Littoral Cell Angioma of the Spleen

• rare, primary splenic neoplasm
• littoral cells line the red pulp sinuses in the spleen
• CECT: 
• enlarged spleen with innumerable hypoattenuating masses
• no calcifications
• no lymphadenopathy
• no hepatomegaly
• US:
• diffuse, coarse, heterogenous echotexture of the spleen
• Differential diagnosis
• neoplasms
• hemangiomas - appear similar but rarely have diffuse involvement, may calcify
• hemangiomatosis - diffuse splenic hemangioma with same enhancement pattern as hepatic hemangioma
• lymphoma - look for extra-splenic lymphadenopathy
• metastatic disease - ovary, breast, endometrium, melanoma
• granulomatous disease
• sarcoidosis - increased echogenicity of spleen, + adenopathy
• TB - look for chest involvement
• infection
• disseminated fungal disease
• septic emboli
• Kaposi's sarcoma

REFERENCES
Kinoshita LL, Yee J, and Nash SR. Littoral cell angioma of the spleen: imaging features. AJR Am J Roentgenol 2000;174(2):467-9.
Levy AD, Abbott AM, and Abbondanzo SL. Littoral cell angioma of the spleen: CT features with clinicopathologic comparison. Radiology 2004;230:485-90.