Ultrasonic differential diagnostics of cyst and cystic tumors of the spleen

The incidence of focal lesions in the spleen is 3.2–4.2% per 100,000 population. Spleen cysts are rare (incidence 0.75 per 100,000). These are single or multiple, thin- and smooth-walled cavities filled with a transparent liquid. Distinguish between primary (or true) cysts, lined with epithelium, and secondary (or false), devoid of epithelial lining. Among the primary cysts, there are congenital cysts formed in the embryonic period due to the migration of peritoneal cells into the spleen tissue, dermoid and epidermoid cysts. A special group of primary cysts are parasitic cysts. Cystic tumors of the spleen include lymphangioma and lymphoma.

The main difficulties in the diagnosis and differential diagnosis of cysts and cystic tumors of the spleen are associated with the rarity of this pathology and, as a consequence, a small number of works, including a significant number of the cases. However, in those works where a large number of the cases are described, most often this is one morphological form and an analysis of its various characteristics.

Purpose. Based on the analysis of our own examination data of a significant number of patients with cysts and cystic tumors of the spleen, to assess the possibility of differential diagnosis of individual morphological forms according to ultrasound data.

Materials and methods. 323 patients with cysts and cystic tumors of the spleen from 15 to 77 years old (men – 105 (32.5%); women – 218 (67.5%) were treated at A.V. Vishnevsky National Medical Research Center of Surgery for the period from 1980 to 2020. All patients underwent ultrasound during examination. Surgical treatment was carried out in various ways – (85.1%), when making a preoperative diagnosis of an uncomplicated spleen cyst of small size, dynamic observation was carried out (verification by puncture biopsy data).

Results. Morphological verification of cysts and cystic tumors of the spleen was presented as follows (taking into account possible difficulties in identifying the epithelial lining): true cyst – 182 (56.4%); dermoid cyst – 3 (0.9%) (malignant – in 1 case); pseudocyst – 16 (5.0%); pancreatogenic – 34 (10.5%); echinococcus – 52 (16.1%); lymphangioma – 24 (7.4%); lymphoma – 10 (3.1%); ovarian cancer metastasis – 2 (0.6%). The article describes the ultrasound signs of the above forms of the lesions with an emphasis on the complexity of diagnosis.

Conclusions. Primary and parasitic spleen cysts are well differentiated according to ultrasound; false cysts of the spleen, depending on the cause of their occurrence, can create difficulties in their identification and differentiation (they require careful dynamic control); cystic tumors of the spleen should be differentiated from malignant tumors and metastases of a cystic structure, as a result of which such vigilance should always be present when they are detected.

1. Borner N., Blank W., Bonhof J., Frank K. Echogenic splenic lesions – incidence and differential diagnosis. Ultraschall. Med. 1990; 11 (3): 112–118.

2. Sadeghi A., Naderpour Z., Ebrahimpur M., Saffar H. Nonparasitic Splenic Cyst. Middle East J. Dig. Dis. 2017; 9: 242–243. http://doi.org/10.15171/mejdd.2017.81.

3. Mazurova V.K. Beloblotsky V.T., Lagunova N.V., Slezkin G.A. To a question of treatment of not parasitic cysts of a spleen. Physiology and abdomen pathology. Coll. articles. Simferopol, 1988: 82–84. (In Russian)

4. Posta C.G. Laparoscopic management of splenic cyst. J. Laparoscop. Endoscop. Surg. 1994; 11 (5): 347–354.

5. Morgenstern L. Nonparasitis splenic cysts (NPSCs). J. Am. Coll. Surg. 2002; 195 (3): 437–438.

6. Martin J.W. Congenital splenic cysts. Am. J. Surg. 1958; 96: 302.

7. Qureshi M.A., Hafner C.D. Splenic cysts. Ann. Surg. 1978; 187: 231–238.

8. Vinogradov A.L., Karseladze A.I., Rusakov I.G. Epidermoid cyst of the spleen. Soviet medicine. 1981; 11: 12–114. (In Russian)

9. Schnorrer M., Figer J., Lavuda M. Splenectomy and sparing surgery of the spleen. Rozhl. Chir. 1995; 71 (2): 93–97.

10. Kabra N.S., Bowen J.R. Congenital splenic cyst: a case report and review of the literature. J. Paediatr. Child Health. 2001; 37 (4): 400–402. http://doi.org/10.1046/j.1440-1754.2001.00620.x

11. Palmieri I., Natale E., Crafa F., Cavallaro A., Mingazzini P.L. Epithelial splenic cysts. Anticancer Res. 2005; 25 (1B): 515–521.

12. Karyachkin A.M., Bykov V.S. About diagnostics of not parasitic cysts of a spleen. Klinicheskaya meditsina. 1973; 51 (8): 114–117. (In Russian)

13. Arkuszewski P., Srebrzyński A., Niedziałek L., Kuzdak K. True and pseudocysts of the spleen – a diagnostic and therapeutic problem. Pol. Przegl. Chir. 2012; 84 (1): 37–43. http://doi.org/10.2478/v10035-012-0006-3

14. Botvinkov N.I., Gorelik P.V. Diagnostics and treatment of diseases and injuries of a spleen. Vestnik khirurgii im. I.I. Grekova. 1989; 10: 54–55. (In Russian)

15. Stepanova Yu.A., Ionkin D.A., Shchegolev A.I., Kubyshkin V.A. Classification of focal formations of the spleen. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2013; 2: 103–114. (In Russian)

16. Mirilas P., Mentessidou A., Skandalakis J.E. Splenic cysts: are there so many types? J. Am. Coll. Surg. 2007; 204: 459–465. http://doi.org/0.1016/j.jamcollsurg.2006.12.012

17. Horibe Y., Murakami M., Yamao K., Imaeda Y.,Tashiro K., Kasahara M. Epithelial inclusion cyst (epidermoid cyst) formation with epithelioid cell granuloma in an intrapancreatic accessory spleen. Pathol. Int. 2001; 51 (1): 50–54. http://doi.org/10.1046/j.1440-1827.2001.01155.x

18. Dominguez I., Franssen-Canovas B., Uribe-Uribe N., Franco R., Campuzano M., Uscanga L.F. Accessory spleen as a differential diagnosis pf intrapancreatic tumors. Case report and review of literature. Rev. Gastroenterol. Mex. 2007; 72 (4): 376–378.

