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Machado PAB, Pereira CDO, de Bortolo JL, Martins ALCL, Campos HG, de Aguiar AJ, Postai RPTA, Wiederkehr JC, Wiederkehr HDA. Littoral cell angioma of the spleen: case report and literature review. EINSTEIN-SAO PAULO 2024; 22:eRC0267. [PMID: 38324846 PMCID: PMC10948099 DOI: 10.31744/einstein_journal/2024rc0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/19/2023] [Indexed: 02/09/2024] Open
Abstract
Littoral cell angioma is an extremely rare splenic vascular tumor originating from the cells lining the splenic red pulp sinuses. Approximately 150 cases of littoral cell angioma have been reported since 1991. Its clinical manifestation is usually asymptomatic and is mostly diagnosed as an incidental finding through abdominal imaging. Herein, we present a case of littoral cell angioma in a 41-year-old woman with no previous comorbidities, which initially presented as a nonspecific splenic lesion diagnosed on imaging in the emergency room. The patient was treated through laparoscopic intervention.
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Affiliation(s)
- Paulo André Bispo Machado
- General and Trauma Surgery ServiceHospital do TrabalhadorUniversidade Federal do ParanáCuritibaPRBrazil General and Trauma Surgery Service , Hospital do Trabalhador , Universidade Federal do Paraná , Curitiba , PR , Brazil .
- Escola de MedicinaPontifícia Universidade Católica do ParanáCuritibaPRBrazil Escola de Medicina , Pontifícia Universidade Católica do Paraná , Curitiba , PR , Brazil .
| | - Caroline de Oliveira Pereira
- General and Trauma Surgery ServiceHospital do TrabalhadorUniversidade Federal do ParanáCuritibaPRBrazil General and Trauma Surgery Service , Hospital do Trabalhador , Universidade Federal do Paraná , Curitiba , PR , Brazil .
| | - Julia Letícia de Bortolo
- Escola de MedicinaPontifícia Universidade Católica do ParanáCuritibaPRBrazil Escola de Medicina , Pontifícia Universidade Católica do Paraná , Curitiba , PR , Brazil .
| | - Ana Luísa Caetano Lopes Martins
- Escola de MedicinaPontifícia Universidade Católica do ParanáCuritibaPRBrazil Escola de Medicina , Pontifícia Universidade Católica do Paraná , Curitiba , PR , Brazil .
| | - Helder Groenwold Campos
- General and Trauma Surgery ServiceHospital do TrabalhadorUniversidade Federal do ParanáCuritibaPRBrazil General and Trauma Surgery Service , Hospital do Trabalhador , Universidade Federal do Paraná , Curitiba , PR , Brazil .
| | - Alan Junior de Aguiar
- Digestive System Surgery ServiceHospital Vita BatelCuritibaPRBrazil Digestive System Surgery Service , Hospital Vita Batel , Curitiba , PR , Brazil .
| | - Rayana Pecharki Teixeira Alves Postai
- Digestive System Surgery ServiceHospital Vita BatelCuritibaPRBrazil Digestive System Surgery Service , Hospital Vita Batel , Curitiba , PR , Brazil .
| | - Julio Cesar Wiederkehr
- Digestive System Surgery ServiceHospital Vita BatelCuritibaPRBrazil Digestive System Surgery Service , Hospital Vita Batel , Curitiba , PR , Brazil .
| | - Henrique de Aguiar Wiederkehr
- General and Trauma Surgery ServiceHospital do TrabalhadorUniversidade Federal do ParanáCuritibaPRBrazil General and Trauma Surgery Service , Hospital do Trabalhador , Universidade Federal do Paraná , Curitiba , PR , Brazil .
- Digestive System Surgery ServiceHospital Vita BatelCuritibaPRBrazil Digestive System Surgery Service , Hospital Vita Batel , Curitiba , PR , Brazil .
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Raja F, Kumar V, Moll E, Hammad A, Ayub S. Sclerosing Angiomatoid Nodular Transformation of the Spleen: A Report of Rare Case and Literature Review. Cureus 2023; 15:e45422. [PMID: 37854759 PMCID: PMC10581663 DOI: 10.7759/cureus.45422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a benign vascular lesion of the spleen with uncertain etiology. It predominantly affects women between the ages of 30 and 60 years. Clinically, it is asymptomatic or can cause abdominal pain, but usually discovered incidentally on imaging, which can identify a mass but may not provide a definitive diagnosis. In uncertain vascular lesions, there is always a risk of spontaneous rupture of large vessels and the potential for spreading malignancy. Hence, the final diagnosis is rendered on microscopy after splenectomy. A middle-aged female came to the clinic complaining of abdominal pain. Radiology showed a solid splenic mass and the patient underwent splenectomy. Gross examination showed a 3 cm white firm mass with focal hemorrhage. Microscopy revealed multiple nodules of variable sizes surrounded by fibrosclerotic stroma. The nodules showed round to slit-like vascular spaces with numerous red blood cells. The internodular stroma consisted of dense fibrous tissue with scattered plump myofibroblasts and lymphoplasmacytic inflammatory cells. These distinctive features lead to the diagnosis of SANT. SANT possesses characteristic histologic features with distinctive immunohistochemistry (IHC). IHC reveals three different types of vessels within the nodules as follows: (1) small veins (CD34-, CD31+, CD8-), (2) sinusoids (CD34-, CD31+, CD8+), and (3) capillaries (CD34+, CD31+, CD8-). All three types of vessels are negative for CD21/CD35 and CD68. Hemangioma and littoral cell angioma are two frequent vascular tumors in the spleen that should be considered differential diagnoses. Both lesions lack the microscopic features of SANT and have only a single type of vessel. The vessels in hemangioma are (CD31+, CD34+, CD8-), while in littoral cell angioma they are (CD31+, CD34-, CD8-, CD21+, CD68+). There are no specific clinical or radiologic findings for SANT. It is important to recognize these characteristic features and to differentiate them from other benign and malignant lesions, such as angiosarcoma. A thorough histopathologic examination and IHC are helpful in making the correct diagnosis.
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Affiliation(s)
- Fnu Raja
- Pathology, MetroHealth Medical Center, Cleveland, USA
| | - Vinesh Kumar
- Pathology, MetroHealth Medical Center, Cleveland, USA
| | - Eric Moll
- Pathology, MetroHealth Medical Center, Cleveland, USA
| | - Azzam Hammad
- Pathology, MetroHealth Medical Center, Cleveland, USA
| | - Salman Ayub
- Pathology, Metrohealth Medical Center, Cleveland, USA
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Abstract
Introduction: Spleen angiosarcoma (SA) is a rare malignant neoplasm that arises from the splenic vascular endothelium, with only around 300 cases reported to date. Due to a limited number of reported cases, there is a paucity of data and a lack of understanding of its presentation, diagnosis, and management. In this study, we aim to provide a comprehensive review of SA.Areas covered: On 27 February 2021, a literature search was done in PubMed and Embase database. The search yielded 122 articles involving 205 patients. The focus was on patient demographics, risk factors, clinical presentations, investigation results, preliminary diagnoses, therapies provided, and patient outcomes. These factors were analyzed to identify possible risk factors, diagnostic modalities, and therapeutic principles that were not mentioned before.Expert opinion: The clinical presentation or investigation results of patients with SA are often nonspecific. Hence, they may not be sufficient to clinch the diagnosis of SA if used alone. The authors recommend a triple assessment of clinical examination, imaging findings, and pathology to diagnose SA with high accuracy. Splenectomy should be the mainstay of management, with chemotherapy and radiotherapy considered as adjuncts, especially in the presence of metastases.
