Splenic Cysts & Tumors

• • 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

Epidemiology

• • 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

Symptoms and Signs

• • 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

Laboratory Findings

• • 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

Imaging Findings

CT Scan: Splenic Mass

• • 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

Rule Out

• • Malignant splenic tumor

• • CT scan

  • CBC to evaluate for hypersplenism

  • Serologic test for E granulosus if suspected

  • Biopsy not usually indicated

When to Admit

• • Severe abdominal pain

  • Secondary splenic infection

  • High risk of rupture

Surgery

• • 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

Indications

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

  • Metastatic tumors: If solitary

  • Pseudocyst: Symptoms or > 10 cm

Medications