Spleen
Vascular tumors
Hemangioma

Author: Vijay Shankar, M.D. (see Authors page)

Revised: 8 March 2018, last major update November 2013

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Hemangioma[TI] spleen

Cite this page: Shankar, V. Hemangioma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/spleenhemangioma.html. Accessed August 17th, 2018.
Definition / general
  • Nonencapsulated benign proliferation of vascular channels that range from capillary to cavernous in size
  • Most common primary tumor of spleen
Epidemiology
Clinical features
  • Usually < 2 cm, incidental mass, asymptomatic
  • May present with a palpable mass or abdominal pain / discomfort
  • May be associated with hemangiomas at other sites
  • May be associated with anemia, thrombocytopenia, Kasabach-Merritt syndrome (thrombocytopenia caused by platelet sequestration and destruction in large cavernous hemangiomas, usually infants, rarely adults) (Srp Arh Celok Lek 2012;140:777)
  • Rarely is large, multiple or involves entire spleen (angiomatosis)
  • Rarely presents with splenic rupture and massive hemorrhage
Diagnosis
  • By ultrasound examination and CT, confirmation by histopathology
Radiology description
  • At CT, hemangiomas appear as hypodense well circumscribed masses with marked homogeneous enhancement of solid components
Radiology images

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Giant splenic hemangioma

Cavernous splenic hemangioma

Splenomegaly and hemangiomas

Case reports
  • 18 year old man with elective laparoscopic splenectomy for giant hemangioma (Cases J 2009;2:10)
  • 42 year old woman with coexisting giant splenic hemangioma and multiple hepatic hemangiomas (J Med Case Rep 2008;2:147)
  • 68 year old man with noncalcified splenic hemangioma identified by radionuclide bone scan (J Nucl Med 1989;30:1111)
Treatment
  • Splenectomy
Gross description
  • Well defined lesions, 0.3 - 7 cm, rarely diffuse
  • Usually solid, larger lesions can be partly cystic
  • Large lesions may have calcifications
Gross images

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Cavernous hemangioma

Microscopic (histologic) description
  • Capillary or cavernous
  • Vascular spaces lined by single layer of bland endothelial cells, without mitoses
  • Thrombosis and infraction can be seen
  • When organized, infarcted hemangioma may resemble leiomyoma
Microscopic (histologic) images

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Vascular channels lined by plump endothelial cells

Multiple blood filled spaces

Positive stains
Negative stains
Differential diagnosis
  • Angiosarcoma: marked atypia, anastomosing vascular spaces
  • Splenic hamartoma: well circumscribed lesion with disorganized blood vessels of varying sizes intermingled with splenic red pulp element; also entrapped adipocytes, focal extramedullary hematopoiesis; CD8+