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Wang H, Hu B, Chen W, Ren J, Liu P, Shi H. Clinicopathological features of sclerosing angiomatoid nodular transformation of the spleen. Pathol Res Pract 2021; 224:153490. [PMID: 34098199 DOI: 10.1016/j.prp.2021.153490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 05/15/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore the clinicopathological features of sclerosing angiomatoid nodular transformation (SANT) of the spleen. METHODS The clinicopathological data of 26 SANT patients were analyzed. RESULT There were 15 men and 11 women, aged 23-62 years (mean: 43.9 years; median: 43 years). Twenty patients were found during health check-ups. Magnetic resonance imaging had significantly higher specificity than other imaging modes in the diagnosis of SANT. Macroscopically, the lesions were gray-red and gray-white, along with well-demarcated nodules. Microscopy showed multiple angiomatoid nodules embedded in hyperplastic fibrous tissues and dense collagen fiber; the angiomatoid structures inside the nodules had varied morphology. Patchy and nodular fresh and old hemorrhages were observed in each lesion. Proliferative fibroblasts were seen in the stroma, along with infiltration of a few mixed inflammatory cells. Serum tumor markers were negative. Fourteen patients (53.8 %) had benign or malignant lesions in other parts of the body, including the liver, kidneys, and adrenal and pituitary glands which were similar to von Hippel-Lindau (VHL) syndrome. The reasons for occurrence of SANT may be as follows: hemangioma/lymphangioma or splenic congestion with extensive hemorrhage and secondary changes. CONCLUSIONS SANT is a rare benign vascular lesion with some clinical manifestations similar to VHL syndrome. Patients have good prognosis after tumor removal.
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Affiliation(s)
- Hongqun Wang
- Department of Pathology, the Third People's Hospital of Bengbu City, Bengbu City, Anhui Province, 233000, China; Department of Pathology, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, 100083, China
| | - Bingrong Hu
- Department of Pathology, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, 100083, China; Department of Pathology, Lu'an People's Hospital, Lu'an City, Anhui Province, 237000, China
| | - Wei Chen
- Department of Pathology, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, 100083, China
| | - Jiaming Ren
- Department of Pathology, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, 100083, China
| | - Peng Liu
- Department of Pathology, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, 100083, China
| | - Huaiyin Shi
- Department of Pathology, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing, 100083, China.
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Sangiorgio VFI, Arber DA. Non-hematopoietic neoplastic and pseudoneoplastic lesions of the spleen. Semin Diagn Pathol 2021; 38:159-164. [DOI: 10.1053/j.semdp.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
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Huang W, Liu T, Duan R, Yuan Y, Qu M, Zhang M, Shang D, Yu X. Primary multiple angiosarcoma of vertebra: A case report. Medicine (Baltimore) 2020; 99:e23587. [PMID: 33327321 PMCID: PMC7738032 DOI: 10.1097/md.0000000000023587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Wei Huang
- Department of Orthopaedics, Zhongshan Hospital of Dalian University, Dalian, 116001, China
- Department of Spine Surgery, Dongguan Tungwah Hospital, Dongguan, 523000, China
| | - Tao Liu
- Department of Orthopaedics, Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Ruimeng Duan
- Department of Orthopaedics, Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Yashuai Yuan
- Department of Orthopaedics, Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Mingjia Qu
- Department of Orthopaedics, Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Meng Zhang
- Department of Orthopaedics, Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Depeng Shang
- Department of Orthopaedics, Zhongshan Hospital of Dalian University, Dalian, 116001, China
| | - Xiaobing Yu
- Department of Orthopaedics, Zhongshan Hospital of Dalian University, Dalian, 116001, China
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Chatterjee S. Benign Lesions of the Spleen—Are They Really So Benign? A Report of Two Cases. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Sangiorgio VFI, Arber DA. Vascular neoplasms and non-neoplastic vascular lesions of the spleen. Semin Diagn Pathol 2020; 38:154-158. [PMID: 32674844 DOI: 10.1053/j.semdp.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
Vascular neoplasms are among the most common conditions affecting the spleen. The majority of these are idiopathic, benign in nature and asymptomatic and therefore treated with a conservative management. Only rare cases cause splenomegaly and/or chronic consumption coagulopathies, thus requiring splenectomy. Among these, the most common is splenic hemangioma, followed by littoral cell angioma and lymphangioma. Peliosis is a peculiar tumor-like non-neoplastic vascular lesion that diffusely affects the spleen and frequently presents with concomitant hepatic involvement. As a distinctive feature, peliosis can occur as a secondary manifestation of infections, malignancies and in individuals using certain drugs. On the opposite spectrum of clinical behavior lies splenic angiosarcoma, a vascular endothelial malignancy with aggressive presentation and poor prognosis. In some cases the endothelial nature of this neoplasm may not be evident on routine histologic examination and immunohistochemistry is used to disclose such phenotype. The term hemangioendothelioma is rarely used to describe borderline vascular neoplasms which appear more aggressive than conventional hemangiomas, but that do not entirely fulfill the diagnostic criteria for angiosarcoma. Some of these neoplasms coexpress endothelial and histiocytic markers and therefore have been proposed as the borderline counterpart of littoral cell angioma. The existence of hemangioendothelioma as a diagnostic entity per se is debated and this diagnosis should be rendered with caution. The current review aims at highlighting the main histologic features of vascular neoplasms and non-neoplastic vascular lesions of the spleen.
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Affiliation(s)
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA.
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Pazzi P, Clift S, Hartman MJ, O'Dell N. Kasabach‐Merritt‐like syndrome in a dog secondary to isolated splenic haemangiomatosis. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Paolo Pazzi
- Department of Companion Animal Clinical StudiesFaculty of Veterinary ScienceUniversity of PretoriaOnderstepoortSouth Africa
| | - Sarah Clift
- Department of Paraclinical SciencesFaculty of Veterinary ScienceUniversity of PretoriaOnderstepoortSouth Africa
| | - Marthinus Jacobus Hartman
- Department of Companion Animal Clinical StudiesFaculty of Veterinary ScienceUniversity of PretoriaOnderstepoortSouth Africa
| | - Nicolize O'Dell
- Department of Paraclinical SciencesFaculty of Veterinary ScienceUniversity of PretoriaOnderstepoortSouth Africa
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Nakamura SI, Tsukahara T. Spontaneous abdominal hemangiosarcoma in a ferret. J Toxicol Pathol 2019; 32:283-287. [PMID: 31719755 PMCID: PMC6831491 DOI: 10.1293/tox.2018-0060] [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: 10/23/2018] [Accepted: 05/02/2019] [Indexed: 11/19/2022] Open
Abstract
Herein, we describe the case of a 6-year-old female ferret that died within a few days of the onset of anorexia and reduced spontaneous locomotor activity. Necropsy revealed a dark red abdominal mass of unknown origin between the right lobes of the pancreas and the proximal jejunum, with massive blood retention in the peritoneal cavity. Histopathologically, spindle-shaped or sometimes polygonal tumor cells were proliferating with irregularly shaped vascular spaces containing blood components and surrounding-tissue infiltration. In some areas, tumor cells formed distinctly dilated blood vessel-like structures. Immunohistochemically, most of the tumor cells were strongly positive for CD31, but factor VIII-related antigen immunoreactivity was confined to the area with dilated blood vessel-like structures. Based on these findings, the tumor was diagnosed as an abdominal hemangiosarcoma. Abdominal hemangiosarcoma excluding cases of the liver and spleen are rare in ferrets.
