Littoral cell angioma: A case report

Table 1 Classification of splenic tumors with associated clinical, pathological and radiological factors[1-12]

Category	Type	Clinical	Pathological	Radiological
	Non Hodgkin lymphoma	Fevers, sweats, change in weight are common symptoms	Derived from B or T cells, lympho-proliferative	CT: Hypodense nodules, diffuse or military distribution
				MRI: Isotense on precontrast images, hypotense on postcontrast images
Lymphoid	Hodgkins lymphoma	Spleen is a rare primary site	Nodular sclerosis subtype, Reed-Sternberg cells	CT: Hypodense nodules with nodular sclerosis
	Inflammatory pseudotumor	Secondary to inflammatory response to infection or injury Benign	Spindle cells, lymphocytes in fibroblastic stroma	CT: Well circumscribed +/- calcifications, hypoattenuating
				MRI: Hypo- or isointense on T1 images. Variable signaling on T2 images
	Plasmacytoma	Rare diagnosis	Diffuse infiltration of plasma cells	Not well categorized findings
	Histocytic lymphoma	Non specific symptoms, elevated ESR	Nodules with central necrosis	US: Cystic appearance
				CT: Sharply demarcated with central necrosis
	Hemangioma	Benign, slow growth, asymptomatic	Sinusoidal epithelium, proliferation of vascular channels	Solid to cystic components
				US: Echogenic solid to complex mass
				CT: Iso- to hypoattenuation associated with calcification
				MRI: Hypo- to isointense on T1 images, hyperintense on T2 images
	Hamartoma	Benign, asymptomatic. Associated with tuberous sclerosis and Wiskott Aldrich	Solid nodules, well circumscribed, well defined gross appearance. Unorganized vascular channels with fibrotic cords	US: More sensitive than CT, solid mass +/- calcification
				CT: Isoattenuating
				MRI: Isointense on T1 images, hyperintense
	Lymphangioma	Asymptomatic, benign, mostly in children	Multiple solitary nodules, Flattened endothelium with proteinaceous material in a capillary, cavernous or cystic presentation	US: Splenic cysts hypoechoic septations
				CT: Thin walled low attenuation masses, subcapsular location
				MRI: Hypointense on T1 images, hyperintense on T2 images
Vascular	Littoral cell angioma	Asymptomatic, benign with malignant potential	Well delineated nodules of anastomosing vascular channels with endothelial cells	US: Hypoechoic to hyperechoic
				CT: Iso to hypoattenuating with contrast enhancement
				MRI: Low intensity lesions
	Angiosarcoma	Older patients, malignant, nonspecific symptoms	Diffuse involvement of spleen arises from sinus endothelial cells, high mitotic rate	US: Complex mass, heterogenous, necrotic degeneration
				CT: Ill-defined mass with heterogenous enhancement, punctate calcification
				MRI: Mixed signal intensity on T1 and T2
	Hemangioendothelioma	Nonspecific symptoms, young adults	Variable morphologic appearance	US: Hypoechoic mass
				CT: Low attenuated mass with enhancement of solid portions
				MRI: Heterogenous solid mass. Hypointense on T1 and T2 images
	Fibrosarcoma	Asymptomatic	Well differentiated, spindle shaped, fibroblasts, collagen is commonly present	Non specific imaging findings
Non- lymphoid	Lipoma	Asymptomatic	Adipose tissue, no atypia, cytoplasmic vacuoles	CT: Well defined fat density mass
	Kaposi sarcoma	Associated with HIV/AIDS +/- skin lesions	Spindle cell proliferation, spongelike vascular channels	CT: Ill-defined nodules, homogeneous
				US: Hyperechoic nodules
	Peliosis	Associated with anabolic steroid, TB, AIDS, cancer. Asymptomatic	Cyst like blood filled cavities within splenic parenchyma	US: Echogenic mass
				CT: Hypoattenuating, multiloculated with septa
Tumor like	Nonparasitic cysts	Congenital or neoplastic in origin. Benign.	Varies according to type of cyst including dermoid cyst	US: Cystic lesions with solid components
				CT: Hypoattenuating lesions, well defined
	Granulomas	Associated with chronic granulomatous disease and sarcoidosis	Granulomas non-necrotizing or necrotizing	CT: Hypodense nodules
				MRI: Hypointense T1 and T2

ESR: Erythrocyte sedimentation rate; CT: Computed tomography; MRI: Magnetic resonance imaging; US: Ultrasound; HIV: Human immunodeficiency virus; AIDS: Acquired immunodeficiency syndrome; TB: Tuberculosis.