Image of the Month—Quiz Case

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. 

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

Figure 2. 

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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).

A. Sarcoidosis

B. Littoral cell angioma

C. Splenic metastases

D. Lymphoma