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Affiliation(s)
- Shin-Ichi Nakamura
- Kyoto Institute of Nutrition & Pathology Inc., 7-2 Furuiketani, Tachikawa, Ujitawara, Tsuzuki-gun, Kyoto 610-0231, Japan
| | - Takamitsu Tsukahara
- Kyoto Institute of Nutrition & Pathology Inc., 7-2 Furuiketani, Tachikawa, Ujitawara, Tsuzuki-gun, Kyoto 610-0231, Japan
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Li MJ, Zhou X, Cao JY, Zhu CZ, Zhou SS, Zang YJ, Wu LQ. Laparoscopic splenectomy for littoral cell angioma of the spleen: A case report. Medicine (Baltimore) 2019; 98:e14825. [PMID: 30882665 PMCID: PMC6426590 DOI: 10.1097/md.0000000000014825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Littoral cell angioma (LCA) is a rare primary vascular neoplasm of the spleen. It can be benign or malignant. Pathology and immunohistochemistry are the gold standards for the diagnosis of LCA. Therefore, splenectomy is recommended for the purpose of diagnosis and treatment, and subsequent follow-up is necessary. There are limited reports about LCA. Here, we present a case of a female patient with LCA undergoing laparoscopic splenectomy in order to provide clinical experience in LCA treatment. PATIENT CONCERNS A 32-year-old female attended the outpatient Department of Hepatobiliary Surgery for follow-up of hepatic hemangiomas. The patient presented with intermittent abdominal distension, which was slightly under no obvious inducement. DIAGNOSIS Physical examination found no signs of abdominal tenderness and rebound tenderness, and liver and spleen were impalpable. The contrast-enhanced computed tomography (CT) showed multiple space-occupying lesions in the spleen, mottled low-density lesions, multiple hypoattenuating nodules with no contrast enhancement on the arterious phase. Delayed contrast-enhanced helical CT scan displayed incomplete filling of hypodense splenic lesions. INTERVENTIONS Given that it was uncertain whether it was a benign or a malignant tumor, a laparoscopic total splenectomy was performed. OUTCOMES The final pathological diagnosis was LCA. Her postsurgical course was uneventful, and no surgery-related complications were found. No signs of recurrence were observed in the 16 months after the operation. LESSONS LCA was a rare primary vascular neoplasm of the spleen, and laparoscopic splenectomy for LCA was safe and feasible, and postoperative course was uneventful. However, regular follow-up and long-time monitoring after splenectomy for LCA is recommended because of its potential malignant biological behavior.
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Affiliation(s)
- Man-Jiang Li
- Medical College of Qingdao University, Qingdao University
- Department of Liver Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuan Zhou
- Department of Liver Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing-Yu Cao
- Department of Liver Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng-Zhan Zhu
- Department of Liver Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - San-Shun Zhou
- Medical College of Qingdao University, Qingdao University
- Department of Liver Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yun-Jin Zang
- Medical College of Qingdao University, Qingdao University
- Department of Liver Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li-Qun Wu
- Medical College of Qingdao University, Qingdao University
- Department of Liver Disease Center, Affiliated Hospital of Qingdao University, Qingdao, China
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Aguilera NS, Auerbach A. Hamartoma, choristomas and malformation of the spleen and lymph node. Semin Diagn Pathol 2018; 36:16-23. [PMID: 30482418 DOI: 10.1053/j.semdp.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nadine S Aguilera
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, United States.
| | - Aaron Auerbach
- Joint Pathology Center, Silver Spring, MD, United States
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Selove W, Picarsic J, Swerdlow SH. Langerin staining identifies most littoral cell angiomas but not most other splenic angiomatous lesions. Hum Pathol 2018; 83:43-49. [PMID: 30130631 DOI: 10.1016/j.humpath.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/10/2018] [Indexed: 12/26/2022]
Abstract
Although littoral cell angiomas (LCAs) are phenotypically well characterized, the antibodies used to support the diagnosis identify many other cells in the normal spleen, and some may be found in other angiomatous lesions. Based on a langerin/CD207+ LCA index case, langerin and other selected immunohistochemical staining was performed on 10 LCAs, 20 other splenic angiomatous lesions, and 7 reactive lymph nodes to further investigate the role of langerin as a diagnostic tool. Ninety percent (9/10) of LCAs were langerin positive, whereas only 1 (5%) of 20 other splenic vascular lesions was partially positive (P < .00001). All LCAs were CD1a-, CD68+, CD34-, and CD8-; 20% were S100+, 70% CD21+, and 90% cyclin D1+. Ultrastructural studies of one LCA did not show Birbeck-type granules in definite lining cells. Sinus lining cells in 7 of 7 reactive lymph nodes showed partial langerin positivity, and 4 of 4 showed partial cyclin D1 positivity. In conclusion, langerin staining is an easily interpreted and highly sensitive and specific (sensitivity [0.90], specificity [0.95]) ancillary study to help distinguish LCA from other vascular tumors of the spleen. Whether this represents cross-reactivity or true CD207 expression is uncertain, as other immunohistochemical and ultrastructural studies do not support a Langerhans cell origin. The cyclin D1 staining seen in most LCA would be consistent with their expression of other selected vascular and histiocytic markers. The similar staining pattern in some lymph node sinus lining cells suggests a possible similar cell of origin, although LCA of lymph nodes is not described.
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Affiliation(s)
- William Selove
- Division of Hematopathology, UPMC Presbyterian, Pittsburgh, PA 15213, USA.
| | - Jennifer Picarsic
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
| | - Steven H Swerdlow
- University of Pittsburgh School of Medicine, UPMC Presbyterian, Pittsburgh, PA 15213, USA.
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Chen X, Li H, Wang F, Liu H. Early detection and integral resection are keys to extend survival in patients suffered from primary angiosarcoma of the spleen: A care-compliant case report and literature review. Medicine (Baltimore) 2018; 97:e9718. [PMID: 29384853 PMCID: PMC5805425 DOI: 10.1097/md.0000000000009718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Primary angiosarcoma of the spleen (PAS) is a very rare malignant neoplasm that originates from endothelial cells of the splenic blood vessels. Without typical clinical presentations and specific radiological features, PAS is very difficult to be early identified and 1-year mortality is extremely high. Late detection and spleen rupture are considered as the most important risk factors for early metastasis. PATIENT CONCERNS Without any obvious symptom, a 35-year-old woman was admitted with splenic neoplasm that was accidentally discovered through a routine physical examination. DIAGNOSES The patient was first diagnosed as lymphoma by laboratory tests and imaging studies, but changed to PAS by histological examinations after the surgery. INTERVENTIONS After careful preoperational assessment, a laparoscopic-assisted splenectomy was scrutinously performed and the entire spleen was removed without any rupture. OUTCOMES The postoperative followed-up was uneventful until 3 years later, when she sought medical attention due to persisting back pain. Bone metastasis was consequently identified and the symptom was quickly alleviated after radiation therapy. However, intra-abdominal metastases leading to intestinal obstruction occurred 4.5 years after surgery. Following short palliative treatment, the patient passed away 4 years and 9 months after the operation due to multiple organ failure. LESSONS PAS is an uncommon and aggressive splenic disease. Once suspected, PAS require prompt and precise surgical procedures to remove the tumor origin. Laparoscopic-assisted splenectomy was technically feasible and therapeutically harmless for PAS treatment compared with open surgery as long as the spleen was removed intact. However, more evaluation of this option will be needed due to limited experience by now. Early discovery, precautious plan, meticulous operation, close follow-up, and comprehensive treatment may significantly prolong the living period of this fatal disease.
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Cheng N, Chen J, Pan Y, Jiang Y, Zhou J, Shao C. Splenic hamartoma with bizarre stromal cells: a case report and literature review. Diagn Pathol 2018; 13:8. [PMID: 29378604 PMCID: PMC6389155 DOI: 10.1186/s13000-018-0687-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Splenic hamartoma is a rare benign vascular proliferative lesion composed of unorganized sinusoid-like channels lined with plump or flat endothelial cells and characterized by a CD8-positive immunophenotype of the lining cells. Scattered bizarre stromal cells can be found in some splenic hamartomas. The presence of splenic hamartoma with bizarre stromal cells is extremely rare and these bizarre cells make it possible to be regarded as a malignancy. Recognition of this rare histologic variant will help to avoid diagnostic confusion and overtreatment of this benign entity. Case presentation We report a case of a 40-year-old man with occasional left-sided waist back pain. A splenic space-occupying lesion was detected by ultrasound and magnetic resonance imaging. Microscopically bizarre large cells were scattered throughout the splenic hamartoma. The cells exhibited atypical nuclei, scarcely visible cytoplasm, and vesicular chromatin, and they did not form expansile clusters and lacked mitotic activity. An immunohistochemical panel was performed. The bizarre cells strongly expressed vimentin, and the Ki-67 index was very low. The lesion was diagnosed as a splenic hamartoma with bizarre stromal cells. Conclusions To the best of our knowledge, this is the first systematic review on a splenic hamartoma with bizarre stromal cells; only six cases have been described in the literature. Proper identification is important to secure adequate treatment.
