Abstract:
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Purpose: Although rare angiosarcoma is the most common non-lymphoid primary splenic malignancy. The purpose of this study is to describe the imaging features of angiosarcoma of the spleen in 12 patients.
Methods and Materials: Twelve cases were accessioned into the AFIP archives from 1984 — 2003. The clinical data, pathologic material and radiographic images were available for review in all cases. Two abdominal radiologists reviewed the US, CT, MR images, and angiograms to determine splenic size, amount of tumor necrosis, degree of enhancement, evidence of intraperitoneal rupture, and the presence of metastases. There were 21 images available for review: CT — 10, US — 6, MRI — 3 and angiograms — 2.
Results: The average age of the six males and six females was 62 years (range 32 to 86 years). The most common clinical symptom was upper abdominal pain or discomfort, present in 7 patients. Two had back pain from pathologic spinal metastases. One had splenomegaly noted on an UGI, one presented with acute hypotension due to splenic rupture and one had left upper quadrant pain after minor trauma. On gross pathology the spleen was enlarged in 8 of 12 patients. Large areas of tumor necrosis were present in the patients with splenomegaly. Ultrasound in 6 patients showed splenomegaly with large heterogeneous masses with increased flow on Doppler. One patient had evidence of intraperitoneal hemorrhage. CTs in 10 patients demonstrated splenomegaly in 7, hypervascular masses in 6 of 8 who received IV contrast, necrosis in 9, and liver metastases in 6. Lymphadenopathy was seen in 2. The MR imaging findings in 3 patients showed that the masses enhanced intensity with Gadolinium. The components of tumors had areas of high and low signal on both T1 and T2. The angiograms showed a large malignant hypervascular tumor in both patients.
Conclusion: The most specific findings on imaging were large necrotic hypervascular masses in an enlarged spleen with significant necrosis of the primary tumor seen in 7 (58%). Two patients had spontaneous rupture of their tumor into the peritoneal cavity and 7 (58%) had metastases at presentation. Based on the imaging findings a specific diagnosis could be made in 8 (67%) patients.
Questions about this event email: thomp132@mc.duke.edu
Thompson MD, W,
Angiosarcoma of the Spleen: Imaging Characteristics in 12 Patients. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3105043.html
