splenomegaly related to a biological bicytopenia. The CT Scan shows a 32 cm splenomegaly.An exploratory laparotomy with splenectomy was performed. The histological and immunohistochemical study confirmed The final diagnosis of Littoral Cell Angioma.

Clinical discussion

Isolated splenomegaly of unknown etiology is the main clinical sign. Splenectomy is required for a diagnostic purpose and substratum for histological study.

Conclusion

Littoral Cell Angioma of the Spleen is a rare benign vascular tumor, however it should be highlighted by clinical and radiological features, the definitive diagnosis is made upon histological study.

Clinical Landscape of Littoral Cell Angioma in the Spleen Based on a Comprehensive Analysis

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.

Laparoscopic Central Splenectomy for Littoral Cell Angioma

BACKGROUND

Splenic littoral cell angioma (LCA) is a rare vascular tumor with malignant potential originating from the red pulp of the spleen.1,2 Although laparoscopic splenectomy is the treatment choice for LCA,³ patients suffer from long-term complications of sepsis, thrombosis, and tumor.4,5 Laparoscopic central splenectomy (LCS) for LCA is a technically challenging operation mainly due to the risk of intraoperative hemorrhage. However, it can be a valuable alternative particularly for adolescent patients in whom maximum preservation of splenic function outweighs the risks associated with organ preservation.

METHODS

A 15-year-old young man was admitted with left upper abdominal dull pain for 1 month. Laboratory tests and enhanced abdominal CT scans were performed. Laboratory test results were all normal, as follows: complete blood count showed normal WBC: 5.74 × 10⁹/l, platelets: 173 × 10⁹/l, Hb: 151 g/l, tumor markers (CEA: 1.62 ng/ml, CA19-9: 10.30 U/ml, AFP: 1.13 ng/ml) which were within normal limits. CT scan showed that a 5 × 5.9-cm solid tumor was discovered in the middle part of the spleen during diagnosis, and the density of this tumor was high in the early artery phase and low in the late portal venous phase of contrast-enhanced CT. LCS was performed where the trunk of the splenic artery was intermittently occluded and several branches of the vessels were freed from the tumor which was then resected. The splenic parenchyma was dissected by following a line 0.5 cm from demarcation line. The tumor was completely removed with the activity of the splenic parenchyma being preserved to the maximum extent. Total operation time was 175 min, with an estimated blood loss of 200 ml; thus, no blood transfusion was required. Intraoperative frozen section suggested vascular tumor-like lesions, and then the tumor was completely removed with the resection margin being free of tumor involvement.

RESULTS

The patient was fully recovered after a 7-day hospital stay. The reason for the 7-day hospital stay is that the patient maintains normal ambulating independent assistance on POD-3 and can eat without intravenous fluids on POD-4. Meanwhile, the patient needs to remove the drainage tube after the abdominal CT scan on POD-6, rather than postoperative complications. Diagnosis of LCA was confirmed using histology, and the symptoms disappearing after the operation was done. A total of 86·laparoscopic partial splenectomy (LPS) procedures were performed at the Department of Pancreatic Surgery, West China Hospital and Department of Hepatopancreatobiliary Minimal Invasive Surgery, Chengdu ShangJin NanFu Hospital from May 2011 to May 2020. Five patients among the total number of patients were diagnosed with LCA of which LPS was performed in four patients and LCS performed for one patient. The mean duration of surgery for LPS was 100 min (range of 80-120 min) while the mean estimated blood loss was 125 ml (range of 100-200 ml). On the other hand, the mean length of hospital stay was 7.5 days (range of 5-11 days) and the mean tumor diameter was 5.1 cm (range of 3.2-7 cm). All patients recovered without complications. In addition, there were no signs of immune insufficiency, thrombosis, and tumor recurrence during the follow-up which had a mean of 31.2 months (range from 10 to 53 months).

CONCLUSION

LCS is a technically feasible technique for a select group of patients with centrally located LCA. The technique helps to maximize preservation of splenic function and maintains the advantages of minimally invasive surgery.

Primary multiple angiosarcoma of vertebra: A case report

RATIONALE

Angiosarcoma is a rare malignant tumors. The objective of this study is to report a patient who suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months, After diagnoses, this was identified as an extremely rare case of primary multiple angiosarcoma of vertebra.

PATIENT CONCERNS

A 54-year-old man with a history of 2-year hypertension and 8-year diabetes, both of which were well controlled by drug management. Lately, he suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months.

DIAGNOSES

Magnetic resonance imaging of lumbar showed a clear pathological fracture and primary multiple angiosarcoma of all vertebra. Postoperative pathology and High-throughput sequencing confirmed the diagnosis of primary multiple angiosarcoma of vertebra.

INTERVENTIONS

The patient underwent minimally invasive pedicle screw fixation combined with bone cement augmentation for the purpose of stabilizing the damaged vertebrae. Following operation, he received both radiotherapy and chemotherapy for a period of time.

OUTCOMES

The operation has achieved positive results in relieving pain and stabilizing the spine. No wound problem or operative complications occurred after operation. The patient reported an obvious remission of low back pain and was only capable to perform restricted physiological activities. A long-term palliative radiotherapy and chemotherapy were performed after operation. Unfortunately, the patient died 18 months later.

CONCLUSION

This article emphasizes primary multiple angiosarcoma of vertebra. Despite being rare, it should be part of the differential when the patient manifested back pain and radiculopathy. We recommended the minimally invasive pedicle screw fixation for angiosarcoma of vertebra. Osteoplasty by bone cement augmentation was also an ideal choice for surgical treatment. It also advocates the use of specific targeted radiotherapy drugs based on gene analysis of tumors.