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Affiliation(s)
- Na Cheng
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Rd, Guangzhou, 510630, China
| | - Jianning Chen
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Rd, Guangzhou, 510630, China
| | - Yuhang Pan
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Rd, Guangzhou, 510630, China
| | - Ye Jiang
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Rd, Guangzhou, 510630, China
| | - Jing Zhou
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Rd, Guangzhou, 510630, China
| | - Chunkui Shao
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Rd, Guangzhou, 510630, China.
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Abstract
Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a morphologically distinctive lesion. Although the clinical course of SANT is benign, its reactive or neoplastic nature remains to be clarified. Furthermore, some investigators have suggested that SANT is related to IgG4 sclerosing lesion or inflammatory pseudotumor with stromal cells positive for Epstein-Barr virus (EBV). In this study, we assessed 22 cases of SANT derived from adult women. Clinical data and follow-up information were obtained by chart review. Immunohistochemical studies for IgG4, IgG, and CD21 stains and in situ hybridization to detect EBV-encoded small RNAs were performed. We also assessed genomic DNA extracted from paraffin-embedded tissue for human androgen-receptor α gene analysis using conventional and methylation-specific polymerase chain reaction methods. The median patient age was 41.5 years (range, 25 to 82 y). Most (77%) patients presented with a single mass that was detected incidentally (59%). The mean size of the lesions was 3.8 cm (range, 1.0 to 9.0 cm). Clinical symptoms correlated with multiple lesions (P=0.043) but not lesional size (P=0.637) or location in the spleen (hilum vs. periphery, P=0.696). None of the cases had evidence of IgG4-related disease or recurred after splenectomy. The mean number of IgG4 cells was 27.7 (range, 4 to 125), and the mean IgG4/IgG ratio was 16.4% (range, 1.6% to 55.7%) with only 2 cases being >40%. Cases with higher IgG4 cells did not correlate with inflammatory pseudotumor-like morphology. No lesions were positive for EBV-encoded small RNAs, and almost all cases with informative results (n=19) showed a polyclonal pattern. We conclude that SANT is a polyclonal, reactive lesion rather than a neoplasm.
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17
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Leon-Castillo A, Chrisinger JSA, Panse G, Samdani RT, Ingram DR, Ravi V, Prieto VG, Wang WL, Lazar AJ. Index report of cutaneous angiosarcomas with strong positivity for tyrosinase mimicking melanoma with further evaluation of melanocytic markers in a large angiosarcoma series. J Cutan Pathol 2017; 44:692-697. [DOI: 10.1111/cup.12968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/21/2017] [Accepted: 05/22/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Alicia Leon-Castillo
- Pathology Service; Hospital Universitario Marques de Valdecilla; Santander Spain
| | - John S. A. Chrisinger
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Gauri Panse
- Department of Pathology; Yale University; New Haven Connecticut
| | - Rashmi T. Samdani
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Davis R. Ingram
- Department of Translational Molecular Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Victor G. Prieto
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
- Department of Dermatology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Wei-Lien Wang
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
- Department of Translational Molecular Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Alexander J. Lazar
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
- Department of Translational Molecular Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
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18
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Application of Immunohistochemistry in Toxicologic Pathology of the Hematolymphoid System. IMMUNOPATHOLOGY IN TOXICOLOGY AND DRUG DEVELOPMENT 2017. [DOI: 10.1007/978-3-319-47377-2_10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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19
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Anbardar MH, Kumar PV, Forootan HR. Littoral cell angioma of the spleen: Cytological findings and review of the literature. J Cytol 2017; 34:121-124. [PMID: 28469325 PMCID: PMC5398021 DOI: 10.4103/joc.joc_118_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Littoral cell angioma (LCA) is a unique lesion of the spleen that arises from the cells lining the venous sinuses of the splenic red pulp and shows the features of combined endothelial and histiocytic differentiation. Several cases of LCA have been reported in the literature; however, the cytological findings have been described for only a few cases. We report the case of an 11-year-old boy with anemia, epigastric abdominal pain, and splenomegaly. The splenic lesions showed anastomosing vascular channels with cyst-like spaces filled by many sloughed endothelial cells, which were positive for CD68 and CD31 and negative for CD34. Scraping cytology revealed isolated and clusters of three-dimensional bland looking, epithelioid foamy tumoral cells with low nuclear cytoplasmic ratio, which mostly contained intracytoplasmic hemosiderin pigment. Although the fine needle aspiration cytology of splenic lesions is uncommon and LCA is a rare splenic lesion, it must be noted in the differential diagnosis of any splenic vascular neoplasm.
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Affiliation(s)
- Mohammad H Anbardar
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Perikala V Kumar
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid R Forootan
- Department of Pediatric Surgery, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Peckova K, Michal M, Hadravsky L, Suster S, Damjanov I, Miesbauerova M, Kazakov DV, Vernerova Z, Michal M. Littoral cell angioma of the spleen: a study of 25 cases with confirmation of frequent association with visceral malignancies. Histopathology 2016; 69:762-774. [PMID: 27374010 DOI: 10.1111/his.13026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022]
Abstract
AIMS Littoral cell angioma (LCA) is a rare primary splenic tumour that is frequently associated with internal malignancies. Immunohistochemistry can demonstrate a distinct hybrid endothelial-histiocytic phenotype of littoral cells, and is a helpful adjunct for making the correct diagnosis. The aims of this study were to present a series of 25 LCAs, with an emphasis on the frequent association of the neoplasm with visceral malignancies, and to provide a detailed immunohistochemical analysis by employing new markers. METHODS AND RESULTS All 25 cases with available tissue blocks were immunohistochemically stained for endothelial and histiocytic markers. Clinical and follow-up data were retrieved from the respective institutions. The tumours were obtained from 16 males and nine females, whose age ranged from 32 to 86 years (mean 56.2 years). Clinical information was available for 24 of 25 patients, and follow-up for 11 of 25 patients (range 2-19 years; mean 11.6 years). Immunohistochemically, all cases were positive for LYVE-1, factor VIII, FLI-1, vascular endothelial growth factor receptor (VEGFR)-2, VEGFR-3, claudin-5, ERG, LMO2, CD31, CD163, lysozyme, and CD4, but negative for D2-40, CD8, and factor XIIIa. Fifteen of 25 cases were associated with various malignancies, including epithelial, mesenchymal and haematological tumours. CONCLUSIONS The cohort of 25 patients is the largest series of LCAs published to date. By using antibodies against recently introduced endothelial markers, we have expanded the immunoprofile of LCA. We have further highlighted the clinical significance of LCA, as more than half of the patients in this study also harboured a coexisting visceral malignancy. Therefore, we conclude that the finding of splenic LCA mandates a thorough clinical evaluation for a concomitant malignancy.
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Affiliation(s)
- Kvetoslava Peckova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic.
| | - Michael Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Plzen and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Ladislav Hadravsky
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Saul Suster
- Department of Pathology and MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ivan Damjanov
- Department of Pathology and Laboratory Medicine, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Marketa Miesbauerova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Dmitry V Kazakov
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Zdenka Vernerova
- Department of Pathology, Charles University, Third Medical Faculty and Charles University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
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21
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Panagopoulos I, Gorunova L, Bjerkehagen B, Lobmaier I, Heim S. Fusion of the TBL1XR1 and HMGA1 genes in splenic hemangioma with t(3;6)(q26;p21). Int J Oncol 2015; 48:1242-50. [PMID: 26708416 PMCID: PMC4750536 DOI: 10.3892/ijo.2015.3310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/26/2015] [Indexed: 11/06/2022] Open
Abstract
RNA-sequencing of a splenic hemangioma with the karyotype 45~47,XX,t(3;6)(q26;p21) showed that this translocation generated a chimeric TBL1XR1-HMGA1 gene. This is the first time that this tumor has been subjected to genetic analysis, but the finding of an acquired clonal chromosome abnormality in cells cultured from the lesion and the presence of the TBL1XR1-HMGA1 fusion in them strongly favor the conclusion that splenic hemangiomas are of a neoplastic nature. Genomic PCR confirmed the presence of the TBL1XR1-HMGA1 fusion gene, and RT-PCR together with Sanger sequencing verified the presence of the fusion transcripts. The molecular consequences of the t(3;6) would be substantial. The cells carrying the translocation would retain only one functional copy of the wild-type TBL1XR1 gene while the other, rearranged allele could produce a putative truncated form of TBL1XR1 protein containing the LiSH and F-box-like domains. In the TBL1XR1-HMGA1 fusion transcript, furthermore, untranslated exons of HMGA1 are replaced by the first 5 exons of the TBL1XR1 gene. The result is that the entire coding region of HMGA1 comes under the control of the TBL1XR1 promoter, bringing about dysregulation of HMGA1. This is reminiscent of similar pathogenetic mechanisms involving high mobility genes in benign connective tissue tumors such as lipomas and leiomyomas.
