大韓放射線흉흉學會誌 第26 卷 第1 號 pp. 151 - 153, 1990 Journal of Korean Radiological Society, 26 (J) 151 -153, 1990
Cavernous Lymphangioma of the Spleen
- A case report-
In Mook Cho, M.D., 8ang Wook Lee, M.D., Kyung 800 Kim, M.D., Yong Hyun Kim
,
M.D.〈국문초록〉
Department 01 Radiology, Masan Korea General Hospial
비장에 발생한 해면채형 임파관종
-1 례 보고-마산고려뱅원 선단방사선과
조인 묵·이 상욱·김 경 수·김 용현
임파판종은 임파계의 양성종양으로 주로 정부에 발생하며， 매장장기에 발생하는 것은 드울다 비장에 발생한 엄파관종은 드물며， 약 90여1가 보고되고 있다.
금벤 저자들은 비장에 발생한 임파판종을 갱헝하였기에 운헨고찰과 함께 보고하는 바이마.
Index Words: Spleen, neoplasms 77.31 Spleen‘ CT 77.1211
Introduction
Lymphangiomas are benign congenital malfor- mations of the Iymphatic system usually affecting the neck and axilla 1) lnvolvement. of the visceral organ is less common2). Splenic involvement is qmte rare.
Approximately 90 cases have been
reportεd
6)
The lesion is characterized by a single or c1assic- ally by multiple macroscopic and microscopic cy- sts3) .We repQft a case of splenic Iymphangioma in which CT appearance suggested the correct diag- nosls
이 논문은 1989년 11월 18 일 정수히여 1989 년 12월 16일 에 채택되었음
Received November 18, accepted December 16, 1989
Case report
A 52 year old women admitted with seven mon- th’s hisotry of a large left upper quadrant mass and epigastric pain. Egg sized mass was initially developed after first delivery 30 years ago. This mass has progressively grown during this interval.
Physical examination revealed a large mass in Ieft upper quadrant which was hard, slightly tender and fixed. Ultrasonogram revealed huge echogenic mass with multiple small, moderate and large sized anechoic rounded lesions(Fig. 1). CT demonstr- ated marked splenomegaly in which m비 tiple
small, moderate and large sized low density chan- ges were seen. Several small calcifictions were also noted within cysts(Fig. 2.A, B.)
Splenectomy was performed. Gross specimen re-
κ ι
大韓放射線醫學會픔 : 第26卷 第l 號1990-
Fig. 1. Ultrasonogram
Longitudinal sonogram reveals huge echogenic mass in the spleen with multiple small, moderate and large sized anechoic rounded arears
vealed huge spleen which measured 24 X 14 X 10 cm and weighted 1780 gm.
The histologic diagnosis was cavernous Iymphan- gioma(Fig. 3)
Discussion
Lymphangioma of the spleen was first reported by Fink in 1885
’
Fowler reported 27 cases in his review of splenic tumors in 19535) In 1981, pyatt reported 90 cases of splenic Iymphangioma in the Iiterature review6) c1inical symptoms are usually nonspecific due to compression of adjacent vis- cera. Pain, discomfort and mass sensation are most common. pathologically, Iymphangioma are c1assified as simple, cavernous and cystic. The sirn- ple type is composed of capillary-sized, 산lÌn walled channels, the cavernous type consists of dilated lymphatic channels often with fibrous adventitial coats, and the cystic type is composed of cysts ranging from a few millimeters to several centime- ters in diameter. The space must be lined by f1at- tened endothelial cells or the diagnosis is suspect Even when a large cyst is presζnt， there often are- 152 b
Fig. 2 CT Scan
a. Higher level CT scan. CT reveals mutiple small, moderate and large sized cystic lesions in the spleen with scattered calcifications
b. Lower level CT scan. CT reveals marked sple nomegaly with multiple variable-sized cystic lesions scattered in the entire spleen
Fig. 3. Photomicrograph of the tumor reveals large, cavernous spaces Iined by flattened or attenuated en- dothelial cells and filled with lymph fluid. The caver nous spaces are separated by thin or slightly thick fibrous tissue with a few areas of remnant splenic tissue
