What is splenomegaly. How is an enlarged spleen diagnosed using CT scans. What are the various causes and treatment options for splenomegaly. When should you seek medical attention for an enlarged spleen.

Understanding Splenomegaly: Causes and Significance

Splenomegaly, or an enlarged spleen, is a condition that can arise from various underlying health issues. The spleen, being the largest collection of lymphoid tissue in the body, plays crucial roles in hematological and immunological functions. Its involvement in malignant diseases makes it a critical organ to assess in cancer patients.

Common causes of splenomegaly include:

• Infections (viral, bacterial, or parasitic)
• Hematologic disorders (leukemia, lymphoma)
• Liver diseases
• Autoimmune conditions
• Metabolic disorders
• Certain cancers and metastases

Understanding the underlying cause of splenomegaly is essential for proper treatment and management. In some cases, an enlarged spleen can be a sign of a serious condition requiring immediate medical attention.

The Role of CT Scans in Diagnosing Splenomegaly

Computed Tomography (CT) scans have become an invaluable tool in diagnosing and assessing splenomegaly. They offer a quick, non-invasive method to visualize the spleen and surrounding structures with high precision.

CT Scan Procedure for Spleen Examination

During a CT scan for splenomegaly:

1. The patient lies on a table that moves through a donut-shaped machine.
2. X-rays and computers create cross-sectional images of the abdomen.
3. Intravenous contrast material may be used to enhance image quality.
4. The entire procedure typically takes 10-30 minutes.

Is contrast material always necessary for spleen CT scans? While non-enhanced CT can provide useful information, contrast-enhanced scans offer optimal evaluation of the spleen. The contrast material helps highlight vascular structures and potential abnormalities within the splenic tissue.

Interpreting CT Scan Results for Splenomegaly

Radiologists assess several factors when examining CT scans for splenomegaly:

• Spleen size and shape
• Parenchymal homogeneity
• Presence of focal lesions
• Vascular patterns
• Surrounding anatomical structures

A normal adult spleen typically measures 12-15 cm in length, 4-8 cm in anteroposterior diameter, and 3-4 cm in thickness. However, these linear measurements can be limited due to the spleen’s irregular shape and oblique orientation.

Advanced CT Techniques for Spleen Assessment

Modern CT technology offers advanced techniques for more precise spleen evaluation:

Splenic Index Calculation

The splenic index provides a quick quantitative assessment of splenic size. It is calculated by multiplying the length, width, and thickness of the spleen. A normal splenic index ranges from 120-480 cm³.

Volumetric Analysis

Three-dimensional volumetric analysis offers a more accurate assessment of splenic size. Normal in vivo adult splenic volume typically ranges from 107 to 314 cm³.

Dual-Energy CT

Dual-energy CT can provide additional information about tissue composition and may help differentiate between various splenic lesions.

How accurate are these advanced CT techniques in detecting splenomegaly? While these methods offer improved accuracy over traditional linear measurements, they should be interpreted in conjunction with clinical findings and other diagnostic tests for a comprehensive evaluation.

Differential Diagnosis: Benign vs. Malignant Splenic Lesions

CT scans can reveal various splenic lesions, both benign and malignant. Differentiating between these is crucial for proper management.

Benign Splenic Lesions

Common benign lesions include:

• Cysts (true or false)
• Hemangiomas
• Hamartomas
• Abscesses
• Infarcts

Cystic lesions appear as well-defined, low-density areas on CT. Hemangiomas, the most common primary benign neoplasm of the spleen, may show characteristic enhancement patterns.

Malignant Splenic Lesions

Malignant lesions can be primary or secondary (metastatic). They include:

• Lymphoma
• Leukemia
• Angiosarcoma
• Metastases from various primary cancers

Malignant lesions often appear as hypodense areas with irregular margins and may show heterogeneous enhancement.

Can CT scans definitively distinguish between benign and malignant lesions? While CT characteristics can provide valuable information, definitive diagnosis often requires additional imaging modalities (like MRI or PET) or biopsy in some cases.

Treatment Options for Splenomegaly

Treatment for splenomegaly depends on the underlying cause and severity of the condition. Options may include:

Conservative Management

For mild cases or those caused by treatable conditions, conservative management may be sufficient. This can involve:

• Treating the underlying condition (e.g., antibiotics for infections)
• Monitoring spleen size through regular imaging
• Lifestyle modifications to prevent complications

Medications

Various medications may be prescribed depending on the cause of splenomegaly:

• Antimicrobials for infectious causes
• Chemotherapy for hematologic malignancies
• Immunosuppressants for autoimmune conditions

Splenectomy

In severe cases or when complications arise, surgical removal of the spleen (splenectomy) may be necessary. This can be performed through open surgery or laparoscopically.