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Affiliation(s)
- Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ludmila Gorunova
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
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22
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de Ridder GG, Galeotti J, Carney J, Wang E. Persistent thrombocytopaenia in a young man with splenomegaly, rebound thrombocytosis after splenectomy and subsequent pulmonary embolism: splenic littoral cell angioma and associated events. BMJ Case Rep 2015; 2015:bcr-2015-212882. [PMID: 26604237 DOI: 10.1136/bcr-2015-212882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Littoral cell angioma (LCA) is a rare endothelial cell neoplasm in the spleen. Although many cases of LCA are asymptomatic, some present with signs and symptoms related to splenomegaly, whereas others manifest with haematological abnormalities, including anaemia and/or thrombocytopaenia (ie, hypersplenism). We report a case of LCA presenting with chronic thrombocytopaenia, probably due to splenic sequestration of platelets or phagocytosis of platelets by neoplastic cells. Following therapeutic splenectomy, the patient suffered from a marked rebound thrombocytosis and subsequently developed pulmonary embolisms. He was treated with anticoagulant therapy combined with antiplatelet therapy, and his symptoms were quickly resolved. This case emphasises an exclusion of primary splenic disorders in patients with chronic thrombocytopaenia, especially in those with splenomegaly and the contemplation of thromboembolism prophylaxis postsplenectomy.
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Affiliation(s)
| | - Jonathan Galeotti
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - John Carney
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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23
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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: 8] [Impact Index Per Article: 0.9] [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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24
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A rare case of hemangiomatosis of the spleen and intrapancreatic accessory spleen. ACTA ACUST UNITED AC 2015; 39:1169-74. [PMID: 24811762 DOI: 10.1007/s00261-014-0149-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We presented a very rare case of hemangiomatosis of the spleen and intrapancreatic accessory spleen in the tail of the pancreas. A previously healthy 45-year-old woman felt left back pain and received CT scan. Multiple splenic masses and a pancreatic mass in the tail were detected. Both the lesions presented gradual and weak enhancement and pooling of the contrast medium until very late phase on dynamic MRI. Since the lesions in the spleen and the pancreas presented the same characteristics on dynamic CT/MRI, ultrasonography, and positron emission tomography using fluorine-18-fluorodeoxyglucose, we suspected these lesions as hemangiomatosis of the spleen and intrapancreatic accessory spleen. We performed distal pancreatectomy with splenectomy, and pathological diagnosis was hemangiomatosis of the spleen and intrapancreatic accessory spleen. We should consider the possibility of splenic tumors arising from the spleen and intrapancreatic accessory spleen when we find similar lesions in the spleen and the tail of the pancreas. Gradual and weak enhancement and pooling of the contrast medium until very late phase may be important findings for diagnosing splenic hemangiomatosis.
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25
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O'Malley DP, Kim YS, Weiss LM. Distinctive immunohistochemical staining in littoral cell angioma using ERG and WT-1. Ann Diagn Pathol 2015; 19:143-5. [PMID: 25792460 DOI: 10.1016/j.anndiagpath.2015.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 01/21/2015] [Accepted: 02/09/2015] [Indexed: 12/19/2022]
Abstract
Littoral cell angioma (LCA) is a rare vascular tumor of the spleen. It has an immunohistochemical staining pattern that is somewhat distinctive but can still be occasionally confused with other vascular and stromal proliferations in the spleen. In this study, LCA was evaluated using Ets-related gene (ERG) and Wilms tumor-1 (WT-1), relatively recently described vascular markers. In addition, other vascular lesions including normal spleen, hemangiomas, hamartoma, peliosis, and sclerosing angiomatoid nodular transformation were evaluated using these stains. In LCA, ERG stains the endothelial cells of the tumor as expected. ERG also was uniformly positive in vascular elements of other lesions except peliosis. However, in contrast to most other vascular elements, LCA was negative for WT-1 staining. This staining pattern may prove useful in diagnosing LCA and may provide insight into the derivation of the distinctive tumor.
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Affiliation(s)
- Dennis P O'Malley
- Clarient Pathology Services, Aliso Viejo, CA; MD Anderson Cancer Center/University of Texas, Houston, TX.
| | - Young S Kim
- City of Hope National Medical Center, Duarte, CA.
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26
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Murgia D, Mori M, Rondena M, Tacchini D. A case of isolated diffuse splenic haemangiomatosis in a dog. VETERINARY RECORD CASE REPORTS 2015. [DOI: 10.1136/vetreccr-2014-000160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Daniela Murgia
- Department of SurgeryAnimal Health TrustNewmarketSuffolkUK
| | | | | | - Damiana Tacchini
- Department of PathologyPoliclinico S. Maria alle ScotteSienaItaly
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27
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Bedir R, Sehitoǧlu I, Calapoǧlu AS, Yurdakul C. A rare case of splenic littoral cell angioma in a child. J Lab Physicians 2014; 6:117-20. [PMID: 25328338 PMCID: PMC4196359 DOI: 10.4103/0974-2727.141511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Littoral cell angioma (LCA) is a rare, benign primary vascular neoplasm of the spleen. The tumor originates from the littoral cells lining the sinuses of the red pulp of the spleen. Preoperative distinction of this tumor from other benign or malign splenic lesions is difficult. Radiologically most cases present as multiple nodules. Definitive diagnosis can only be made histopathologically and immunohistochemically following splenectomy. This clinical situation can coexist with various malignancies and autoimmune disorders. Even though, it is mostly benign, since it has the potential to become malignant after splenectomy, long-term follow-up is required. We present an LCA case, which appeared as a solitary mass in the spleen of an 11-year-old girl with abdominal pain admitted to our hospital.
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Affiliation(s)
- Recep Bedir
- Department of Pathology, Recep Tayyip Erdogan University of Medical Faculty, Rize, Turkey
| | - Ibrahim Sehitoǧlu
- Department of Pathology, Recep Tayyip Erdogan University of Medical Faculty, Rize, Turkey
| | - Ahmet Salih Calapoǧlu
- Department of Pediatric Surgery, Recep Tayyip Erdogan University of Medical Faculty, Rize, Turkey
| | - Cüneyt Yurdakul
- Department of Pathology, Recep Tayyip Erdogan University of Medical Faculty, Rize, Turkey
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28
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He P, Yan XD, Wang JR, Guo RC, Zhang HB. Splenic littoral cell hemangioendothelioma: report of a case with hepatic metastases and review of the literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:308-312. [PMID: 24420309 DOI: 10.1002/jcu.22120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 08/01/2013] [Accepted: 10/18/2013] [Indexed: 06/03/2023]
Abstract
Littoral cell tumors are unique to the spleen and are different from all other primary splenic tumors. These tumors may be divided into three types: "littoral cell angioma," "littoral cell hemangioendothelioma," and "littoral cell angiosarcoma." We present a patient with splenic littoral cell hemangioendothlioma accompanied by hepatic metastases.
