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  • • Many discovered incidentally on CT scan or during laparotomy or laparoscopy

    • Splenomegaly and left upper quadrant abdominal pain may be present

    • CT scan shows evidence of splenic mass

    • Low diagnostic yield by percutaneous needle aspiration or core needle biopsy

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Epidemiology

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  • Malignant primary tumors

    • -Non-Hodgkin lymphoma (NHL): Most common; disease limited to the spleen

      -Angiosarcomas: Rapid growth and early metastases; may rupture

    Malignant metastatic tumors: Usually represent widespread dissemination

    Benign splenic tumors

    • -Hemangiomas: Most common; splenomegaly uncommon; may rupture

      -Lymphangiomas: Typically affect children and young adults

      -Inflammatory pseudotumor: Infiltrative; may mimic a malignant process

    Splenic cysts

    • -True parasitic cysts (5%); usually hydatid—Echinococcus granulosus

      -True nonparasitic cysts (20%); epidermoid is most common

      -Pseudocysts (80%); post-trauma or infarction

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Symptoms and Signs

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  • • NHL: Splenomegaly, constitutional symptoms

    • Angiosarcomas: Abdominal pain, palpable abdominal mass

    • Metastatic tumors: Splenomegaly

    • Hemangiomas: Usually asymptomatic

    • Lymphangiomas: Usually asymptomatic

    • Inflammatory pseudotumor: Fever, malaise, weight loss

    • True parasitic cysts: Abdominal pain

    • True nonparasitic cysts: Abdominal pressure or pain

    • Pseudocysts: Abdominal pain, splenomegaly

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Laboratory Findings

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  • • NHL: Anemia, thrombocytopenia, leukopenia due to hypersplenism

    • Angiosarcoma: Angiopathic hemolytic anemia

    • Hemangioma: May cause consumptive coagulopathy, thrombocytopenia, microangiopathic anemia, disseminated intravascular coagulation

    • True parasitic cysts: Positive serologic test for E granulosus

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Imaging Findings

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CT Scan: Splenic Mass

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  • • NHL: Splenomegaly with solitary mass (> 5 cm) or multiple masses

    • Angiosarcoma: Solitary mass with central tumor necrosis

    • Hemangioma: Well circumscribed nodules with enhancement; cystic changes and calcifications

    • Lymphangiomas: Cystic with multiple septations

    • True parasitic cysts: Unilocular, calcified splenic mass with daughter cysts

    • Pseudocysts: Round, well circumscribed unilocular cyst; may have a calcified rim

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  • • Some clinicians advocate splenectomy for all splenic masses in order to avoid undertreatment of potential malignancy

    • Poor diagnostic yield with percutaneous needle aspiration or core needle biopsy

    • NHL: Peripheral adenopathy and bone marrow involvement occur late in the disease

    • Rupture of splenic parasitic cysts can cause dissemination of scoleces and anaphylaxis

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Rule Out

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  • • Malignant splenic tumor

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  • • CT scan

    • CBC to evaluate for hypersplenism

    • Serologic test for E granulosus if suspected

    • Biopsy not usually indicated

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When to Admit

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  • • Severe abdominal pain

    • Secondary splenic infection

    • High risk of rupture

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Surgery

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  • • Splenectomy for all primary malignant tumors and parasitic cysts

    • Partial or complete splenectomy for benign tumors and cysts if symptomatic, risk for rupture, or otherwise indicated

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Indications

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  • • Symptomatic: Abdominal pain, splenomegaly, hypersplenism with cytopenia

    • Metastatic tumors: If solitary

    • Pseudocyst: Symptoms or > 10 cm

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Medications

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  • • NHL: Chemotherapy with or without radiation

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