Isolated splenic littoral cell angioma in a child: a case report

We report a case of isolated splenic littoral cell angioma (LCA) in a 9-year-old male child, who was admitted for surgical treatment after an incidental discovery of a splenic space-occupying lesion during a physical examination one year prior at an external hospital(no significant reduction on follow-up). The child had no specific clinical symptoms, with only a slightly elevated platelet count (454×10⁹/L) and normal results of other laboratory and auxiliary examinations. Abdominal computed tomography (CT) showed a round-like hypodense mass (4.8 cm×4.8 cm×5.3 cm) in the upper pole of the spleen (plain CT value: ~43 HU). On enhanced CT, the mass exhibited characteristic "fireball-like" enhancement in the arterial phase (CT value: ~182 HU), continuous progressive enhancement in the portal venous phase (CT value: ~133 HU), and uniform density with mild attenuation in the delayed phase (CT value: ~98 HU), remaining slightly hyperdense relative to the normal spleen. Laparoscopic partial splenectomy was performed, and pathological examination combined with immunohistochemistry (CD31+, CD34+, CD68+, CD8+, SMA+, CD163+; Ki67: ~7%; D2-40-, CD21-, CD3-, CD20-) confirmed the diagnosis of LCA. No recurrence was observed at 3-month and 6-month postoperative follow-up. LCA is a rare primary splenic vascular tumor, especially uncommon as an isolated lesion in children. Its clinical manifestations are nonspecific, and CT enhancement features have important indicative value. Definitive diagnosis relies on pathology, and surgical resection yields a favorable prognosis.