google ads
Spleen: Malignant Tumors Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Spleen ❯ Malignant Tumors

-- OR --

  • “Splenic angiosarcoma is exceedingly rare, but it is the most common primary nonhematolymphoid malignant neoplasm of the spleen. It is a highly aggressive malignancy with a poor prognosis. The majority of patients present with abdominal pain or a palpable abdominal mass. Occasionally, widespread metastases or splenic rupture will be the presenting manifestation. The clinicopathologic features of splenic angiosarcoma are widely reported throughout the medical literature .”
    Angiosarcoma of the Spleen: Imaging Characteristics in 12 Patients
    William M. Thompson,  et al
    Radiology 2005; 235:106–115
  • “Similar to our results, previous CT reports have demonstrated solitary or multiple nodular masses of heterogeneous low attenuation in an enlarged spleen. Some of these masses show peripheral enhancement, and the margins of the lesions are often irregular or poorly marginated. On precontrast CT scans, the tumors may appear hyperattenuating, which corresponds to acute hemorrhage. On dynamic contrast-enhanced CT scans, the lesions may exhibit substantial peripheral contrast enhancement similar to that of hepatic hemangiomas.”
    Angiosarcoma of the Spleen: Imaging Characteristics in 12 Patients
    William M. Thompson,  et al
    Radiology 2005; 235:106–115
  • “Angiosarcoma is an extremely rare tumor but is the most common primary non-hematolymphoid malignancy. It is an extremely aggressive neoplasm with widespread metastasis and splenic rupture common presenting manifestations. The most common CT finding is a patient with splenomegaly (60%) containing a large heterogenous solid mass or masses that nearly replace the spleen.”
    MDCT Findings of Splenic Pathology
    Sangster GP et al.
    Current Problems in Diagnostic Radiology 2021 (in press)
  • “Splenic angiosarcoma is the most common (nonhematolymphoid) primary malignant neo- plasm of the spleen and arises from the endo- thelial lining of splenic blood vessels. Angio- sarcoma either appears as a well-defined mass or can be diffusely infiltrative in appearance.”
    Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities
    Thipphavong S et al.
    AJR 2014;203: 315-322
  • “Unlike primary hepatic angiosarcoma, there is no reported association between splenic angiosarcoma and chemical exposures of vinyl chloride, arsenic, or prior injection of Thorotrast, a suspension containing particles of the radioactive compound thorium dioxide that was once used as a radiographic contrast agent. Patients typically present with left upper quadrant pain, anemia, or thrombocytopenia.”
    Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities
    Thipphavong S et al.
    AJR 2014;203: 315-322
  • “CT shows an enlarged spleen with areas of low and high attenuation, due to acute hemor- rhage or hemosiderin deposits, and calci- fications can be seen. Contrast enhancement of angiosarcoma is variable depending on the degree of tumoral necrosis and can mimic that of a hepatic hemangio- ma by showing avid peripheral enhancement.”
    Nonneoplastic, Benign, and Malignant Splenic Diseases: Cross-Sectional Imaging Findings and Rare Disease Entities
    Thipphavong S et al.
    AJR 2014;203: 315-322
  • Hepatic Angiosarcoma: Risk Factors
    - vinyl chloride       
    --- used to make polyvinyl chloride (PVC) pipes, wire coatings, plastic kitchen ware, and insulation
    - arsenic
    - anabolic steroids
    - radiation
    - thorium dioxide
  • “Hepatic angiosarcoma is uncommon and accounts for only 2% of all primary hepatic malignancies, but it is the most common malignant mesenchymal tumour of the liver. It predominantly affects patients aged 50–70 years, with a slight male predilection.  In the majority of cases of primary hepatic angiosarcoma, no obvious risk factor can be identified. However, it is reported that the tumour has an association with environmental, iatrogenic and occupational exposure to certain carcinogens. These include thorium dioxide, vinyl chloride, arsenic and radiation. Haemochromatosis and von Recklinghausen disease are also known to be linked to angiosarcoma.”
    “Angiosarcoma: clinical and imaging features from head to toe.” 
    Gaballah, Ayman H et al.
    The British journal of radiology vol. 90,1075 (2017): 20170039. doi:10.1259/bjr.20170039
  • "The gross pathology and imaging findings of hepatic angiosarcoma can show four different patterns: multiple nodules a large dominant mass , a combination of dominant mass and smaller nodules, and rarely, a diffusely infiltrating micronodular tumour.The two predominant patterns are large solitary mass and multifocal lesions.”
