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Diagnostics (Basel, Switzerland) Jun 2023Cross-sectional imaging of the upper abdomen, especially if intravenous contrast has been administered, will most likely reveal any acute or chronic disease harbored in... (Review)
Review
Cross-sectional imaging of the upper abdomen, especially if intravenous contrast has been administered, will most likely reveal any acute or chronic disease harbored in the spleen. Unless imaging is performed with the specific purpose of evaluating the spleen or characterizing a known splenic lesion, incidentally discovered splenic lesions pose a small challenge. Solitary benign splenic lesions include cysts, hemangiomas, sclerosing angiomatous nodular transformation (SANT), hamartomas, and abscesses, among others. Sarcoidosis and tuberculosis, although predominantly diffuse micronodular disease processes, may also present as a solitary splenic mass lesion. In addition, infarction and rupture, both traumatic and spontaneous, may take place in the spleen. This review aims to describe the imaging features of the most common benign focal splenic lesions, with emphasis on the imaging findings as these are encountered on routine cross-sectional imaging from a multicenter pool of cases that, coupled with clinical information, can allow a definite diagnosis.
PubMed: 37371015
DOI: 10.3390/diagnostics13122120 -
Medicine Nov 2023Splenic diseases may be caused by infections and can be either malignant, such as lymphoma and lung cancer, or benign, such as hemangioma. In some cases, diagnostic...
Splenic diseases may be caused by infections and can be either malignant, such as lymphoma and lung cancer, or benign, such as hemangioma. In some cases, diagnostic uncertainty of imaging persists, and image-guided splenic needle biopsy is a useful diagnostic tool to avoid the disadvantages of incorrect diagnosis, including performing unnecessary splenectomy or not giving the necessary treatment. Splenic biopsies can be divided into ultrasound-guided, computed tomography (CT)-guided fine-needle aspiration, or core needle biopsy (CNB). However, few studies have focused exclusively on complications associated with CT-guided CNB of the spleen. Therefore, we assessed bleeding, the most common complication of CT-guided CNB of the spleen, and evaluated factors associated with the bleeding. Using the biopsy database maintained at the institution, all patients who underwent CT-guided CNB of the spleen between May 2012 and September 2022 were identified retrospectively. The 18 identified patients were divided into post-biopsy bleeding and non-bleeding groups for analysis. In total, 17 patients (94.4%) could be diagnosed accurately with CT-guided CNB. Bleeding complications occurred in 7 cases of CT-guided CNB; of these, 2 patients with Common Terminology Criteria for Adverse Events grade 4 disease required transcatheter arterial embolization. The bleeding group was characterized by diffuse spleen tumors in all cases, with significantly more diffuse spleen tumors than the non-bleeding group. CT-guided CNB is a useful option for neoplastic lesions of the spleen that are difficult to diagnose using imaging alone. However, consideration should be given to post-biopsy bleeding in patients with diffuse splenic tumors.
Topics: Humans; Retrospective Studies; Splenic Neoplasms; Image-Guided Biopsy; Tomography, X-Ray Computed; Hemorrhage; Biopsy, Large-Core Needle
PubMed: 37986279
DOI: 10.1097/MD.0000000000034951 -
Medicine Mar 2024Current study aimed to investigate the clinical characterization, differential diagnosis, and treatment of splenic littoral cell angioma (LCA). (Review)
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.
Topics: Humans; Endothelial Cells; Retrospective Studies; Splenic Neoplasms; Hemangioma
PubMed: 38552075
DOI: 10.1097/MD.0000000000037550 -
Indian Journal of Pathology &... Nov 2023Hemangiomatosis of the spleen is a benign vascular condition occurring as a manifestation of systemic angiomatosis. It is usually associated with Klippel-Trenaunay...
Hemangiomatosis of the spleen is a benign vascular condition occurring as a manifestation of systemic angiomatosis. It is usually associated with Klippel-Trenaunay syndrome (KTS), which is a rare congenital malformation characterized by a triad of varicose veins, bony and soft tissue hypertrophy, and cutaneous and visceral hemangiomas and/or venous malformations. The association of splenic hemangiomatosis with KTS is less documented in the literature. In this report, we describe a 63-year-old female who presented with massive splenomegaly, the histopathology of which showed features of diffuse hemangiomatosis. Based on the histopathological diagnosis, a retrospective evaluation of the patient was carried out and she was diagnosed as KTS. To the best of our knowledge, this is the first report in the Indian literature describing splenic hemangiomatosis in a patient with KTS.
PubMed: 38394434
DOI: 10.4103/ijpm.ijpm_897_22 -
Indian Journal of Pathology &... Jul 2023Sclerosing angiomatoid nodular transformation (SANT) is a reactive non-neoplastic, rare vascular lesion of the spleen. The histology shows multiple angiomatoid nodules...
