• 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
• 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
• 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
• 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
• 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
• CT scan
• CBC to evaluate for hypersplenism
• Serologic test for E granulosus if suspected
• Biopsy not usually indicated
• 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
• Symptomatic: Abdominal pain, splenomegaly, hypersplenism with cytopenia
• Metastatic tumors: If solitary
• Pseudocyst: Symptoms or > 10 cm
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