脾原发血管性肿瘤的CT表现及其鉴别诊断
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摘要
目的探讨脾原发血管性肿瘤的CT表现及其鉴别诊断。方法回顾性分析经病理证实的52例脾原发血管性肿瘤的临床及CT资料。结果 52例中,良性肿瘤41例(血管瘤18例,错构瘤1例,淋巴管瘤3例,血管淋巴管瘤19例),潜在恶性肿瘤(窦岸细胞血管瘤) 9例,恶性肿瘤(血管肉瘤) 2例。脾血管瘤易于单发,可有3种强化方式;错构瘤CT表现与血管瘤类似;淋巴管瘤为典型囊性病灶,无强化;血管淋巴管瘤多为多发,兼有血管瘤与淋巴管瘤的影像表现;窦岸细胞血管瘤表现为脾内多发低密度结节,呈渐进性强化或轻度强化;血管肉瘤表现为脾大,脾内占位可出现坏死或异常肿瘤血管。结论脾原发血管性肿瘤影像表现有一定特征性,也有部分表现重叠,CT检查能够对其进行鉴别诊断。
Objective To investigate the CT findings of primary vascular neoplasms of the spleen,and to discuss their differential diagnosis. Methods CT findings and clinic materials of 52 patients of primary vascular neoplasms of the spleen were reviewed and analyzed. Results 41 cases of benign primary vascular tumors included 18 cases of hemangioma,1 case of hamartoma,3 cases of lymphangioma,and 19 cases of hemolymphangioma. Littoral cell angioma( 9 cases) was potentially malignant and the primary malignant vascular neoplasm of the spleen was angiosarcoma( 2 cases). Most of the hemangiomas were single lesions in the spleen with 3 different enhancement patterns. The appearance of hamartoma is similar to hemangioma,and the typical appearance of lymphangioma is cystic lesion without enhancement. Most of the hemolymphangiomas are multiple lesions in the spleen,can be cystic,solid,cystic-solid or mixed lesions with similar enhancement patterns to hemangiomas and lymphangiomas. Littoral cell angiomas were manifested as exclusively multiple small hypodense lesions in the spleen with progressive or minimal enhancement. Angiosarcomas were manifested as splenomegaly,with necrosis of abnormal neoplastic vessels. Conclusion The CT findings of primary vascular neoplasms of the spleen have some characteristics,but also have some overlaps. CT can be helpful in the differential diagnosis of the tumors.
Objective To investigate the CT findings of primary vascular neoplasms of the spleen,and to discuss their differential diagnosis. Methods CT findings and clinic materials of 52 patients of primary vascular neoplasms of the spleen were reviewed and analyzed. Results 41 cases of benign primary vascular tumors included 18 cases of hemangioma,1 case of hamartoma,3 cases of lymphangioma,and 19 cases of hemolymphangioma. Littoral cell angioma( 9 cases) was potentially malignant and the primary malignant vascular neoplasm of the spleen was angiosarcoma( 2 cases). Most of the hemangiomas were single lesions in the spleen with 3 different enhancement patterns. The appearance of hamartoma is similar to hemangioma,and the typical appearance of lymphangioma is cystic lesion without enhancement. Most of the hemolymphangiomas are multiple lesions in the spleen,can be cystic,solid,cystic-solid or mixed lesions with similar enhancement patterns to hemangiomas and lymphangiomas. Littoral cell angiomas were manifested as exclusively multiple small hypodense lesions in the spleen with progressive or minimal enhancement. Angiosarcomas were manifested as splenomegaly,with necrosis of abnormal neoplastic vessels. Conclusion The CT findings of primary vascular neoplasms of the spleen have some characteristics,but also have some overlaps. CT can be helpful in the differential diagnosis of the tumors.
引文
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2 Abbott RM,Levy AD,Aguilera NS,et al. From the archives of the AFIP:primary vascular neoplasms of the spleen:radiologic-pathologic correlation[J]. RadioGraphics,2004,24:1137-1163.
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7 Bowerson M,Menias CO,Lee K,et al. Hot spleen:hypervascular lesions of the spleen[J]. Abdomen Imaging,2015,40:2796-2813.
8 Zhang Y,Chen XM,Sun DL,et al. Treatment of hemolymphangioma of the spleen by laparoscopic partial splenectomy:a case report[J].World J Surg Oncol,2014,12:60.
9 Kosmidis I,Vlachou M,Koutroufinis H,et al. Hemolymphangioma of the lower extremities in children:two case reports[J]. J Orthop Surg Res,2010,5:56.
10 Yong Sik Woo,Kwang Ro Joo,Kyung-Yup Kim,et al. unusual presentation of cystic lymphangioma of the gallbladder[J]. Korean J Intern Med,2007,22:197-200.