Sclerosing angiomatoid nodular transformation (SANT) is a reactive non-neoplastic, rare vascular lesion of the spleen. The histology shows multiple angiomatoid nodules surrounded by proliferative stroma. A 31-year-old lady presented with an abdominal mass for 6 months. Contrast-enhanced computed tomography (CECT) abdomen was suggestive of hemangiopericytoma/hemangioendothelioma. An open splenectomy was performed, and the resected specimen was sent for histopathology examination. The gross examination showed a bosselated mass present at the lower pole of the spleen measuring 8 × 8 cm with peripherally located coalescing red-brown nodules embedded in a dense fibrous stroma on the cut surface. On microscopy, multiple circumscribed angiomatoid nodules comprising irregular slit-like vascular channels lined by plump endothelial cells were seen embedded in dense sclerotic stroma. Because of the lack of specific diagnostic features, it is difficult to diagnose SANT clinically and radiologically. However, the typical histopathological findings are a clue in clinching the diagnosis.
PubMed: 38391371
DOI: 10.4103/ijpm.ijpm_452_22 -
Cureus Sep 2023Sclerosing angiomatoid nodular transformation (SANT) is a benign vascular lesion of the spleen with uncertain etiology. It predominantly affects women between the ages...
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.
PubMed: 37854759
DOI: 10.7759/cureus.45422 -
Urology Case Reports Nov 2023Splenogonadal fusion in female patients is seldom reported. We describe a 6-month-old girl who represents the youngest living female with splenogonadal fusion reported...
Splenogonadal fusion in female patients is seldom reported. We describe a 6-month-old girl who represents the youngest living female with splenogonadal fusion reported to date. The lesion was diagnosed as an incidental finding during screening abdominal ultrasonography performed for a vulvar infantile hemangioma. A tail-like structure with splenic echotexture connecting a normally located spleen and the left ovary was detected and better characterized by MRI. We also reviewed the pertinent literature on managing this usually asymptomatic condition, especially in female patients. Greater professionals' awareness of this benign anomaly is paramount to avoid the unnecessary removal of an otherwise normal gonad.
PubMed: 38033426
DOI: 10.1016/j.eucr.2023.102620 -
Revista Espanola de Enfermedades... Jan 2024Case 1: A 69-year-old male underwent magnetic resonance imaging (MRI) to evaluate hepatic hemangiomas that incidentally revealed a homogeneous hypervascular solid nodule...
Case 1: A 69-year-old male underwent magnetic resonance imaging (MRI) to evaluate hepatic hemangiomas that incidentally revealed a homogeneous hypervascular solid nodule (19 mm) in pancreatic tail. Differential diagnosis included neuroendocrine tumor (NET). Normal chromogranin A and CA19.9 levels. PET-68Ga-DOTANOC scan showed pancreatic tail enhancement consistent with NET. Suspicion of neoplasia persisted after two Endoscopic Ultrasounds with Fine-Needle Aspiration without neoplastic cells. Consequently, distal pancreatectomy was performed, revealing an accessory intrapancreatic spleen. Case 2: A 77-year-old female with dyspepsia performed an abdominal CT followed by MRI and both revealed a solid nodule (11.7 mm) in pancreatic tail with regular margins, suggestive of accessory spleen or pancreatic neoplasia. EUS confirmed a hypoechoic, homogeneous nodule consistent with accessory spleen (11.7mm). A scintigraphy using fragile erythrocytes (4) confirmed intrapancreatic accessory spleen, which requires no treatment.
PubMed: 38235715
DOI: 10.17235/reed.2024.10202/2023 -
Veterinary Sciences Apr 2024Vascular neoplasms, including hemangiosarcoma (HSA) and hemangioma (HMA), are more common in dogs than other domestic animal species; however, comprehensive laboratory...
Vascular neoplasms, including hemangiosarcoma (HSA) and hemangioma (HMA), are more common in dogs than other domestic animal species; however, comprehensive laboratory screening tests for early diagnosis are currently limited. The aims of this study were to investigate general signalments, anatomic locations, and clinicopathological abnormalities of dogs diagnosed with vascular neoplasms and to determine the diagnostic significance of these abnormalities. Retrospective data of dogs with HMA, HSA, and healthy dogs were analyzed. Dogs with HMA and HSA were seniors, with mixed breeds being most affected. HMA affected predominantly non-visceral sites, while HSA was more common in visceral sites, particularly the spleen. In multivariate model analyses, the odds of HMA diagnosis were 5.5 times higher in anemic dogs and 33.0 times higher in lymphopenic dogs compared to dogs without the abnormalities. The odds of HSA diagnosis were 42.5 times higher in anemic dogs, 343 times higher in lymphopenic dogs and 92.7 times higher in dogs with hyperfibrinogenemia compared to dogs without the abnormalities. The study suggested that these identified abnormalities were nonspecific and commonly observed in various chronic diseases, and hence their combination with clinical information, such as diagnostic imaging and histopathology, is important to facilitate a more precise diagnosis of canine vascular neoplasms.
PubMed: 38787161
DOI: 10.3390/vetsci11050189