Spleen Diseases – Dr. BARTOȘ

Tumour formations of the spleen (benign, malignant)

Benign tumours are non-cancerous tumours that remain in one place and do not spread to other parts of the body. Also after they are removed they do not reappear. Even if they are not cancerous, they can cause symptoms by putting pressure on surrounding structures. Pre-cancerous (pre-malignant) tumours are benign tumours containing abnormal cells that have the potential to turn into cancer if left untreated.

In contrast, malignant tumours are cancerous tumours that develop in nearby tissues, contain cells that can rupture and reach the blood or lymphatic system, thus spreading to lymph nodes and other distant regions of the body.

Benign splenic tumours include: haemangioma, splenic fibroma, splenic hamartoma, or rarer tumours such as: tumours of neurogenic origin (neurinoma, schwannoma), lipoma.

Malignant splenic tumours are divided into primary and secondary (splenic metastases).

Primary malignant splenic tumours: epithelial tumours, angiosarcoma, Kaposi’s sarcoma.

Secondary malignant splenic tumours (splenic metastases): are much more common than primary tumours, being produced by haematogenous or direct invasion of the neighbourhood; their diagnosis and treatment are related to that of the original primary tumours.

Signs and symptoms

Depending on the size of the tumour you may or may not have symptoms. If symptoms are present they may be:

Abdominal pain, abdominal discomfort due to compression on nearby organs, splenomegaly (enlargement of the spleen) and painful tenderness in the left and upper abdomen (left hypochondrium)
Anemic syndrome, hemorrhage, in case of splenic rupture
The following tirade may be present in malignant splenic tumours
Significant, irregular, firm, painful splenomegaly
Cachexia (weight loss, ascites, pleural effusion, etc.)
Febrile syndrome (through intratumoral necrosis)

Establishing the diagnosis

–
Abdominal ultrasound – non-invasive and atraumatic imaging method, based on ultrasound, which can reveal splenomegaly, presence of splenic tumour formation, perisplenic, intra-abdominal collections, in case of haemorrhage

–
Computed tomography (CT)
– takes a series of detailed images of certain regions of the body, these images are taken from different planes; for better highlighting of the region explored, contrast material is used; establishes with greater accuracy splenic lesions and lesions associated with other intra-abdominal organs

–
Blood tests
– haemoglobin count (low haemoglobin)

Treatment

Surgical treatment – surgical removal of the spleen (splenectomy) which can be performed either by laparoscopic or classic/open approach.

STOMACH DISEASE TREATMENT DIAGNOSIS

Splenic cysts and abscesses

Splenic cysts are benign formations and are classified into several types: Non-parasitic splenic cysts – include dermoid, epidermoid (occur mainly in young women who have suffered trauma to the left hypochondrium, slow to form, do not adhere to surrounding organs, contain serohematic fluid), serous (cystic degeneration of the spleen, may be single or multiple and contain pure serosity), blood-tinged (occur after post-traumatic haematoma, adhere to surrounding organs and may become infected).
Splenic pseudocysts
– can be serous, haemorrhagic, inflammatory, not having a wall of their own; most often they are closed haematomas arising after a splenic infarction or rupture.

Hydatid splenic cysts – a rare location of echinococcosis (parasitic disease), the route of infestation being the blood (arterial) route; calcification of the wall occurs less frequently, the cyst is well defined, with clear or purulent content, adherent to the surrounding organs and with a compressive effect on them. Spleen abscess is a localized collection of necrotic inflammatory tissue caused by bacterial, fungal or parasitic factors.

The main causes of splenic abscess can be the following:

anaerobic bacterial infection (considered the main cause)
metastatic infection with bacterial blood dissemination (sepsis)
ongoing infection (perinephric abscess or infected pancreatitis)
splenic infarction and super-added infection
spleen injury
immunodeficiency conditions (chemotherapy/organ transplants, leukaemia and AIDS)

Signs and symptoms

Most of the time patients with splenic cysts are asymptomatic for a long time, being discovered incidentally during routine investigations. The symptoms when they appear are non-specific:

Abdominal pain, abdominal discomfort due to compression on nearby organs, splenomegaly (enlargement of the spleen) and painful tenderness in the left and upper abdomen (left hypochondrium
Dyspeptic disorders (in case of compression on the stomach)
In rarer situations, exertional dyspnoea (shortness of breath following exertion), pain at the base of the left hemithorax

Splenic abscesses are present:

Abdominal pain in the left hypochondrium with the possibility of pain migrating to the left shoulder
Fever
Alteration of general condition

Establishing the diagnosis

–
Abdominal ultrasound
– non-invasive and atraumatic imaging method, based on ultrasound, which can reveal splenomegaly, presence of splenic cystic formation, perisplenic, intra-abdominal collections, in case of ruptured cysts

–
Computed tomography (CT)
– takes a series of detailed images of certain regions of the body, these images are taken from different planes; for better highlighting of the region explored, a contrast substance is used; establishes with greater accuracy cystic splenic lesions and lesions associated with other intra-abdominal organs

–
Blood tests
– blood count (leukocytosis – in case of splenic abscesses, eosinophilia in case of echinococcosis)

Treatment

If symptoms occur, surgical treatment is indicated, which involves removal of all or part of the spleen (total or partial splenectomy). In the case of serous splenic cysts, the cyst may be removed with evacuation of the serous contents (partial cystectomy).

In particular situations, for splenic abscesses (in addition to antibiotic treatment) image-guided percutaneous drainage or open drainage by surgical approach may be indicated.