19. Forum “Echography” http://echographia.ru/forum/index.php?topic=2640.0 (date of acsess 07/08/2020) (In Russian)

20. Rana A.P., Kaur M., Singh P., Malhotra S., Kuka A.S. Splenic epidermoid cyst – a rare entity. J. Clin. Diagn. Res. 2014; 8 (2): 175–176. http://doi.org/10.7860/JCDR/2014/6901.4050.

21. Vuyyuru S., Kharbutli B. Epidermoid cyst of the spleen, a case report. Int. J. Surg. Case Rep. 2017; 35: 57–59. http://doi.org/10.1016/j.ijscr.2017.04.014

22. Marjanovic Z.O., Djordjevic I.M. Epidermoid splenic cysts in children and adolescents. Acta Chir. Iugosl. 2008; 55 (1): 63–67. http://doi.org/10.2298/aci0801063m

23. Thipphavong S., Duigenan S., Schindera S.T., Gee M.S., Philips S. Am. J. Roentgenol. 2014; 203 (2): 315–322. http://doi.org/10.2214/AJR.13.11777

24. Vancauwenberghe T., Snoeckx A., Vanbeckevoort D., Dymarkowski S., Vanhoenacker F.M. Imaging of the spleen: what the clinician needs to know. Singapore Med. J. 2015; 56 (3): 133–144. http://doi.org/10.11622/smedj.2015040

25. Shiryaev A.A. Diagnosis and treatment of nonparasitic spleen cysts: Dis. ... Cand. of med. sci. M., 2010. 91 p. (In Russian)

26. Giovagnoni A., Giorgi C., Goteri G. Tumours of the spleen. Cancer Imaging. 2005; 5 (1): 73–77. http://doi.org/10.1102/1470-7330.2005.0002.

27. Heider R., Behrns K.E. Pancreatic pseudocysts complicated by splenic parenchymal involvement: results of operative and percutaneous management. Pancreas. 2001; 23: 20–25. http://doi.org/10.1097/00006676-200107000-00003

28. Pomelov V.S., Kubyshkin V.A., Tsvirkun V.V., Ionkin D.A., Vukolov A.V. Organ-saving surgery for benign spleen cysts. Pirogov Russian Journal of Surgery = Khirurgiya. Zhurnal imeni N.I. Pirogova. 1996; 2: 28–30. (In Russian)

29. Gharbi H.A., Hassine W., Brauner M.W., Dupuch K. Ultrasound examination of the hydatid liver. Radiology. 1981; 139: 459–463.

30. Rodríguez-Montes J.A., Collantes-Bellido E., Marín- Serrano E., Prieto-Nieto I., Pérez-Robledo J.P. Linfangioma esplénico. Un tumor raro. Presentación de 3 casos y revisión de la bibliografía [Splenic lympangioma. A rare tumour. Presentation of 3 cases and a literature review.]. Cirugía y Cirujanos. 2016; 84 (2): 154–159. http://doi.org/10.1016/j.circen.2016.02.014

31. Aleksandrovich Yu.S., Fomin S.A., Pshenisnov K.V. Features of the hormonal status in newborns with congenital malformations requiring surgical intervention. Intensive care bulletin them. A.I. Saltanov. 2019; 4: 106–112. http://doi.org/10.21320/1818-474X-2019-4-106-112. (In Russian)

32. Abbott R.M., Levy A.D., Aguilera N.S., Gorospe L., Thompson W.M. From the archives of the AFIP: primary vascular neoplasms of the spleen: radiologic–pathologic correlation. Radiographics. 2004; 24 (4): 1137–1163. http://doi.org/10.1148/rg.244045006

33. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Swerdlow S.H., Campo E., Harris N.L., Jaffe E.S., Pileri S.A., Stein H., Thiele J. (eds). Revised 4th ed. Lyon: IARC Press, 2017. 585 p.

34. Manzella A., Borba-Filho P., D'Ippolito G., Farias M. Abdominal manifestations of lymphoma: spectrum of imaging features. ISRN Radiol. 2013; 2013: 483069. http://doi.org/10.5402/2013/483069

35. Lee W.-K., Lau E.W.F., Duddalwar V.A., Stanley A.J., Ho Y.Y. Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings. Am. J. Roentgenol. 2008; 191 (1): 198–206. http://doi.org/10.2214/AJR.07.3146

36. De Jong P.A., Van Ufford H.M.Q., Baarslag H.-J., de Haas M.J., Wittebol S.H., Quekel L.G., de Klerk J.M. CT and 18F-FDG PET for noninvasive detection of splenic involvement in patients with malignant lymphoma. Am. J. Roentgenol. 2009; 192 (3): 745–753. http://doi.org/10.2214/AJR.08.1160.

37. Compérat E., Bardier-Dupas A., Camparo P., Capron F., Charlotte F. Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis. Arch. Pathol. Lab. Med. 2007; 131 (6): 965–969. http://doi.org/10.1043/1543-2165(2007)131[965:SMCPDD]2.0.CO;2