1. Ozturk, Omer MD
  2. Koklu, Seyfettin MD
  3. Basar, Omer MD
  4. Purnak, Tugrul MD
  5. Yuksel, Osman MD

Article Content

Hemangioma is the most common primary neoplasm of the spleen, and it generally presents as a solitary tumor. Splenic hemangiomatosis, which forms multiple hemangiomas, is extremely rare (Makino, Tajima, Kitagawa, Nakagawara, & Ohta, 2014). Herein we report a case of splenic hemangiomatosis that is asymptomatic up to 69 years.


A 69-year-old man was admitted to the gastroenterology clinic with iron-deficiency anemia. His medical history was unremarkable other than occasional melena. Physical examination was normal other than mild splenomegaly on palpation. His laboratory tests were as follows: leukocytes, 5.5 x 103/ml; hemoglobin, 10.6 g/dl; platelet count, 223 x 103; ferritin, 10 ng/ml; and transferrin saturation, 5%. His upper endoscopy showed normal findings, but multiple telangiectasias were present during colonoscopy. These telangiectasias were coagulated with argon plasma coagulation. Abdominal ultrasonography showed multiple hyperechogenic lesions in the spleen and splenomegaly (Figure 1). Abdominal magnetic resonance imaging revealed splenomegaly (14 cm) and multiple splenic masses compatible with cavernous hemangiomatosis (Figure 2). The patient did not have any problems at the 3 months' follow-up.

Figure 1 - Click to enlarge in new windowFIGURE 1. Appearance of splenic hemangiomatosis on abdominal ultrasonogram.
Figure 2 - Click to enlarge in new windowFIGURE 2. Multiple hemangiomatosis in the spleen on abdominal magnetic resonance image.

Hemangioma is a benign vascular proliferation. It is usually asymptomatic and incidentally discovered as a solitary tumor (Makino et al., 2014; Steininger, Pfofe, Marquardt, & Markwat 2004). Its cause and pathogenesis are not well known. Otherwise, splenic hemangiomatosis is a rare benign tumor of the spleen. It may occur together with hemangiomatosis of the liver, or it can be part of angiomatosis in different viscera (Steininger et al., 2004). In our patient, however, there was no hemangioma in the other organs. On the contrary, our patient had another type of vascular lesion, telangiectasias, in the colon. Patients with splenic hemangiomatosis may present with splenomegaly, thrombocytopenia, in addition to disturbances in blood coagulation (Makino et al., 2014; Steininger et al., 2004). Our patient had only anemia as a consequence of bleeding telangiectasias.


The differential diagnosis of solid mass in the spleen includes angiosarcoma, lymphoma, hamartoma, and metastases. Due to limitations of imaging and the risks associated with percutaneous biopsy of the spleen, splenectomy is generally suggested for accurate diagnosis of lesions in the spleen (Louis, Sanders, Stephenson, Harbour, & Ford, 2011; Steininger et al., 2004). However, splenectomy may lead to serious complications, especially in older adults. Following these patients with radiological images seems to be more suitable.




Louis T. H., Sanders J. M., Stephenson J. S., Harbour L. N., Ford K. L. III. (2011). Splenic hemangiomatosis. Baylor University Medical Center Proceedings, 24 356-358. [Context Link]


Makino I., Tajima H., Kitagawa H., Nakagawara H., Ohta T. (2014). A rare case of hemangiomatosis of the spleen and intrapancreatic accessory spleen. Abdominal Imaging, 39 1169-1174. [Context Link]


Steininger H., Pfofe D., Marquardt L., Markwat R. (2004) Isolated diffuse hemangiomatosis of the spleen: Case report and review of literature. Pathology, Research and Practice, 200 479-485. [Context Link]