What are the potential risks and benefits of splenectomy? While splenectomy can resolve symptoms and prevent complications of severe splenomegaly, it also increases the risk of certain infections. Patients who undergo splenectomy require lifelong vaccinations and antibiotic prophylaxis.

Complications and Follow-up Care for Splenomegaly

Splenomegaly can lead to various complications if left untreated:

• Splenic rupture
• Anemia
• Thrombocytopenia
• Increased risk of infections
• Portal hypertension

Regular follow-up care is essential for patients with splenomegaly. This typically involves:

1. Periodic physical examinations
2. Blood tests to monitor cell counts and liver function
3. Repeat imaging studies to assess spleen size and detect any new lesions
4. Management of underlying conditions

How often should follow-up CT scans be performed for patients with splenomegaly? The frequency of follow-up imaging depends on the underlying cause and severity of splenomegaly. Typically, scans may be repeated every 3-6 months initially, with longer intervals as the condition stabilizes.

Emerging Research and Future Directions in Splenomegaly Management

Ongoing research in splenomegaly diagnosis and management is focused on several areas:

Advanced Imaging Techniques

Researchers are exploring novel imaging modalities and techniques to improve the accuracy of spleen assessment:

• Contrast-enhanced ultrasound for better characterization of splenic lesions
• Artificial intelligence algorithms for automated spleen segmentation and volume calculation
• Molecular imaging techniques for early detection of malignant transformation

Targeted Therapies

Development of targeted therapies aims to address specific causes of splenomegaly:

• JAK inhibitors for myelofibrosis-associated splenomegaly
• Novel immunomodulators for autoimmune-related splenomegaly
• Gene therapies for inherited disorders affecting the spleen

Minimally Invasive Interventions

Researchers are investigating less invasive alternatives to splenectomy:

• Splenic artery embolization for partial splenic infarction
• Radiofrequency ablation of splenic lesions
• Cryoablation techniques for focal splenic diseases

How might these emerging technologies and treatments impact the management of splenomegaly in the future? As these innovations continue to develop, they may offer more precise diagnosis, targeted treatments, and reduced need for invasive procedures, potentially improving outcomes and quality of life for patients with splenomegaly.

In conclusion, CT scans play a crucial role in the diagnosis and management of splenomegaly. By providing detailed images of the spleen and surrounding structures, they help clinicians accurately assess splenic size, detect lesions, and monitor treatment response. As research progresses, we can expect even more advanced techniques and targeted therapies to further improve the care of patients with enlarged spleens.

CT of splenic disease | Cancer Imaging

• Review
• Open Access
• Published: 05 May 2015

• S. A. Sohaib¹ 

Cancer Imaging
volume 2, pages 101–103 (2002)Cite this article

• 13k Accesses

• Metrics details

Introduction

The spleen is the largest collection of lymphoid tissue in the body. It has important haematological and immunological functions and may be involved in malignant disease. CT offers a simple, rapid way to assess the spleen in patients with cancer and here we review CT of splenic disease in such cases.

CT

The spleen on non-enhanced CT is homogeneous and has an attenuation of 35–55HU, that is 5–10HU less than that of liver. The spleen is optimally evaluated with the use of intravenous contrast material. The spleen normally demonstrates heterogeneous enhancement immediately after bolus injection of contrast material. Only after a minute or more does the splenic parenchyma achieve uniform homogeneous enhancement. This is thought to reflect the variable blood flow within different compartments of the spleen and should not be misinterpreted for pathology.

The shape and position of the normal spleen can vary considerably. The radiologist also needs to be aware that a number of normal variants and congenital anomalies affect the spleen. Residual clefts between adjacent lobulations may mimic lacerations and prominent lobes may mimic splenic mass lesions. Ectopic splenic tissue of congenital origin gives rise to accessory spleen. In autopsy series accessory spleens are present in 10–30% of the population. They are usually solitary and occur near the splenic hilum (75%), but may be found elsewhere in the abdomen. Accessory spleen varies in size from a few millimetres to several centimetres in diameter. After splenectomy, an accessory spleen can hypertrophy dramatically causing recurrence of problems in patients who have undergone splenectomy for hypersplenism. The typical accessory spleen has a smooth, round or ovoid shape and its blood supply is usually derived from the splenic artery with drainage into the splenic vein.

