INTRODUCTION: Littoral cell angioma of the spleen (LCA) is a rare benign neoplasia originating from the littoral cells that line the splenic sinuses of the red pulp. To our knowledge only a few cases of littoral cell angioma of the spleen diagnosed by contrast enhanced ultrasound (CEUS) have been reported so far. We want to present an interesting clinical case with this rare entity to describe CEUS features and furthermore to compare our findings with the ones described so far.
CASE DESCRIPTION: A 32 – year – old woman who was treated for infertility and multiple recidivant myomas of uterus, sigmoid colon and the pelvic cavity underwent CT scan which incidentally revealed multiple hypodense lesions of the spleen. All laboratory tests were within normal ranges. The B – mode technique showed enlarged spleen with heterogenuous splenic parenchyma. Color Doppler imaging revealed irregular vascular pattern. CEUS revealed well vascularized spleen in arterial phase and multiple 4 – 17 mm large hypoenhanced lesions in late phase. The patient underwent operation where splenectomy and resection of myomas was performed. Definite diagnosis of littoral cell angioma of spleen was confirmed by histology and immunochemical analysis which demonstrated cells of vascular origin positive for CD34 and CD68. The further clinical course was stable and the patient is in good health.
DISCUSSION: Splenic LCA usually presents with splenomegaly. As in other cases our B – mode and color Doppler revealed heterogeneous splenic parenchyma and irregular vascular pattern. Furthermore, the CEUS pattern was similar as in previous cases as well – hyperenhancement in arterial phase and multiple well defined hypoenhanced lesions in late phase. Differential diagnosis of multiple splenic lesions include lymphoma, metastasis, hemangiomas, lymphangiomas and sarcoidosis. Definitive diagnosis is based on histopathology and immunochemical analysis. Nevertheless, it is important to think also about the diagnosis of LCA in spite of being so rare.
