PMC6159194_01
Transaxial and coronal images of the splenic mass at presentation, measuring 7.5 x 7.3 x 7.0 cm (AP x ML x CC) and showing a well-defined predominantly hypoattenuating mass with a rim of peripheral serpiginous enhancement (arrows).
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f1
The lesion was very well defined and the imaging characteristics were interpreted as being consistent with a benign mass such as haemangioma or hamartoma; however, malignancy could not be excluded (Figure 1).
(a) Anterior and posterior blood flow images of 99mTc-RBC scan showed a normal blood flow to the spleen. (b) Delayed images showed a photopenic defect in the region of the splenic mass with mild peripheral blood pooling (arrows).
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f2
It showed a normal blood flow and on delayed images showed a photopenic defect at the location of the mass with mild peripheral blood pooling (Figures 2 and 3), which was interpreted as possibly representing a haemangioma with central thrombosis, or an atypical haemangioma, however malignancy could not be excluded and further imaging was recommended.
99mTc-RBC scan SPECT/CT fusion images, transaxial, sagittal and coronal of the splenic mass.
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f3
It showed a normal blood flow and on delayed images showed a photopenic defect at the location of the mass with mild peripheral blood pooling (Figures 2 and 3), which was interpreted as possibly representing a haemangioma with central thrombosis, or an atypical haemangioma, however malignancy could not be excluded and further imaging was recommended.
Ultrasound images showed a hypoechoic splenic mass with no internal vascularity (arrow). There were no focal lesions in the liver.
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f4
The findings on the ultrasound study were interpreted as being in keeping with haemangioma (Figure 4).
Core biopsy of the liver. (a) H/E staining (OM 200x), (b) H/E staining (OM 400x), (c) EBER positive staining (OM 400x) and (d) fascin positive staining (OM 400x).
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f5
Immunohistochemistry was positive for EBER and Fascin and negative for CD21, CD35, CAM 5.2, CD31, ERG, S100, pan-keratin, CD45, CD43, CD34, ALK-1, PAX 5, CD30, CD68, CD23, HMB-45, lysozyme, myeloperoxidase, podoplanin, CD20 and muscle specific A (Figure 5).
A staging 18F-FDG PET/CT. Maximum intensity projection (MIP) images showed innumerable intensely 18F-FDG avid lesions in the liver and spleen.
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f6
Maximum intensity projection (MIP) images showed innumerable intensely 18F-FDG avid lesions in the liver and spleen (Figure 6).
Transaxial PET/CT fusion (left) and CT (right) images showed that the largest splenic mass measured 9.6 x 7.5 cm with maximum standardized uptake value (SUVmax) 15.8. The liver and splenic lesions were almost entirely necrotic, with a thin rim of intense 18F-FDG uptake.
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f7
The largest splenic mass measured 9.6 x 7.5 cm with maximum standardized uptake value (SUVmax) 15.8 (Figure 7).