The normal adult spleen size measures approximately 12–15 cm in length, 4–8 cm in antero-posterior diameter and 3–4 cm in thickness. However the irregular shape and oblique orientation of the spleen means that these linear measurements are of limited use. Furthermore, splenic volume varies greatly from one individual to another. Normal in vivo adult splenic volume ranges from 107 to 314 cm³. A quick quantitative assessment of splenic size can be made on imaging on CT using splenic index, i.e. the product of the length, width and thickness. The normal splenic index is between 120–480 cm³.

Splenomegaly

There are many causes of splenomegaly, and it may occasionally be related to neoplastic disorders such as lymphoma, leukaemia, primary benign or malignant tumours and metastases. A clue to the underlying cause can sometimes be identified on imaging, e.g. abdominal lymph node enlargement may suggest lymphoma.

Benign mass lesion

Splenic cystic lesions may be due to cystic neoplasm (lymphangioma or haemangioma), cystic metastasis or abscess (haematoma or pseudocyst). Non-neoplastic splenic cysts are true (primary) cysts, which possess a cellular lining or false (secondary) cyst which have no cellular lining. True cysts are either parasitic (echinococcal) or non-parasitic (i. e. epithelial also called epidermoid, mesothelial, or primary cyst). Epithelial cysts are congenital in origin while false cysts, i.e. pseudocysts are post traumatic in origin and thought to represent the final stage in the evolution of a splenic haematoma.

On CT, splenic cysts are well defined, of water density or signal, and show no enhancement after intravenous contrast. It is usually difficult to distinguish between true and false cysts on imaging, but certain characteristics may be useful in differentiating between them. CT demonstrates cyst wall calcification in 14% of true cysts and 50% of false cysts. Cyst wall trabeculation or peripheral septation occurs in 86% of true cysts and 17% of false cysts. High attenuation cysts may occur in up to one third of false cysts.

Haemangioma is the most common primary benign neoplasm of the spleen occurring in 0.03% to 14% of cases at autopsy. Most lesions are detected incidentally but in large haemangioma splenic rupture and anaemia, thrombocytopenia and coagulopathy (Kasabach-Merritt syndrome) has been reported. Splenic haemangiomas can be multiple and a part of a generalised angiomatosis as in Klippel-Trenauny-Weber syndrome. On CT, haemangiomas may appear either solid and/or cystic and may enhance in a similar pattern to hepatic haemangioma. Some lesions are relatively avascular or show slow filling of contrast material.

Lymphangioma can occur as single or multiple lesions and are usually asymptomatic and are categorised as capillary, cavernous or cystic depending on size of the abnormal lymphatic channels. In the spleen the cystic type is most common. CT shows multiple thin walled, well-marginated cysts often subcapsular in location. No enhancement is seen and the attenuation measurements vary from 15–35HU.

Splenic hamartomas (also called splenomas, or nodular hyperplasia of the spleen) are rare benign lesions composed of an anomalous mixture of normal splenic elements with red pulp predominating. The hamartoma occur singly or less commonly as mutiple nodules. On CT, they appear iso or hypodense on the precontrast images, with the occasional lesion showing cystic component.

Splenic malignancy

Splenic lymphoma is the most common splenic malignancy and is usually a manifestation of generalised lymphoma. It is estimated that at the time of diagnosis, splenic involvement is present in 25–35% of patients with lymphoma. In patients with NHL, splenic involvement is associated with para-aortic nodal involvement in approximately 70% of patients. On imaging, splenic involvement in lymphoma can take several forms: (1) homogeneous enlargement; (2) miliary nodules; (3) multifocal 1 to 10 cm lesions; (4) single solitary mass. In the majority of patients, the involvement is diffuse and difficult to identify on CT because splenomegaly does not necessarily indicate involvement. One third of patients have splenomegaly without infiltration; conversely one third of normal-sized spleen are found to have tumour following splenectomy. Necrosis of large lesion can give rise to an irregular cystic lesion. Radiologically visible calcification has been reported in aggressive lesions and after chemotherapy.

Primary splenic lymphoma, which is usually of the non-Hodgkin’s type, is rare and comprises 1–2% of all lymphoma. Other primary tumours of the spleen are very rare and include angiosarcoma, fibrosarcoma, leiomyosarcoma, malignant teratoma and malignant fibrous histocytoma. Splenic angiosarcoma is very rare but is the most common non-lymphoid primary malignant tumour of the spleen. The prognosis is very poor (20% surviving months). About 70% of all angiosarcoma metastasise to the liver and approximately 30% undergo spontaneous rupture. Imaging reveals an enlarged spleen with a poorly defined mass and there may be areas of haemorrhage within it.