(H & E, X 100)
- In Mook Cho, et al.: Cavernous Lymphangioma 01 the Spleen -
other small cysts in the splenic parenchyma or in the subcapsular region3). Plain abdomen film may discIose splenomegaly, curvilinear ca\cification in the cyst wall, and mass effect upon adjacent visce- ra7)
RadionucIide scans show splenomegaly with multiple focal defects8). Angiographic findings in- cIude well defined avascular lesions scattered thr- oughout the spleen with absence of neovascularity
,
arteriovenous shunting, and venous pooling. A cIassic “Swiss-cheese appearance" has peen descri- bed9). Sonogram may reveal the presence of sple- nomegaly
Depending on the size and macroscopic mor- phology of the spleen, it’s sonographic appearance may vary. A single well defined cyst smiliar to a post-traumatic cyst can be seen. In diffuse Iy- mphangiomasis multiple variablesized sonolucent arears are depicted
CT will show single or multiple low density cys- tic arears, some of which may be subcapsular in location, and deform the splenic contour. CT numbers range from 15 to 33 HU, depending mos- tIy on the proteinous content of the fluid. The thin wall and sharp margination the lesion should sug- gest Iymphangioma rather than other neoplasms which may be of low density due to necrosis or Iipid content6,11,12)
The differential diagnosis of multifocal splenic disease is extensive and incIudes Iymphoma
,
infar- ction, splenic emboli, metastasis (melanoma, bre- ast, ovary and the lung), and splenic cyst. Deter- mination of the cystic nature of the lesions is extremely helpful and narrows the differential di- agnosis considerablly. The cIinical calssification of splenic cysts by Pearl and Nassar is usefuI3): the three categories are 1) parasitic cyst (taenia echi- nococcuS)2), primary cyst with true cellular lining, such as those that are endothelial-lined (hemangi- oma, Iymphangioma) and those that are epitheli-al-lined (dermoid, epidermoid) and secondary or traumatic cysts without a true cellular lining.
The presence of thin walled, well defined, none- nhancing splenic cysts withc contains mural calvi- fications may suggest the diagnosis of Iymphan- gIOma.
REFERENCES
l. Bill AH, Sumner DS: A uni!ied concept of lymphan gioma and cystic hygroma. Surg Gynecol Obstet 120 79-86, 1965
2. Peradotto F, Zannetti PP, Obialero M, et al.: Lym- phangicma of the spleen. Remarks on two obserbed cases. Minerva Med 75:2295-2300, 1986
3. Pearl GS, Nasser VH: Cystic lymphangioma of the spleen. South Med ] 72:667-669, 1979
4. Fink F: Zur kenntuis der geschwulsbildungen in der milz. Z Heilk 6.399, 1885
5. Fowler RH: Nonparasitic benign cystic tumors of the spleer. Int Absts Surg 96:209-227, 1953 6. Pyatt RS, William ED, Clark M: CT diagnosis &
splenic cystic lymphangiomatosis. ] Compt Assist Tomogr 5(3). 446,448, 1981
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8. NovetSKY GJ. Epstein AJ Cystic lymphangioma unusual cause of splenic scintigraphic defects. Clin Nuc1 Med 7416-417, 1982
9. Tuttle RJ, Minielly ]A. Splenic cystic Iymphan giomatosis: Unusual casuse of massive splenomega ly. Radiology 126:47-48, 1978
10 김재헨， 원정연， 김영순 둥=임파판종의 초음파 소견 대한땅사선의학회지 21 =969-974, 1985
11. 김순용， 임재훈， 고영태 둥=유마액을 함유하는 장간 막임파종 1례. 대한방사선학회 20=148- 151, 1984 12. 김 정 숙， 장용웅， 구철희 =회 장장간악에 서 발생 한 해
연쳐l형 임파판종. 대한방사선의학회지 25=45-48, 1989
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