Partial splenectomy for littoral cell angioma

doi:10.1016/j.jpedsurg.2008.07.031

Journal of Pediatric Surgery

Volume 43, Issue 12, December 2008, Pages 2288-2290

https://doi.org/10.1016/j.jpedsurg.2008.07.031 Get rights and content

Abstract

Littoral cell angioma is a rare primary splenic tumor that is difficult to differentiate preoperatively from other benign and malignant splenic lesions and may have immunogenic origins. Preoperative ultrasound and computed tomographic scan showed that our patient's lesion was solitary and localized. Total splenectomy is usually required because littoral cell angioma is generally large and/or diffuse. However, a partial splenectomy was able to be performed, making this the first reported partial splenectomy for littoral cell angioma.

Section snippets

Case report

An 18-year-old girl was briefly evaluated after a motor vehicle collision, discharged, but returned 2 days later with vague abdominal pain and low-grade fever. Physical examination revealed mild left upper quadrant abdominal tenderness. The hemoglobin level had decreased for the 2 days from 10 to 8 g/dL, which prompted a computed tomographic (CT) scan of the abdomen. A splenic mass was found and initially interpreted as a splenic hematoma. The patient's medical history was extensive and

Discussion

Littoral cell angioma is a rare vascular tumor of the spleen that was first described in 1991 [1]. It arises from cells in the red-pulp sinuses and usually presents with anemia, pyrexia, or thrombocytopenia in either sex but typically in middle-aged adults with splenomegaly. Occasionally, children are affected [1], [2], [3]. Other diagnostic considerations are metastasis, hamartoma, hemangioma, lymphoma, and abscess. The tumor is benign, but malignant littoral cell angiosarcoma can occur [4].

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Littoral cell angioma of the spleen in a child with Cornelia De Lange syndrome
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There would seem to be no known genetic predisposition to either of these conditions. Another interesting finding in the 12 cases reported was the high prevalence [3] of a history of trauma [3,10,11]. An additional case was a sportsman who might well have sustained some trauma [9].
Partial splenectomy: Who, when and how. A systematic review of the 2130 published cases
2019, Journal of Pediatric Surgery
Citation Excerpt :
Starting in the late ‘70s, with a hemostatic purpose, some authors reported the use of various collagen products [24,40,42,149] and omentoplasty [41,49,64,67,101,102,147]. In the ‘80s and later on, parenchymal section/hemostasis was reportedly performed by various types of electrocoagulation [17,27,31,35,38–40,42,43,49,58,62,66,72,78,80,82,85,87,94,95,108,117–123], ultrasonic dissectors [23,26,40,49,53,59,67,93,99,124–126], and mechanical staplers [7,25,29,34,35,37,41,42,51,65,74,76,78,90,96,108,114,119,127–133], at times reinforcing the raw surface with interrupted [38,49] or mattress suture [30,57,103,113,145,146]. Since the 90’s, authors reported the use of then new generation hemostatic agents, including Surgicel® [41,48,49], Spongostan® [16], and various other cellulose products [116,151], as well as of Argon beam [7,42,48,73,117] and Microwave coagulation [11].
In order to avoid consequences of total splenectomy (including severe postsplenectomy sepsis), partial splenectomy (PS) is increasingly reported. Without guidelines and indications concerning a rarely-indicated procedure, a review of literature should be an asset.
A systematic review of all PSs from 1960 to December 2017 was performed, with special focus on surgical indications, sites of resection, approaches and techniques of vascular dissection and parenchymal section/hemostasis of the spleen, perioperative morbidity/mortality, including complications compelling to perform total splenectomy.
Among 2130 PSs, indications for resection were hematological disease in 1013 cases and nonhematological conditions in 1078, including various tumors in 142 and trauma in 184. Parenchymal transection was performed using several techniques through the years, most frequently after having induced partial ischemia by splenic hilum vascular dissection/ligation. 371 laparoscopic/robotic PSs were reported. Rescue total splenectomy was required in 75 patients.
Although good results are probably overestimated by such a retrospective review, PS should be considered as a procedure associated with a low morbidity/mortality. Nevertheless, severe complications are also reported, and the need of total splenectomy should not to be minimized. Laparoscopic/robotic procedures are increasingly performed, with good results and rare conversions.
Systematic review.
IV.
Littoral cell angioma of the spleen
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Littoral cell angioma (LCA) is a rare primary benign vascular neoplasm of the spleen. The case of a 52-year-old female with LCA is reported. The patient did not have any symptoms or a significant past medical history. Computed tomography (CT) and ultrasound (US) imaging studies showed multiple lesions in the spleen and gallbladder stones. The tumour was removed successfully by laparoscopic splenectomy and simultaneously cholecystectomy was conducted for gallbladder stones. The patient recovered uneventfully. The tumour lining cells were positive for CD31/CD68 markers, and negative for CD34. This is the first report of a LCA combined with gallbladder stones.
Littoral cell angioma of the spleen: A study of 10 cases case series and literature review
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Littoral cell angiomas: Benign lesion with a penchant for visceral malignancies
2023, Annals of Hepato-Biliary-Pancreatic Surgery

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Independent case reportsPartial splenectomy for littoral cell angioma

Abstract

Section snippets

Case report

Discussion

Pathology

Littoral cell angioma: a novel splenic vascular lesion demonstrating histiocytic differentiation

Am J Surg Pathol

Splenic vascular tumors: a histologic, immunophenotypic, and virologic study

Am J Surg Pathol

Splenic Littoral cell angioma in an infant

J Pediatr Surg

Littoral cell angiosarcoma of the spleen. Case report with immunohistochemical and ultrastructural analysis

Am J Surg Pathol

Littoral cell angioma of the spleen in a patient with severe aplastic anemia

Haematologica

Independent case reports
Partial splenectomy for littoral cell angioma