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Affiliation(s)
- Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
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29
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Pradhan D, Mohanty SK. Sclerosing angiomatoid nodular transformation of the spleen. Arch Pathol Lab Med 2013; 137:1309-12. [PMID: 23991745 DOI: 10.5858/arpa.2012-0601-rs] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen is a rare benign lesion of the spleen with unknown etiology. SANT is classically considered to be a female-predominant disease, with most of the patients in the 30- to 60-year age group. Most lesions are found incidentally on imaging. Although SANT has specific imaging findings, the differential diagnosis from other splenic tumors or malignant lesions is very difficult. Histopathologically, these tumors reveal multiple confluent angiomatoid nodules; these nodules are surrounded by concentric collagen fibers exhibiting an inflammatory and myofibroblastic response and are accompanied by numerous erythrocytes and siderophages. The nodules are populated by endothelial cells, phenotypically recapitulating normal splenic vasculature, such as sinusoids, capillaries, and small veins. Nuclear atypia is minimal, mitotic figures are extremely rare, and necrosis is consistently absent. This lesion has a unique immunohistochemical profile characterized by CD34(-)CD31(+)CD8(+) sinusoids, CD34(+)CD31(+)CD8(-) capillaries, and CD34(-)CD31(+)CD8(-) small veins. CD68 is positive in macrophages. Splenectomy is a useful and effective technique for the management of SANT. SANT patients have a good prognosis, with no recurrence after splenectomy. In this review, we discuss the current knowledge of SANT of the spleen and its clinical relevance.
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30
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Simultaneous laparoscopic splenectomy and right hemihepatectomy for littoral cell angiosarcoma accompanied with liver metastases. World J Surg Oncol 2013; 11:215. [PMID: 23984838 PMCID: PMC3765743 DOI: 10.1186/1477-7819-11-215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/07/2013] [Indexed: 01/01/2023] Open
Abstract
Despite the wide acceptance of laparoscopic resection for treatment of abdominal tumors, only few cases of simultaneous laparoscopic removal of the spleen and the right liver have been reported to date. Littoral cell angiosarcoma (LCAS), which arises from the littoral cells lining the sinus channels of the splenic red pulp, is a rare condition, and there is limited literature on littoral cell angiosarcoma with liver metastases. We present the case of a 28-year-old woman with postoperative pathologically-proven LCAS with right liver metastases. The patient’s surgery was safely performed, and her postoperative course was uneventful until now. This case suggests that concomitant laparoscopic splenectomy (LS) and right hemihepatectomy is a suitable surgical option for selected patients.
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31
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Larsen BT, Bishop MC, Hunter GC, Renner SW. Low-Grade, Metastasizing Splenic Littoral Cell Angiosarcoma Presenting With Hepatic Cirrhosis and Splenic Artery Aneurysm. Int J Surg Pathol 2013; 21:618-26. [DOI: 10.1177/1066896913476737] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The behavior of littoral cell neoplasms ranges from benign (littoral cell angioma, LCA) to highly malignant (angiosarcoma). Two unusual cases of low-grade metastatic littoral cell angiosarcoma (LCAS) have been reported with late recurrence and bulky metastases. We present the third case of this rare neoplasm in a 38-year-old man with cirrhosis and a large splenic artery aneurysm, without extrasplenic masses. The spleen showed nodules resembling LCA, immunoreactive for CD31, factor VIII, CD68, and CD163 but not CD8 or CD34. Also present were solid areas of immunophenotypically identical bland spindle cells, although lighter CD31 immunostaining distinguished them from LCA-like angiomatous channels. Similar cells diffusely infiltrated the cirrhotic liver. After splenectomy, pancytopenia resolved, and he is asymptomatic 19 months later. Low-grade LCAS is a previously unreported cause of cirrhosis and may metastasize without forming masses. In cases of LCA, CD31 immunohistochemistry may facilitate detection of LCAS and indicate metastatic potential.
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Affiliation(s)
- Brandon T. Larsen
- University of Arizona, Tucson, AZ, USA
- Southern Arizona Veterans Affairs Health Care System, Tucson, AZ, USA
| | - Maria C. Bishop
- Southern Arizona Veterans Affairs Health Care System, Tucson, AZ, USA
| | - Glenn C. Hunter
- Southern Arizona Veterans Affairs Health Care System, Tucson, AZ, USA
| | - Stephen W. Renner
- Southern Arizona Veterans Affairs Health Care System, Tucson, AZ, USA
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32
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Rehg JE, Bush D, Ward JM. The utility of immunohistochemistry for the identification of hematopoietic and lymphoid cells in normal tissues and interpretation of proliferative and inflammatory lesions of mice and rats. Toxicol Pathol 2012; 40:345-74. [PMID: 22434870 DOI: 10.1177/0192623311430695] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Expression of antigens in cells and tissues can be readily studied immunohistochemically with the use of antibodies. A panel of antibodies to cell-specific markers can be used to diagnose lesions, including tumors, in the hematopoietic and lymphoid systems. This review discusses the use of readily available antibodies and procedures to identify antigens expressed in normal tissues and in proliferative and inflammatory lesions in formalin-fixed, paraffin-embedded (FFPE) murine specimens.
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Affiliation(s)
- Jerold E Rehg
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
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33
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Ogembo JG, Milner DA, Mansfield KG, Rodig SJ, Murphy GF, Kutok JL, Pinkus GS, Fingeroth JD. SIRPα/CD172a and FHOD1 are unique markers of littoral cells, a recently evolved major cell population of red pulp of human spleen. THE JOURNAL OF IMMUNOLOGY 2012; 188:4496-505. [PMID: 22490440 DOI: 10.4049/jimmunol.1103086] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Asplenic individuals are compromised not only in their ability to destroy infectious agents, but are at increased risk for death from autoimmune disease, certain tumors, and ischemic heart disease. Enhanced mortality is attributed to lack of phagocytes sequestered in spleen that efficiently engulf and destroy appropriate targets, although related cells are found elsewhere. To determine whether a unique population regulates RBC-pathogen clearance and filtration of altered self, we reviewed the anatomic literature and analyzed in situ by immunohistochemistry and immunofluorescence the expression patterns of a little-characterized cell that dominates the splenic red pulp of humans and closely related primates: the venous sinus-lining or littoral cell (LC). High expression of the formin homology domain protein 1 outlines the LC population. Although LCs are endothelial-like in distribution, they express several macrophage-directed proteins, the RBC Duffy Ag receptor for chemokines and T cell coreceptor CD8α/α, yet they lack lineage-associated markers CD34 and CD45. Strikingly, SIRPα (CD172a) expression in human spleen concentrates on LCs, consistent with recent demonstration of a key role in RBC turnover and elimination versus release of infected or altered self. Our results indicate human LCs (SIRPα(+), formin homology domain protein 1(+), CD8α/α(+), CD34(-), CD45(-)) comprise a highly plastic barrier cell population that emerged late in primate evolution coordinate with CD8 expression. Unique to Hominidae, LCs may be the ultimate determinant of which cells recirculate after passage through human spleen.
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Affiliation(s)
- Javier Gordon Ogembo
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA 02215
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Mohr Z, Klippel S, Spiethoff A, Trick D, Willis S. [Laparoscopic splenectomy for sclerosing angiomatoid nodular transformation]. Chirurg 2012; 82:714-8. [PMID: 21290093 DOI: 10.1007/s00104-010-2045-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sclerosing angiomatoid nodular transformation (SANT) is a benign lesion of the spleen which can be cured by splenectomy. In the literature about 45 cases have been reviewed. Although it is defined by the morphological details, data regarding surgical therapy are scarce. To the best of our knowledge, a laparoscopic approach has not been published before. We investigated in one case of SANT the feasibility of a laparoscopic approach. Histological investigations confirmed the diagnosis of a SANT which was resected in toto. This report shows that the laparoscopic splenectomy is a feasible, safe and effective method for treatment of SANT.
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Affiliation(s)
- Z Mohr
- Chirurgische Klinik A, Allgemein-, Viszeral-, Thorax- und Unfallchirurgie, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, Ludwigshafen, Germany.
