脾臟淋巴管瘤－－放射線與病理的關聯

Splenic Cystic Lymphangioma: Radiologic-Pathologic Correlation

脾臟淋巴管瘤是一種罕見且術前診斷困難之疾病。我們意外地在一名因膽結石住院的四十二歲女性病患身上發現一個無症狀的巨大脾臟淋巴管瘤。超音波掃瞄發現脾臟腫大、多房性低音波且無內部回音或隔膜之脾臟腫瘤。電腦斷層掃瞄則發現其呈多個平滑邊緣、低密度的腫瘤，經施打對比劑後腫瘤並沒有顯影。血管攝影顯示脾臟內部動脈血管伸展及彎曲，呈多房性平滑邊緣低血管性腫瘤。經脾臟切除後，臨床診斷為脾臟多囊性腫瘤；組織學診斷確定為脾臟淋巴管瘤。臨床影像之診斷與腫瘤之目視、顯微表徵是相符的。術後的過程平順。我們因而歸納出囊狀腫瘤的鑑別診斷必須包含淋巴管瘤。

Splenic cystic lymphangioma is a rare disease entity, and accurate preoperative diagnosis is difficult. An asymptomatic huge splenic cystic lymhangioma was incidentally found in a 42-year-old female patient who was admitted for gallstone. Echogram showed splenomegaly with multiloculated hypoechoic spaces without septation or internal echo. Computerized Tomographic scan demonstrated an enlarged spleen with multiple well-marginated low-attenuation masses that were not enhanced after administration of contrast medium. Splenic angiogram revealed stretching and bowing of intrasplenic arteries and multiloculated, well-defined hypovascular lesions occupying the splenic parenchyma. Multiple splenic cystic tumors were clinically diagnosed and were confirmed histologically as lymphangiomas after splenectomy. The diagnostic imaging features, gross and microscopic appearance of the resected specimen are correlated. Postoperative course was uneventful. We, therefore, concluded that a lymphangioma must be included in the differential diagnosis of cystic tumors of the spleen.