Real-time CEUS-guided biopsy revealing a littoral cell angioma of the spleen after inconclusive CT and MRI findings

The aim of this case report is to present real-time CEUS-guided biopsy for diagnosing rare benign splenic pathologies after inconclusive findings on cross-sectional imaging. We present the case of a 50-year-old male patient who received a contrast-enhanced computed tomography scan of the thorax during the evaluation for lung transplant due to lung fibrosis, with incidental finding of disseminated hypodense splenic lesions. During follow-up imaging, the patient did not tolerate a complete MRI examination, and two acquired pulse sequences did not confirm the final diagnosis. While CT-guided biopsy revealed no results, CEUS-guided target biopsy with repeated contrast injections showed a benign littoral cell angioma of the spleen. The use of real-time CEUS-guided target biopsy during lesion washout may be a useful tool to improve the accuracy of biopsy and accelerate the diagnosis in patients with parenchymal lesions after inconclusive cross-sectional imaging findings which may pose a challenge for CT-guided biopsy.

LITTORAL CELL ANGIOMA OF SPLEEN - A RARE CASE REPORT

INTRODUCTION Littoral- cell angioma (LCA) is a rare benign vascular tumour of the spleen. There have been less then 250 cases reported in the literature. Recent reports have described it to be a Benign lesion with congenital and immunologic associations. We report a case of LCA of the spleen. PRESENTATION OF CASE A 09 -year-old male patient was admitted to hospital with a one month duration of intermittent upper abdominal pain and nausea. Imaging studies, including Ultrasonography and Colourdoppler Imaging of portal venous systems. Radiology show moderate gross enlargement-16cm & normal in echotexture with no focal lesion. Splenic vein-10mm in caliber with partial thrombus formation. An open splenectomy was performed and his post-operative recovery was uneventful. DISCUSSION Littoral cell angioma of the spleen is a benign vascular tumour that has been infrequently reported in the English literature. While it does have malignant potential, the vast majority are benign. Diagnosis depends on the expression of endothelial markers like CD31 and histiocytic markers like CD68.Malignant potential enhanced by the presence of splenomegaly as well. CONCLUSION This rare condition is made by the presence of rare vascular tumour in the spleens as well.