Metastatic disease

Metastatic deposits in the spleen are unusual, comprising 4–7% of patients with metastases in multiple organs. The most common primary sites for splenic metastases are the breast, lung and melanoma. Splenic metastases most frequently appear as multiple nodules. On CT, nodular metastases appear as rounded hypodense lesions. Cystic lesions may occur with metastases from ovary, breast, endometrium and melanoma. Calcification is uncommon but occurs in patients with mucinous adenocarcinoma primary. Peritoneal implants in patients with ovarian, GI or pancreatic cancer can cause scalloping of the splenic capsular surface.

Miscellaneous spleen lesions in oncology patients

Splenic infection may arise as a consequence of immunosuppression from chemotherapy especially fungal infection. The most common pathogens are Candida and Aspergillus. Fungal infection in the spleen is most likely to appear as a miliary or multifocal process.

Splenic infarcts may occur from mass lesion compressing splenic vasculature, e.g. pancreatic tumours. Splenic infarction may be diffuse or focal. On CT, infarcts typically appear as sharply marginated, low-density wedge-shaped areas. Occasionally the infarct may be multiple, resulting in poorly defined hypodense lesions. When the entire spleen is infarcted only rim enhancement of the capsule occurs from capsular vessels.

Key points

1. (1)

   The early heterogeneous enhancement in the spleen should not be misinterpreted for pathology

2. (2)

   The commonest splenic malignancy is lymphoma. The spleen is involved as a part of the generalised lymphoma. An enlarged spleen is not a reliable indicator of lymphomatous involvement.

3. (3)

   Metastases to the spleen are very uncommon.

Further Reading

1. Sohaib SA, Reznek RH. The Reticuloendothelial system: spleen. In: Diagnostic Radiology, 4th edn. Grainger R, Allison DJ, Adam A, Dixon A, eds. London: Harcourt Publishers Ltd, 2001: 1433–46.

   Google Scholar 

2. DeSchepper AM, Vanhoenacker F. Medical Imaging of the Spleen, Berlin: Spinger, 2000.

   Book 

   Google Scholar 

3. Warshauer DM, Koehler RE. Spleen. In: CT with MRI Correlation, 3rd edn. Lee JK, Sagel SS, Stanley RJ, Heiken JP, eds. Philadelphia: Lippincott-Raven, 1998: 845–72.

   Google Scholar 

Download references

Author information

Authors and Affiliations

1. Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK

   S. A. Sohaib (Consultant Radiologist)

Authors

1. S. A. Sohaib

   View author publications

   You can also search for this author in
   PubMed Google Scholar

Corresponding author

Correspondence to
S. A. Sohaib.

Additional information

This paper is available online at http://www.cancerimaging.org. In the event of a change in the URL address, please use the DOI provided to locate the paper.

Rights and permissions

Reprints and Permissions

About this article

Unusual CT and MR Imaging Characteristics of Splenic Lymphoma

On this page

AbstractIntroductionCase ReportDiscussionReferencesCopyrightRelated Articles

Lymphoma is the most common malignancy of the spleen. The imaging features of splenic lymphoma are nonspecific and mostly lymphomas present as a diffusely enlarged spleen. Focal lesions are described but remain of low density or intensity on CT or MRI, respectively. We describe a histologically proven case of splenic lymphoma that showed an atypical hyperdense/hyperenhancing appearance on imaging suspicious for a vascular pathology. To the best of our knowledge and based on review of English literature, such an appearance of splenic lymphoma is extremely unusual and rare.

1. Introduction

Lymphoma is the most common tumor of the spleen and it may be primary or secondary to a diffuse lymphomatous process [1]. Splenic involvement in lymphoma is important in deciding the line of treatment and determines the overall prognosis. Splenic involvement by lymphoma has varied appearances including the spleen being normal that is microscopic involvement or splenomegaly with or without focal mass lesions [2, 3]. Focal involvement is typically hypodense on noncontrast CT and mildly hyperintense on T2-weighted MRI with poor postcontrast enhancement on both [2–4]. Our case is unique in that the splenic lesions of lymphoma were intensely enhancing on CT and MRI, which is not typically described or expected on imaging of splenic lymphoma.

2. Case Report

A 60-year-old Caucasian male presented to the ER with one-month history of weakness, fatigue, and left upper quadrant pain. Past medical history was significant for diabetes Mellitus, hypertension, and hyperlipidemia. Patient worked in a fertilizing chemical business with history of exposure to chemicals and pesticides over the last 2 decades. Physical examination was remarkable for pallor and splenomegaly extending 7-8 cm below costal margin. Laboratory analysis showed hemoglobin of 9 g/dL, hematocrit 28%, white count 4.0 × 10³/mm³, and platelet count of 70 × 10³/μL. Peripheral blood smear did not show any abnormal lineage cells.