    “Angiosarcoma: clinical and imaging features from head to toe.”
    Gaballah, Ayman H et al.
    The British journal of radiology vol. 90,1075 (2017): 20170039. doi:10.1259/bjr.20170039
  • “The CT appearance of angiosarcoma of the liver is consistent with that of an aggressive vascular tumour .Unenhanced CT demonstrates a predominantly hypoattenuating mass when compared with the surrounding liver parenchyma, with or without hyperattenuating foci, known to reflect haemorrhage.Hepatic angiosarcoma resulting from thorium dioxide exposure produces distinct imaging findings of a hypoattenuating mass on unenhanced CT with hyperattenuating linear meshwork appearance characteristic of residual Thorotrast, as well as a dense spleen and lymph nodes resulting from the agent .On contrast-enhanced CT, large dominant masses exhibit heterogeneous enhancement, which indicates central necrosis and fibrotic change Small nodular lesions usually appear as hypoattenuating areas with some enhancing foci .Irregular or ring enhancement can also be seen .The enhancement is usually less than that of the aorta in the early phases with delayed progressive enhancement.
    “Angiosarcoma: clinical and imaging features from head to toe.” 
    Gaballah, Ayman H et al.
    The British journal of radiology vol. 90,1075 (2017): 20170039. doi:10.1259/bjr.20170039
  • Metastases Involving the Spleen
    - Metastatic lesions to the spleen are uncommon despite the fact that spleen has a rich blood supply (up to 7% in cancer patients).
    - Usually seen in patients with widespread metastases.
    - Common primary sites: breast, lung, ovary, stomach, malignant melanoma, prostate gland.
  • Metastases Involving the Spleen
    - Typically appear as hypoattenuating solid or cystic masses with homogeneous or occasionally heterogeneous contrast enhancement.
    - Serosal implants to the spleen are seen with peritoneal carcinomatosis, most commonly from ovary, but also seen in association with gastrointestinal adenocarcinoma and pancreatic cancer.
  • "Exposure to thorium dioxide (Thorotrast) is the most common iatrogenic cause of hepatic angiosarcoma and it can also cause splenic angiosarcoma. Thorotrast is a highly radioactive contrast agent used until the 1950s. Because Thorotrast has a half- life of 22 years, it has great radioactive potential, leading to fibrosis and carcinogenesis, and may eventually lead to malignancy in patients up to 65 years after injection, especially in the liver and spleen because of the biodistribution and clearance. In some cases, patients may present with concurrent spontaneous hemoperitoneum resulting from rupture of the highly vascular tumor.”
    Calcified Splenic Lesions: Pattern Recognition Approach on CT With Pathologic Correlation
    Consul N et al.
    AJR 2020; 214:1083–1091
  • "Surface nodular metastases are most commonly a result of mucinous neoplasm that disseminates throughout the peritoneal cavity, studding the splenic hilum with hypoattenuating cystic lesions that may have faint, linear, or coarse calcifications. Ovarian mucinous neoplasm in particular may involve psammomatous calcifications that invade the splenic parenchyma. Associated findings with ovarian cancer or other metastatic cancers may include malignant ascites, peritoneal carcinomatosis, and omental cake.”
    Calcified Splenic Lesions: Pattern Recognition Approach on CT With Pathologic Correlation
    Consul N et al.
    AJR 2020; 214:1083–1091
  • “Angiosarcoma is the most common prima- ry malignant splenic solid tumor, but it is very rare overall. It presents in adults 40–79 years old and is not related to chemical exposures (unlike hepatic angiosarcoma). This malignancy arises from highly mitotic splenic sinus endothelial cells along disorganized, anastomosing vascular channels. There is a high 1-year mortality rate associated with this malignancy.”
    Calcified Splenic Lesions: Pattern Recognition Approach on CT With Pathologic Correlation
    Consul N et al.
    AJR 2020; 214:1083–1091
  • "Incidental splenic calcifications have a broad differential diagnosis; however, they can be readily categorized into a clinically useful shortened list according to the imaging patterns and clinical context. This article proposes an algorithmic approach to diagnosing splenic lesions with calcifications that should be used in conjunction with the patient’s history and other imaging findings. In general, splenic lesions are managed conservatively even when the patient is showing symptoms of disease. Additional treatment is best determined after diagnosing the underlying abnormality.”