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Ambrosio MR, Rocca BJ, Di Mari N, Ambrosio A, Lazzi S. Multifocal Capillary Hemangioma (Hemangiomatosis) of the Spleen. TUMORI JOURNAL 2012; 98:e22-6. [DOI: 10.1177/030089161209800133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The spleen is mainly affected by benign tumors that originate from the vascular endothelium. The most common is hemangioma, which presents as a small, localized lesion. Isolated diffuse hemangiomatosis of the spleen is a rare entity in which the entire splenic parenchyma is replaced by a proliferation of neoplastic blood vessels. Here we illustrate the case of a 26-year-old man presenting with splenomegaly due to diffuse hemangiomatosis of the white pulp who underwent a splenectomy. Methods Representative samples of the spleen were stained with hematoxylin and eosin, and immunohistochemical analysis was performed for Mib-1, CD20, CD30, CD15, CD34, CD31, CD8, factor VIII, D2–40, CD68PGM1, and LMP1. Results Macroscopically, the splenic parenchyma contained multiple, red-brown nodules ranging from 0.4 to 1.5 cm. Microscopically, the nodules were roundish and confluent with an angiomatoid appearance and high positivity for CD34 and factor VIII, while they were negative for D2–40. Conclusions The differential diagnosis of splenic tumors includes lymphangioma, lymphangiomatosis, peliosis, littoral cell angioma, hemangioendothelioma, hamartoma, angiomatoid transformation of the spleen, and angiosarcoma. It is debated whether diffuse hemangiomatosis is a malformation of the postsinusoidal venous system or a slowly growing neoplasm arising from the splenic sinuses. The positivity of the cavernous vessels for CD8 seems to be in favor of the malformative nature of the tumor.
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Affiliation(s)
- Maria Raffaella Ambrosio
- Department of Human Pathology and Oncology, Section of Anatomic Pathology, University of Siena, Siena
| | - Bruno Jim Rocca
- Department of Human Pathology and Oncology, Section of Anatomic Pathology, University of Siena, Siena
| | | | | | - Stefano Lazzi
- Department of Human Pathology and Oncology, Section of Anatomic Pathology, University of Siena, Siena
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Sclerosing angiomatoid nodular transformation of the spleen treated by laparoscopic partial splenectomy. Wideochir Inne Tech Maloinwazyjne 2011; 6:249-55. [PMID: 23255989 PMCID: PMC3516950 DOI: 10.5114/wiitm.2011.26261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 12/19/2022] Open
Abstract
The authors describe a case of sclerosing angiomatoid nodular transformation (SANT) of the spleen treated at the 2nd Department of Surgery, Jagiellonian University, Medical College. The patient was a 23-year-old woman. Clinically she presented with 2-year history of recurrent mild fever, diffuse joint pain, abdominal discomfort and iron deficiency anaemia of chronic disease. The laboratory tests revealed a non-characteristic chronic inflammatory response. A splenic solid lesion 9 cm in diameter was found on abdominal computed tomography. The patient underwent uneventful laparoscopic resection of the upper half of the splenic parenchyma. The resected tumour showed characteristic histological and immunophenotypical findings of SANT as previously described in the literature. In long-term follow-up, improvement of preoperative symptoms and abnormalities in the blood tests was documented.
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Hu ZQ, A YJ, Sun QM, Li W, Li L. The splenic Littoral cell angioma in China: a case report and review. World J Surg Oncol 2011; 9:168. [PMID: 22172167 PMCID: PMC3271992 DOI: 10.1186/1477-7819-9-168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/15/2011] [Indexed: 01/18/2023] Open
Abstract
Littoral cell angioma (LCA) is a rare splenic vascular neoplasm that arises from the cells lining the red pulp sinuses. It is deemed to be a benign and incidental lesion. The earliest literature report of littoral cell angioma has been described by Falk. The examination of samples after splenectomy reveals similar pathological change and its change rule is summarized. However, many recent reports have described it to be a malignant tumor with congenital and immunological associations. Generally speaking, the definitive diagnosis can only be made after histological and immunohistochemical profiles. In this case report, we presented the case of a 48-year-old woman with multiple splenic LCAs. Initially, the patient was characteristics of abdominal distension, weakness and fatigue. Multiple hemangiomas were observed in the spleen through abdominal ultrasonic diagnosis. Computed tomography (CT) scans revealed the splenomegaly with multiple round and hyperdense lesions. The patient subsequently underwent splenectomy. Postoperative histological and immunohistochemical studies confirmed the diagnosis of LCA. Based on the presentation of this case, clinical, radiographic and pathological results of LCA as well as recent advances in our understanding of this uncommon splenic lesion were reviewed. LCA is an uncommon splenic tumor diagnosed in patients with or without abdominal discomfort. Only a few case reports regarding this kind of tumor have been published as inconsistent results. In the present paper, we have reported a case of LCA and reviewed the literature.
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Affiliation(s)
- Zong-Qiang Hu
- Ganmei Affiliated Hospital of Kunming Medical University, Kunming, China
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γ-Synuclein Is a Promising New Marker for Staining Reactive Follicular Dendritic Cells, Follicular Dendritic Cell Sarcoma, Kaposi Sarcoma, and Benign and Malignant Vascular Tumors. Am J Surg Pathol 2011; 35:1857-65. [DOI: 10.1097/pas.0b013e3182297c2e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hudson JB, Murad FM, Kunkel JE, Collins BT. Endoscopic ultrasound guided fine-needle aspiration of a splenic hemangioma with extramedullary hematopoiesis. Diagn Cytopathol 2011; 41:1086-90. [PMID: 22102556 DOI: 10.1002/dc.21862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 10/07/2011] [Indexed: 12/26/2022]
Abstract
Extramedullary hematopoiesis (EMH) is the production of mature blood elements outside of the bone marrow and can occur as a compensatory result of a marrow replacing process or from marrow space occupying lesions such as tumor or marrow fibrosis. EMH can also be induced by factors elicited by neoplasms, such as vascular endothelial growth factor (VEGF). Usually, EMH is a diffuse process most commonly observed in lymph nodes, liver, and spleen. Rarely, EMH can form a mass lesion. Although the spleen is a common site for diffuse EMH, it is a rare location for a mass forming EMH. Hemangiomas are the most common benign tumors of the spleen. A case of a discrete, 8 cm lesion was noted incidentally on CT scan in a 59-year-old man with no significant past medical history. Endoscopic ultrasound guided fine-needle aspiration (EUS FNA) biopsy was performed and cytologic examination revealed trilinear hematopoiesis, with the most distinctive elements being megakaryocytes and erythroid precursors. A diagnosis of EMH was made. On resection, the mass was a hemangioma with EMH. EUS guided FNA is a useful tool for diagnosing splenic masses. Awareness of EMH, both as a mass forming lesion and a feature associated with benign and malignant vascular lesions is important, especially in patients with hematologic malignancies or marrow replacing processes.
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Affiliation(s)
- Jena B Hudson
- Department of Pathology and Immunology, Washington University, St Louis, Missouri
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40
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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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Bhavsar T, Wang C, Huang Y, Karachristos A, Inniss S. Littoral cell angiomas of the spleen associated with solid pseudopapillary tumor of the pancreas. World J Gastrointest Pathophysiol 2011; 2:53-6. [PMID: 21860837 PMCID: PMC3158892 DOI: 10.4291/wjgp.v2.i3.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/31/2011] [Accepted: 04/07/2011] [Indexed: 02/06/2023] Open
Abstract
Littoral cell angiomas (LCA) of the spleen are vascular tumors of unknown etiology arising from the littoral cells of the splenic red pulp sinuses. Usually a benign and incidental finding, LCA have been repeatedly reported in association with a variety of visceral malignancies and hold the potential for dissemination per se. We encountered a case of a 30 year old female who was diagnosed with solid pseudopapillary tumor of the head and distal pancreas by fine needle aspiration cytology. A distal pancreatectomy with splenectomy was performed in addition to a pylorus-preserving Whipple’s procedure and cholecystectomy. Histopathological examination confirmed solid pseudopapillary tumor of the pancreas and showed multiple well-circumscribed anastomosing vascular channels in the spleen. The diagnosis of LCA of the spleen was confirmed by immunohistochemistry that revealed co-expression of endothelial cell marker, CD31 and CD34, along with histiocytic marker, CD68 by the vascular lining cells. LCA has been previously reported in association with colorectal and pancreatic adenocarcinoma, malignant lymphoma, myelodysplasia and autoimmune disorders. We report the first case of LCA associated with solid pseudopapillary tumor of the pancreas.
