Multimodality imaging findings in image-guided biopsy proven splenic littoral cell angioma: series of three cases Sundeep Shah, 1 Ashish Wasnik, 1,2 Amit Pandya, 1 Ronald O. Bude 1 1 Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109, USA 2 Taubman Center, B1-132 F, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA Abstract Littoral cell angioma (LCA) is a rare primary splenic vascular tumor arising from the littoral cells that line the splenic sinuses of the red pulp. Definitive diagnosis of this entity depends on histology and immunochemical studies, for which splenectomy is usually performed. We present three image-guided percutaneous core biopsy proven cases of splenic LCA and also discuss imaging features of these rare tumors on CT, MR, and US findings. Key words: Littoral cell angioma—Splenic tumor—Percutaneous biopsy—Computed tomography—Ultrasonography—Magnetic resonance imaging Littoral Cell Angioma (LCA) is a rare benign vascular neoplasm of the spleen, first described in 1991 by Falk et al. [1]. It arises from the littoral cells of the spleen which line the red pulp sinuses. While vascular lesions are the most common primary splenic neoplasm, the majority of these arise from vascular endothelium. Definitive diagnosis of this vascular neoplasm depends on histological and immunological analysis [1]. Case series Case 1 A 78-year-old male status post right radical nephrectomy and adrenalectomy for renal cell carcinoma (RCC) 2 years earlier presented for a second Computed tomography (CT) surveillance. The patient was clinically asymptomatic. Contrast-enhanced CT demonstrated a new solitary hypodense lesion in a normal-sized spleen. Given history of RCC, possibility of metastasis was raised. On magnetic resonance imaging (MRI), the lesion demonstrated high signal intensity on T2-weighted ima- ges and low signal intensity on T1-weighted images, relative to the adjacent spleen (Fig. 1A, B). Following intravenous gadolinium administration, the lesion dem- onstrated subtle arterial enhancement and subsequently became isointense to the splenic parenchyma on delayed phase images (Fig. 1C, D). An uncomplicated ultra- sound-guided percutaneous biopsy was performed with an 18 gauge biopsy needle through a 17 gauge introducer (Fig. 1E). Histology and immunochemical analysis demonstrated cells of vascular origin positive for CD31 (Fig. 1F) and negative for CK, consistent with LCA. Case 2 A 57-year-old male with recently diagnosed giant cell tumor of the right femur underwent a preoperative evaluation with CT scan of chest, abdomen, and pelvis. CT of the abdomen showed a 3.0 9 2.5 cm hypodense mass in a normal-sized spleen (Fig. 2A). The patient’s hematological profile was normal. To exclude metastasis, uncomplicated CT guided core biopsy was performed (Fig. 2B). Immunohistological analysis confirmed benign LCA showing cells positive for CD31 and CD 68. Case 3 A 50-year-old male with history of endocarditis and aortic aneurysm presented for annual CT surveillance of the aortic aneurysm. CT demonstrated new multiple hypo- dense lesions of the spleen (Fig. 3A). Color Doppler ultrasound demonstrated the lesion to be slightly hetero- geneous but demonstrated little in the way of demonstra- ble vessels (Fig. 3B). Given the history of endocarditis, the possibility of abscess was raised. Ultrasound-guided core Correspondence to: Ashish Wasnik; email: drashish_w@yahoo.com ª Springer Science+Business Media, LLC 2011 Published online: 12 February 2011 Abdominal Imaging Abdom Imaging (2011) 36:735–738 DOI: 10.1007/s00261-011-9697-x