    Calcified Splenic Lesions: Pattern Recognition Approach on CT With Pathologic Correlation
    Consul N et al.
    AJR 2020; 214:1083–1091
  • “Primary splenic angiosarcomas are rare, aggressive malignant neoplasms arising from splenic sinusoidal vascular endothelium. First described by Langhans in 1879,it is among the rarest types of neoplasm, with an estimated annual incidence of 0.14 to 0.25 cases per million persons.”
    Primary Splenic Angiosarcoma
    Kamran S. Hamid et al.
    JSLS. 2010 Jul-Sep; 14(3): 431–435.
  • “ Primary angiosarcoma of the spleen is a rare and aggressive malignant neoplasm arising from splenic vascular endothelium and mesenchymal-derived elongated endothelial cells lining the spleen's spongy network of sinusoids. In general, angiosarcomas are rapidly proliferating, highly infiltrating anaplastic cells that tend to recur locally, spread widely, and have an increased rate of lymph node and systemic metastases.”
    Primary Splenic Angiosarcoma
    Kamran S. Hamid et al.
    JSLS. 2010 Jul-Sep; 14(3): 431–435.
  • Thorium dioxide, vinyl chloride, and arsenic have been implicated in the formation of hepatic angiosarcomas, but no etiologic association between these substances and splenic angiosarcomas has been substantiated.”
    Primary Splenic Angiosarcoma
    Kamran S. Hamid et al.
    JSLS. 2010 Jul-Sep; 14(3): 431–435.
  • "Macroscopically, there may be diffuse involvement of the spleen and replacement of the entire splenic parenchyma with tumor. Solitary masses are uncommon, and most tumors have usually undergone hemorrhage and necrosis. The histologic appearance of splenic angiosarcomas is quite heterogeneous. Immunohistochemical investigations have suggested that primary splenic angiosarcomas may arise from splenic sinus endothelial cells.”
    Primary Splenic Angiosarcoma
    Kamran S. Hamid et al.
    JSLS. 2010 Jul-Sep; 14(3): 431–435.
  • "Metastases occur in 69% to 100% of cases of splenic angiosarcoma.Neuhauser et al reported the rates of metastases as 89% to the liver, 78% to the lungs, 56% to lymph nodes, and 44% to bone. Falk et al found rates of metastases as 41% to the liver, 22% to bone or its marrow, and 3% to lymph nodes..”
    Primary Splenic Angiosarcoma
    Kamran S. Hamid et al.
    JSLS. 2010 Jul-Sep; 14(3): 431–435.
  • "On CT scans, the most common finding is an ill-defined heterogeneously enhancing splenic mass with areas of necrosis. In the event of acute rupture, hemorrhage will appear hyperattenuated on unenhanced images. There is no particular pattern of calcification associated with splenic angiosarcoma, but areas of hypervascular metastases to the liver, lungs, bones, and lymphatic system are well demonstrated on CT.”
    Primary Splenic Angiosarcoma
    Kamran S. Hamid et al.
    JSLS. 2010 Jul-Sep; 14(3): 431–435.
  • “Splenic angiosarcoma is exceedingly rare, but it is the most common primary nonhematolymphoid malignant neoplasm of the spleen. It is a highly aggressive malignancy with a poor prognosis. The majority of patients present with abdominal pain or a palpable abdominal mass. Occasionally, widespread metastases or splenic rupture will be the presenting manifestation.”
    Angiosarcoma of the Spleen: Imaging Characteristics in 12 Patients
    Thompson WM et al.
    Radiology 2005; 235:106-115
  • “The most common CT finding, found in six (60%) patients, was an enlarged spleen that contained a large heterogeneous complex mass or masses that almost completely replaced the spleen. In two of these patients, there was substantial contrast enhancement, and in the other four patients, there was only minimal con- trast enhancement, with areas of decreased attenuation suggesting necrosis.”
    Angiosarcoma of the Spleen: Imaging Characteristics in 12 Patients
    Thompson WM et al.
    Radiology 2005; 235:106-115
  • INTRODUCTION: Spleen-preserving left pancreatectomy (SPDP) with splenic vessels preservation (SVP) or without (Warshaw technique, WT) has been described with robotic, laparoscopy and open surgery. Nevertheless, significant data on medium- and long-term follow-up are still not available, since data in literature are scarce and the level of evidence is low.
    CONCLUSIONS: WT is safe and feasible, even if there are not definitive evidences that demonstrate it is superior to classic SVP. RCTs are needed to determine advantages and disadvantages of WT compared to the classic SVP.
Distal pancreatectomy with splenic preservation: A short-term outcome analysis of the Warshaw technique.


