DOI: 10.1097/RUQ.0000000000000100
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PMID: 25148505
Issn Print: 0894-8771
Publication Date: 2014/09/01
Sclerosing Angiomatoid Nodular Transformation of the Spleen
Megan Lee; Melanie Caserta; Hisham Tchelepi
Excerpt
A 38-year-old female patient without significant past medical history initially presented with upper abdominal discomfort associated with nausea. Laboratory values were unremarkable, including amylase, lipase, and liver function tests. Hematologic laboratory values were as follows: hemoglobin level, 13.5 g/dL; white blood cell count, 12,900; and platelet count, 224,000. The patient was initially evaluated with an abdominal ultrasound, which demonstrated a 5.2-cm hypoechoic hypervascular mass within the spleen. A multiphasic contrast-enhanced computed tomography (CT) of the abdomen was then performed for further evaluation. Computed tomography imaging demonstrated a hypervascular mass measuring 5.1 × 4.7 cm in the spleen with well-defined margins. The lesion was hypodense compared with the surrounding splenic tissue on noncontrast images. Avid peripheral contrast enhancement was seen during the early arterial phase of imaging, with a central area of hypoenhancement. On delayed imaging, the central areas of the lesion began to demonstrate contrast enhancement, with the entire lesion beginning to more closely approximate the contrast enhancement pattern of the surrounding splenic parenchyma. On imaging, this lesion within the spleen was favored to represent a hamartoma, with additional differential diagnostic considerations including hemangioma and angiosarcoma favored to be less likely. Given the concern for a possible malignancy, the patient was treated with splenectomy. Gross pathologic analysis of the splenic mass revealed “multiple tan well-defined nodules… ranging from 0.8 cm up to 1.2 cm.
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