[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.161.130.145. Please contact the publisher to request reinstatement.
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Special Feature
November 01, 2005

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: Departments of Surgery (Drs Cheng, Yang, and Liu) and Pathology (Dr Chen), Mackay Memorial Hospital, Taipei, Taiwan.

Arch Surg. 2005;140(11):1127. doi:10.1001/archsurg.140.11.1127-a

A 44-year-old woman with a long history of chronic urticaria and chronic hepatitis B virus infection presented with vague epigastric pain of 1 month’s duration. She had been diagnosed as having asymptomatic splenomegaly during annual ultrasonographic follow-up 2 years earlier. Five years before presentation, she had undergone a hysterectomy for uterine leiomyomata. She had not experienced weight loss, fever, or night sweats. The physical examination and laboratory investigation results were unremarkable. Computed tomography of the abdomen disclosed multiple hypodense lesions in the spleen (Figure 1). A splenectomy was performed. Grossly, the spleen weighed 160 g, measured 12 × 8 × 3 cm, and had a nodular surface. Cut sections showed a spongy appearance and multiple tan, cystic lesions throughout the splenic parenchyma that ranged in size from 0.5 to 1.5 cm. The intervening splenic parenchyma was unremarkable. A photomicrograph of the splenic lesions is shown in Figure 2.

Figure 1.
Computed tomographic scan of the abdomen with 2-dimensional reconstruction demonstrating multiple hypoattenuating masses of various sizes throughout an enlarged spleen.

Computed tomographic scan of the abdomen with 2-dimensional reconstruction demonstrating multiple hypoattenuating masses of various sizes throughout an enlarged spleen.

Figure 2.
Photomicrograph showing anastomosing vascular channels with irregular lumina and papillary projections. The vascular spaces are lined with plump endothelial cells that have vesicular nuclei and clear to eosinophilic cytoplasm, some of which have sloughed into the lumen (hematoxylin-eosin, original magnification ×200).

Photomicrograph showing anastomosing vascular channels with irregular lumina and papillary projections. The vascular spaces are lined with plump endothelial cells that have vesicular nuclei and clear to eosinophilic cytoplasm, some of which have sloughed into the lumen (hematoxylin-eosin, original magnification ×200).

What Is the Diagnosis?

A. Sarcoidosis

B. Littoral cell angioma

C. Splenic metastases

D. Lymphoma

×