    Boselli C et al.
Int J Surg. 2015 Sep;21 Suppl 1:S40-3. doi: 10.1016/j.ijsu.2015.06.051. Epub 2015 Jun 26.
  • CT of the Spleen: Lymphoma
    Lymphoma is the most cpmmon malignancy of the spleen
    Splenic involvement is seen in 33% of all patients with Hodgkin lymphoma and in 30-40% of patients with non-Hodgkin lymphoma
    CT appearance ranges form diffuse infiltration to discrete nodules of varying sizes
  • CT of the Spleen: Metastases
    Most common tumors metastatic to the spleen include melanoma and cancers of the breast, lung, overy, stomach and prostate.
  • “Splenic angiosarcoma is the most common (nonhematolymphoid) primary malignant neoplasm of the spleen and arises from the endothelial lining of splenic blood vessels. Angiosarcoma either appears as a well-defined mass or can be diffusely infiltrative in appearance. The most common site of metastases is to the liver, with spread also to lungs, bone, bone marrow, and the lymphatic system.” 

    Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities.
    Thipphavong S et al.
    AJR Am J Roentgenol. 2014 Aug;203(2):315-22
  • “Splenic metastases can occur with wide- spread disease, and parenchymal disease is caused by hematogenous dissemination. The most common primary cancers with splenic metastases include melanoma and cancers of the breast, lung, ovary, stomach, and prostate.” 

    Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities.
    Thipphavong S et al.
    AJR Am J Roentgenol. 2014 Aug;203(2):315-22
  • "Lymphoma is the most common malig- nant tumor of the spleen. Lymphoma either can be primary splenic or can be involved in diffuse systemic disease. Splenic involvement is seen at presentation in 33% of all patients with Hodgkin lymphoma and in 30–40% of patients with non-Hodgkin lymphoma.” 

    Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities.
    Thipphavong S et al.
    AJR Am J Roentgenol. 2014 Aug;203(2):315-22
  • “The most common finding, seen in seven (58%) patients, was a complex mass or masses in an enlarged spleen. Four of these patients had evidence of metastases and one had intraperitoneal hemorrhage. Two patients had solitary hypervascular tumors and liver metastases. One patient had a normal-sized spleen with multiple lesions that ranged 2-3 cm in size, as well as metastases to the spine. The 11th patient had two small lesions, with small calcifications in the periphery of one lesion. The 12th patient had intraabdominal hemorrhage around the spleen and no obvious mass at CT. “
    Angiosarcoma of the spleen: imaging characteristics in 12 patients.
    Thompson WM et al.
    Radiology. 2005 Apr;235(1):106-15
  • “Splenic angiosarcoma is exceedingly rare, but it is the most common primary nonhema- tolymphoid malignant neoplasm of the spleen . It is a highly aggressive malignancy with a poor prognosis. The majority of patients present with abdominal pain or a palpable abdominal mass.” Angiosarcoma of the spleen: imaging characteristics in 12 patients.
    Thompson WM et al.
    Radiology. 2005 Apr;235(1):106-15
  • “The most common CT finding, found in six (60%) patients, was an enlarged spleen that contained a large heterogeneous complex mass or masses that almost completely replaced the spleen. In two of these patients, there was substantial contrast enhancement, and in the other four patients, there was only minimal contrast enhancement, with areas of decreased attenuation suggesting necrosis.” Angiosarcoma of the spleen: imaging characteristics in 12 patients.
    Thompson WM et al.
    Radiology. 2005 Apr;235(1):106-15
  • What processes involve both the liver and the spleen?
    - Lymphoma
    - Metastatic disease (melanoma)
    - Infections (especially candidiasis in immunocomprimised patient)
    - sarcoidosis
  • Multiple Splenic Lesions Differential Dx:

    - Lymphoma
    - Metastases
    - Sarcoidosis
    - Abscess
    - Hemangioma
    - Cyst
    - Hamartoma
  • Splenic Lymphoma: Facts:

    Primary Splenic Lymphoma

    - most common primary tumor of the spleen
    - rare, 1-2 % of all lymphomas
    - usually Non-Hodgkin, B cell type
    - Secondary Splenic Lymphoma

    Secondary splenic involvement

    - common in both Hodgkin and non-Hodgkin lymphoma
    - at time of diagnosis, spleen involvement in 25%
  • "Many processes affecting the liver also involve the spleen because of reticuloendothelial system involvement. Combining this knowledge with detection of concurrent hepatic and splenic disease allows the radiologist to streamline a long list of potential disease, resulting in faster and more efficient diagnosis."

    Concurrent Focal Hepatic and Splenic Lesions: A Pictorial Guide to Differential Diagnosis
    Bean MJ, Horton KM, Fishman EK
    J Comput Assit Tomogr 2004;28:605-612
  • Concurrent Hepatic and Splenic Lesions: Differential Diagnosis

    - Infectious disease
    - TB
    - Histoplasmosis
    - Candidiasis
    - Pneumocystis carinii
  • Concurrent Hepatic and Splenic Lesions: Differential Diagnosis

    - Neoplastic Disease
    - Lymphoma
    - Leukemia
    - Metastatic disease (lung cancer, breast cancer, melanoma)
  • Concurrent Hepatic and Splenic Lesions: Differential Diagnosis

    - Miscellaneous conditions
    - Sarcoidosis
    - Amyloidosis
    - Peliosis
    - Thorotrast
    - Gaucher disease
  • Angiosarcoma: Facts

    - Most common nonhematolymhoid malignant tumor of the spleen
    - Splenomegaly and LUQ mass is common clinical presentation
    - Spontaneous rupture occurs in up to 30% of cases

Privacy Policy

Copyright © 2024 The Johns Hopkins University, The Johns Hopkins Hospital, and The Johns Hopkins Health System Corporation. All rights reserved.