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Abstract
Early diagnosis and prompt splenectomy prior to splenic rupture may be the best chance for surviving this rare, aggressive malignant neoplasm arising from splenic vascular endothelium. Primary splenic angiosarcoma is a rare, aggressive malignant neoplasm arising from splenic vascular endothelium. A 70-year-old woman presented with shortness of breath and chest discomfort secondary to a left-sided pleural effusion. A thoracentesis revealed a reactive effusion suspicious for malignancy. Splenic enlargement with heterogeneous enhancement was identified on CT of the abdomen. Laboratory findings at initial presentation revealed mild anemia (10.5g/dL) with normal platelets (300 × 109/L). Laparoscopic splenectomy was performed, and a primary splenic angiosarcoma was discovered. After 2 rounds of chemotherapy, a CT scan showed progressive disease with metastasis to the liver and lung. The patient's antineoplastic regimen was switched to Ifosfamide and Doxorubicin. She is currently alive with evidence of disease at 9 months but without further progression. Primary splenic angiosarcoma is almost universally fatal despite treatment. The best chance for survival is early diagnosis and prompt splenectomy prior to splenic rupture.
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Affiliation(s)
- Kamran S Hamid
- The Texas A&M University Health Science Center, 2401 South 31st Street, Temple, Texas 76508, USA.
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43
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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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44
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Chiu A, Czader M, Cheng L, Hasserjian RP, Wang M, Bhagavathi S, Hyjek EM, Al-Ahmadie H, Knowles DM, Orazi A. Clonal X-chromosome inactivation suggests that splenic cord capillary hemangioma is a true neoplasm and not a subtype of splenic hamartoma. Mod Pathol 2011; 24:108-16. [PMID: 20852592 DOI: 10.1038/modpathol.2010.168] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Splenic hamartoma is a rare tumor-like lesion composed of structurally disorganized red pulp elements. It has been hypothesized that two other splenic lesions, cord capillary hemangioma and myoid angioendothelioma, may fall within the spectrum of splenic hamartoma, simply representing morphological variants. In this study, we compared the vascular and stromal composition of cord capillary hemangioma and myoid angioendothelioma with those of classical hamartoma. In addition, we assessed the clonal vs polyclonal nature of the lesions in nine female cases by performing clonality analysis for X-chromosome inactivation at the human androgen receptor locus (HUMARA) on laser-assisted microdissected samples. In 15 of 17 cases, increased reticulin and/or collagen content was observed. The classical hamartoma cases showed a vasculature predominantly composed of CD8+ CD31+ CD34- splenic sinuses, whereas cases of cord capillary hemangioma and myoid angioendothelioma contained many CD8- CD31+ CD34+ cord capillaries, but very little CD8+ vasculature. All cases lacked expression of D2-40 and Epstein Barr virus-encoded RNA. All cases showed a proliferation index of ≤5% by Ki-67. Cases of classical hamartoma lacked significant perisinusoidal expression of collagen IV and low-affinity nerve growth factor receptor. Both markers were variably expressed in the other lesions. Increased CD163-positive histiocytes were found in four cases (three cord capillary hemangiomas and one myoid angioendothelioma). HUMARA analysis was informative in all nine tested cases, of which three cases showed a non-random X-chromosome inactivation pattern, indicating clonality. All three clonal cases were cord capillary hemangiomas. Our study has shown that in spite of considerable morphologic heterogeneity and overlapping features, classical hamartoma and cord capillary hemangioma and myoid angioendothelioma are different in terms of their vascular and stromal composition. Clonality analysis supports a true neoplastic origin for the cord capillary hemangioma. A larger study using additional immunohistochemical and molecular studies is necessary to further evaluate the biological significance of the current findings.
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Affiliation(s)
- A Chiu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, USA
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45
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Venkatanarasimha N, Hall S, Suresh P, Williams MP. Littoral cell angioma in a splenunculus: a case report. Br J Radiol 2010; 84:e11-3. [PMID: 21172957 DOI: 10.1259/bjr/60430925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Littoral cell angioma (LCA) is a rare primary splenic vascular tumour that arises from the littoral cells that line the red pulp sinuses. It is usually asymptomatic and is discovered incidentally on imaging for other pathologies. Radiologists should be aware of these lesions as they may be mistaken for malignant lesions and lead to unnecessary surgery. We present a case of LCA recurrence within a splenunculus that was discovered incidentally in a 60-year-old patient being investigated for right upper quadrant pain.
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46
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Hao X, Fredrickson TN, Chattopadhyay SK, Han W, Qi CF, Wang Z, Ward JM, Hartley JW, Morse HC. The histopathologic and molecular basis for the diagnosis of histiocytic sarcoma and histiocyte-associated lymphoma of mice. Vet Pathol 2010; 47:434-45. [PMID: 20472805 DOI: 10.1177/0300985810363705] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Histiocytic sarcoma (HS) and histiocyte-associated lymphoma (HAL) of mice are difficult to distinguish histologically. Studies of multiple cases initially diagnosed as HS or HAL allowed us to define HS as round, fusiform, or mixed cell types that were F4/80+, Mac-2+, and PAX5-; that lacked markers for other sarcomas; and that had immune receptor genes in germline configuration. Two other subsets had clonal populations of lymphocytes. The first, HAL, featured malignant lymphocytes admixed with large populations of normal-appearing histiocytes. The second appeared to be composites of lymphoma and HS. Several cases suggestive of B myeloid-lineage plasticity were also observed.
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Affiliation(s)
- X Hao
- Laboratory of Immunopathology, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
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47
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Stanislas S. [Splenic pathology. Case 5. Splenic angiosarcoma]. Ann Pathol 2010; 30:223-7. [PMID: 20621601 DOI: 10.1016/j.annpat.2010.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 02/24/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Sophie Stanislas
- Département de pathologie, hôpital Haut-Lévêque, CHU, université de Bordeaux, Pessac, France.
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Affiliation(s)
- Fabio Facchetti
- Department of Pathology, University of Brescia, Brescia, Italy.
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Pilz JB, Sperschneider T, Lutz T, Loosli B, Maurer CA. Littoral cell angioma in main and accessory intrapancreatic spleen presenting as splenic rupture. Am J Surg 2010; 201:e15-7. [PMID: 20409532 DOI: 10.1016/j.amjsurg.2009.11.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 11/24/2009] [Accepted: 11/24/2009] [Indexed: 01/13/2023]
Abstract
We report the incidental finding of a nodular mass in the pancreatic tail on a contrast-enhanced computed tomography scan preinterventional to emergency laparotomy for splenic rupture. Because of the past surgical history and radiologic appearance, differential diagnosis included atypical lymphoma in the spleen and regional lymph node, pancreatic adenocarcinoma with splenic metastasis, and intrapancreatic metastase of malignant melanoma; the patient underwent both splenectomy and pancreatic tail resection. A diagnosis of littoral cell angioma in main and accessory intrapancreatic spleen was made. To our knowledge, this is the first description of littoral cell angioma of the spleen involving both main and accessory organ presenting as splenic rupture.
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Affiliation(s)
- Julia B Pilz
- Department of Gastroenterology, Liestal Hospital, Switzerland
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50
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Forest F, Duband S, Clemenson A, Peoc'h M. Traumatic subcapsular splenic hematoma revealing littoral cell angioma and Gaucher's disease. Ann Hematol 2010; 89:1061-2. [PMID: 20155266 DOI: 10.1007/s00277-010-0909-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
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