Littoral Cell Angioma of the Spleen Presenting With Hypersplenism: A Case Report

Littoral cell angioma (LCA) is a rare primary vascular neoplasm of the spleen that may present with nonspecific symptoms, diagnostic dilemmas, and haematological abnormalities related to hypersplenism.We report the case of a 50-year-old man who presented with a three-month history of generalised weakness, intermittent fever, anorexia, and progressive abdominal fullness.Physical examination revealed marked splenomegaly extending to the umbilicus.Laboratory investigations demonstrated anaemia, thrombocytopenia, and leucopenia, while peripheral blood film showed microcytic hypochromic anaemia with thrombocytopenia.Bone marrow examination, haemoglobin electrophoresis, iron profile, and liver function tests revealed no significant abnormalities.Abdominal ultrasonography demonstrated marked splenomegaly, with the spleen measuring about 15.5 x 6.5 cm and multiple ill-defined hypoechoic space-occupying lesions within it, the largest measuring about 3.4 x 2.5 cm.Following multidisciplinary evaluation, the patient underwent laparoscopic splenectomy for symptomatic splenomegaly and hypersplenism.Histopathological examination demonstrated multiple anastomosing, blood-filled vascular channels lined by tall endothelial cells with focal haemophagocytosis, consistent with LCA.The postoperative course was uneventful, and the patient was discharged on the sixth postoperative day with improvement in his presenting symptoms and haematological abnormalities.LCA is an uncommon vascular tumour with a variable clinical presentation ranging from incidental detection to symptomatic hypersplenism.Imaging findings are nonspecific.Splenectomy remains both a diagnostic and a therapeutic modality.LCA should be considered in the differential diagnosis of splenomegaly with multiple splenic lesions and pancytopenia.Histopathological examination following splenectomy is essential for definitive diagnosis.