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Everything you need to know about Computed Tomography (CT) & CT Scanning

Spleen: Benign Tumors Imaging Pearls - Learning Modules | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Spleen ❯ Benign Tumors

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  • “Splenic hemangiomas are the most fre- quently occurring benign tumor of the spleen, with a rate of occurrence in autopsy series of 0.03–14%. Splenic hemangiomas are thought to be congenital in origin, arising from sinusoidal epithelium, and most are the cavernous type. Most hemangiomas are small (reported size range, 0.5–7.0 cm), incidental, and asymptomatic.” 


    Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities 
Thipphavong S et al.
AJR 2014; 203:315–322
  • “Lymphangiomas are slow-growing benign tumors that are usually found in the soft tissues of the neck, axilla, mediastinum, retroperitoneum, or extremities. Lymphangiomas can also involve the liver, spleen, kidney, or gastrointestinal tract. Three histologic sub- types are described: simple lymphangiomas, cavernous lymphangiomas, and cystic hygromas. Splenic lymphangiomas can be seen with lymphangiomatosis or systemic cystic angiomatosis (lymphangiomas and hemangi- omas) involving several body parts or organs in the body. Diffuse lymphangiomatosis with splenic involvement is rare, and most cases have been reported in children.” 


    Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities 
Thipphavong S et al.
AJR 2014; 203:315–322
  • “On CT, multiple discrete, nonenhancing low-attenuation lesions are present. Lymph- 
angiomas are usually subcapsular in location. Curvilinear peripheral mural calcifications can be seen. On MRI, well-circumscribed fluid-signal-intensity lesions are present on T2- weighted images. High signal intensity can be seen on T1-weighted imaging if there has been internal bleeding or if there is a large amount of intracystic proteinaceous material.” 


    Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities 
Thipphavong S et al.
AJR 2014; 203:315–322
  • “Splenic hamartomas are tumors composed of a varying mixture of tumor tissue and normal splenic tissue, with reported sizes ranging from 0.3 to 20.0 cm. Hamartomas are solid lesions that may contain a cystic or necrotic component. Splenic hamartomas can be associated with syndromes—namely, tuberous sclerosis and Wiskott-Aldrich-syndrome. Two subtypes of splenic hamartomas can occur: white pulp lesions, which are composed of aberrant lymphoid tissue, and red pulp lesions, which are composed of an aberrant complex of sinuses. Most hamartomas are a mixture of the two subtypes.”

    
Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities 
Thipphavong S et al.
AJR 2014; 203:315–322
  • “On unenhanced CT, hamartomas are usually isodense to splenic parenchyma. Depending on size, splenic hamartomas can cause distortion of the splenic con- tour. Sometimes the contour abnormality is the only noticeable feature on unenhanced CT. Calcification, cystic change, and fat can occasionally be seen.” 


    Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities 
Thipphavong S et al.
AJR 2014; 203:315–322
  • “Splenic lesions are commonly encountered and are often incidental in nature. Benign splenic vascular neoplasms include hemangioma, hamartoma, lymphangioma, extra-medullary hematopoiesis (EMH), and sclerosing angiomatoid nodular transformation (SANT). Uncommonly encountered entities of the spleen include focal EMH, focal myeloma, angiomyolipoma, and SANT. Primary splenic angiosarcoma is the most common malignant nonhematolymphoid malignancy of the spleen. Lymphoma, myeloma, and metastases are the other malignant entities involving the spleen.”

    Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities.
    Thipphavong S et al.
    AJR Am J Roentgenol. 2014 Aug;203(2):315-22
  • “Congenital cysts (i.e., epithelial cysts, epidermoid cysts) of the spleen are cysts lined with epithelial cells. These cysts are thought to present as either mesothelial cysts or cysts with squamous metaplasia within preexisting mesothelial cysts, arising from embryonic inclusions of the surface mesothelium in the developing spleen. They usually present in patients without symptoms and are found incidentally on imaging.” 

    Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities.
    Thipphavong S et al.
    AJR Am J Roentgenol. 2014 Aug;203(2):315-22
  • “Splenic hemangiomas are the most frequently occurring benign tumor of the spleen, with a rate of occurrence in autopsy series of 0.03–14% . Splenic hemangiomas are thought to be congenital in origin, arising from sinusoidal epithelium, and most are the cavernous type. Most hemangiomas are small (reported size range, 0.5–7.0 cm) , incidental, and asymptomatic.” 

    Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities.
    Thipphavong S et al.
    AJR Am J Roentgenol. 2014 Aug;203(2):315-2
  • “Splenic hamartomas are tumors composed of a varying mixture of tumor tissue and nor- mal splenic tissue, with reported sizes ranging from 0.3 to 20.0 cm. Hamartomas are solid lesions that may contain a cystic or necrotic component. Splenic hamartomas can be associated with syndromes—namely, tuberous sclerosis and Wiskott-Aldrich- syndrome. Two subtypes of splenic hamarto- mas can occur: white pulp lesions, which are composed of aberrant lymphoid tissue, and red pulp lesions, which are composed of an aberrant complex of sinuses. Most hamartomas are a mixture of the two subtypes.” 

    Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities.
    Thipphavong S et al.
    AJR Am J Roentgenol. 2014 Aug;203(2):315-22
  • Splenic Hemangioma: Facts
    - Most common benign splenic tumor
    - Can be single or multiple
    - May enhance similar to a hepatic hemangioma occassionally
    - Multiple lesions may be seen in KTW syndrome
  • Multiple Splenic Lesions: Differential Dx
    - Cysts
    - Hemangiomas
    - Hamartoma
    - Lymphoma
    - Metastases
    - Abscesses
    - Infarcts
  • Cystic Splenic Lesions: Differential Dx
    - Epidermoid cyst
    - Hematoma due to trauma
    - Post traumatic cyst
    - Cystic degeneration of an infarct
    - Abscess
    - Lymphoma
    - Metastases
  • Splenomegaly: Differential Dx
    - Congestion (cirrhosis, CHF, acute sequestration)
    - Neoplasm (lymphoma)
    - Infection (abscesses)
    - Collagen vascular disease (SLE, rheumatoid arthritis
    - sarcoidosis
  • Splenic Hemangioma: Facts
    - Most common benign splenic tumor
    - Can be single or multiple
    - May enhance similar to a hepatic hemangioma occassionally
    - Multiple lesions may be seen in KTW syndrome
  • Littoral Cell Angioma
    - Rare vascular neoplasm of the spleen first described in 1991. 
    - Commonly an incidental finding, although patients can sometimes present with anemia, thrombocytopenia or splenomegaly. 
    - Most littoral cell angiomas are benign,  but there are case reports of malignant lesions.
  • Littoral Cell Angioma
    - Usually appear as multiple low density nodules varying in size up to 6cm.
    - Demonstrate enhancement after IV contrast and in some patients may become isodense to the spleen on delayed images.
    - There is nothing specific about the CT appearance.
  • Sclerosing Angiomatoid Nodular Transformation (SANT) of the Spleen
    - Recently recognized
    - Rare, 30 reported cases
    - Nonneoplastic vascular lesion
    - Microscopically, all the reported cases have multiple angiomatoid nodules in a fibrosclerotic stroma
    - DDX: splenic hamartoma, inflammatory myofibroblastic tumor, littoral cell angioma, and hemangioendothelioma
    - F>>M
    - Age 22-74 years
  • Sclerosing Angiomatoid Nodular Transformation (SANT) of the Spleen
    - Most incidental findings in asymptomatic patients
    - Some present with abdominal pain or discomfort
    - Splenomegaly rare
    - Benign course with splenectomy curative
  • “ While there are several imaging features of SANT which have been described in the literature, it is not routinely possible to make a prospective diagnosis based on the imaging features alone.  Moreover, it may not be possible to exclude malignancy based on the imaging features, and needle biopsy or splenectomy may be required in certain cases.”
    Sclerosing Angiomatoid Nodular Transformation of the Spleen (SANT) – Multimodality Imaging Appearance of Five Cases with Radiology-Pathology Correlation
    Raman SP, Hruban RH, Singhi A, Horton KM, Fishman EK
    AJR (submited)
  • “Finally, as a benign lesion, one would expect that SANT would remain stable in size and appearance over time.  While there have been no reports of growth of lesions in the literature, we have seen at least one case where the lesion has grown substantially, eventually necessitating splenectomy.  Ultimately, in many cases, there may be no option other than splenic biopsy or splenectomy.”
    Sclerosing Angiomatoid Nodular Transformation of the Spleen (SANT) – Multimodality Imaging Appearance of Five Cases with Radiology-Pathology Correlation
    Raman SP, Hruban RH, Singhi A, Horton KM, Fishman EK
    AJR (submited)
  • Sarcoidosis:Abdominal Manifestations
    - Up to 59% of patients with sarcoidosis have splenic involvement
    - CT findings range from splenomegaly, to solitary nodules to multiple nodules
  • Sarcoidosis:Abdominal Manifestations
    - Liver
    - Spleen
    - Kidney
    - Lymph nodes
    - Small Intestine
    - Stomach
  • Sarcoidosis: Facts
    - Most common in age range of 30-50
    - AfroAmericans affected 3x more frequent then whites
    - Pulmonary complications most common cause of death
    - Symptoms include fatigue, fever and weight loss
  • Hamartoma: Facts:

    - Rare, occur at any age
    - anomalous mixture of splenic elements, congenital
    - usually solitary, but can be multiple
    - associated with Tuberous Sclerosis
  • Hamartoma: CT Findings:

    - CT appearance
    - iso or hypodense on non contrast CT
    - slow enhancement after IV contrast
    - CT appearance can be similar to hemangioma
    - Well-defined
  • Lymphangioma: Facts

    - uncommon splenic tumor
    - usually asymptomatic
    - cystic type most common in spleen

    CT appearance

    - usually small and multiple
    - cystic (HU 15-35)
    - often subcapsular location
    - typically do not enhance
  • Increased Attenuation of the Spleen-Differential Dx:

    - Thorotrast
    - Sickle cell disease
    - Thallasemia
    - Hemochromatosis and hemosiderosis
    - Treated lymphoma
© 1999-2018 Elliot K. Fishman, MD, FACR. All rights reserved.