11 Sun LF,Ye HL,Zhou QY,et al. A giant hemolymphagioma of the pancreas in a 20-year-old girl:a report of one case and review of the literature[J]. World J Surg Oncol,2009,7:317.
12 Ben-Izhak O,Bejar J,Ben-eliezer S,et al. Spleen:littoral cell haemangioendothelioma:a new low-grade variant of malignant littoral cell tumor[J]. Histopathology,2011,39:469-475.
13 Bisceglia M,Sickel,JZ,Giangaspero F,et al. Littoral cell angioma of the spleen:an additional report of four cases with emphasis on the association with visceral organ cancers[J]. JSLS,2005,9:222-224.
14 Goldfeld M,Cohen I,Loberant N,et al. Littoral cell angioma of the spleen:appearance on sonography and CT[J]. J Clin Ultrasound,2002,30:510-513.
15 Neuhauser TS,Derringer GA,Thompson LD,et al. Splenic angiosarcoma:a clinicopathologic and immunophentypic study of 28 cases[J]. Mod Pathol,2000,13:978-987.
16 Hamid KS,Rodriguez JA,Lairmore TC. Primary splenic angiosarcoma[J]. JSLS,2010,14:431-435.
17 Kinoshita T,Ishii K,Yajima K,et al. Splenic hemangiosarcoma with massive calcification[J]. Abdominal Imaging,1999,24:185-187.
18 Shanbhogue AK,Prasad SR. Spleen benign and malignant tumors and tumor conditions[J]. Abdominal Imaging,2013,1495-1509.
2 Abbott RM,Levy AD,Aguilera NS,et al. From the archives of the AFIP:primary vascular neoplasms of the spleen:radiologic-pathologic correlation[J]. RadioGraphics,2004,24:1137-1163.
3 Lam KY,Yip KH,Peh WC. Splenic vascular lesions:unusnal features and a review of the literature[J]. Aust N Z J Surg,1999,69:422-425.
4 Wang JH,Ma XL,Ren FY,et al. Multi-modality imaging findings of splenic harmatoma:a report of nine cases and review of the literature[J]. Abdom Imaging,2013,38:154-162.
5 Walezyk J,Walas MK. Standards of Polish ultrasound society update. Spleen examination[J]. J Ultrason,2013,13:50-64.
6 Luna A,Ribes R,Caro P,et al. MRI of focal lesions without and with dynamic Gadolinium enhancement[J]. AJR,2006,186:6.
7 Bowerson M,Menias CO,Lee K,et al. Hot spleen:hypervascular lesions of the spleen[J]. Abdomen Imaging,2015,40:2796-2813.
8 Zhang Y,Chen XM,Sun DL,et al. Treatment of hemolymphangioma of the spleen by laparoscopic partial splenectomy:a case report[J].World J Surg Oncol,2014,12:60.
9 Kosmidis I,Vlachou M,Koutroufinis H,et al. Hemolymphangioma of the lower extremities in children:two case reports[J]. J Orthop Surg Res,2010,5:56.
10 Yong Sik Woo,Kwang Ro Joo,Kyung-Yup Kim,et al. unusual presentation of cystic lymphangioma of the gallbladder[J]. Korean J Intern Med,2007,22:197-200.
11 Sun LF,Ye HL,Zhou QY,et al. A giant hemolymphagioma of the pancreas in a 20-year-old girl:a report of one case and review of the literature[J]. World J Surg Oncol,2009,7:317.
12 Ben-Izhak O,Bejar J,Ben-eliezer S,et al. Spleen:littoral cell haemangioendothelioma:a new low-grade variant of malignant littoral cell tumor[J]. Histopathology,2011,39:469-475.
13 Bisceglia M,Sickel,JZ,Giangaspero F,et al. Littoral cell angioma of the spleen:an additional report of four cases with emphasis on the association with visceral organ cancers[J]. JSLS,2005,9:222-224.
14 Goldfeld M,Cohen I,Loberant N,et al. Littoral cell angioma of the spleen:appearance on sonography and CT[J]. J Clin Ultrasound,2002,30:510-513.
15 Neuhauser TS,Derringer GA,Thompson LD,et al. Splenic angiosarcoma:a clinicopathologic and immunophentypic study of 28 cases[J]. Mod Pathol,2000,13:978-987.
16 Hamid KS,Rodriguez JA,Lairmore TC. Primary splenic angiosarcoma[J]. JSLS,2010,14:431-435.
17 Kinoshita T,Ishii K,Yajima K,et al. Splenic hemangiosarcoma with massive calcification[J]. Abdominal Imaging,1999,24:185-187.
18 Shanbhogue AK,Prasad SR. Spleen benign and malignant tumors and tumor conditions[J]. Abdominal Imaging,2013,1495-1509.