Noncontrast CT abdomen showed massive splenomegaly with multiple hyperdense foci within the spleen (Figure 1, arrowheads) representing hemorrhage within the splenic parenchyma. Post contrast CT (Figure 2) revealed multifocal intensely enhancing areas in the splenic parenchyma suggesting the highly vascular nature of these masses. Differential diagnoses based on these findings included atypical hemangioma, splenic peliosis, and angiosarcoma [4, 5]. MRI revealed massive splenomegaly with multifocal cystic areas, which showed evidence of variable sized blood products. On postcontrast MRI, there was central enhancement of these lesions (Figure 3) with intralesional traversing blood vessels (not shown). Prospective diagnosis based on MR findings was splenic peliosis with giant cavernous hemangioma being a close second possibility.

Bone marrow biopsy, however, revealed a B-cell lymphoma and an initial staging PET scan showed massively enlarged spleen with increased FDG uptake (Figure 4) with an SUV of 6.23 consistent with lymphoma or other malignant process [3, 6]. A week after the presentation, the patient presented in ER with splenic rupture and underwent emergent splenectomy, splenic pathology showed diffuse large B cell lymphoma.

3. Discussion

CT is the most widely used and currently the imaging modality of choice for assessment of lymphoma. The overall accuracy of CT in depicting splenic lymphoma is approximately 22–65% [3], differences between series may be partly explained by advances in multidetector imaging allowing greater spatial resolution and acquisition during optimal splenic enhancement. When focal splenic involvement is detected, deposits are of lower attenuation than adjacent normal splenic parenchyma on unenhanced CT and demonstrate little or no enhancement following injection of intravenous iodinated contrast medium [3, 7]. The lymphomatous deposits in spleen in our case were hyperdense on noncontrast CT with significant enhancement following administration of contrast.

Conventional T1- and T2-weighted MR sequences have poor sensitivity for splenic involvement in lymphoma, which is due to the similar relaxation times of lymphoma and normal splenic tissue using these sequences [8]. Identifiable foci within the spleen are hypointense and hyperintense on T1- and T2-weighted sequences, respectively. Gadolinium-enhanced MRI increases conspicuity of lymphoma deposits as a consequence of their relatively poor enhancement compared to normal splenic parenchyma [9, 10]. In our case, the MRI showed multifocal blood, filled cystic areas of variable age with marked enhancement postcontrast.

The differential diagnoses based on CT and MRI imaging characteristics involved pathologies with a high vascular content, namely, splenic peliosis, cavernous atypical hemangioma, or an angiosarcoma. The bone marrow biopsy obtained given the history of chemical exposure and the finding of pancytopenia, however, showed B cell lymphoma. This was confirmed by PET scan (SUV 6.23) and splenic pathology when patient presented with a splenic rupture. In a study of 68 patients with known malignant disease, an SUV threshold of 2.3 correctly differentiated benign from malignant lesions with the sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%, respectively [6].

In conclusion, splenic lymphoma could present with imaging features simulating a vascular malformation or tumor and should be considered in differential of a multifocal hypervascular lesion, in an appropriate clinical setting.

References

1. C. Goerg, W. B. Schwerk, K. Goerg, and K. Havemann, “Sonographic patterns of the affected spleen in malignant lymphoma,” Journal of Clinical Ultrasound, vol. 18, no. 7, pp. 569–574, 1990.

   View at:

   Publisher Site | Google Scholar

2. R. K. Kaza, S. Azar, M. M. Al-Hawary, and I. R. Francis, “Primary and secondary neoplasms of the spleen,” Cancer Imaging, vol. 10, no. 1, pp. 173–182, 2010.

   View at:

   Publisher Site | Google Scholar

3. K. Bhatia, A. Sahdev, and R. H. Reznek, “Lymphoma of the spleen,” Seminars in Ultrasound, CT and MRI, vol. 28, no. 1, pp. 12–20, 2007.

   View at:

   Publisher Site | Google Scholar

4. D. M. Warshauer and H. L. Hall, “Solitary splenic lesions,” Seminars in Ultrasound, CT and MRI, vol. 27, no. 5, pp. 370–388, 2006.

   View at:

   Publisher Site | Google Scholar

5. F. M. Vanhoenacker, B. Op de Beeck, A. M. De Schepper, R. Salgado, A. Snoeckx, and P. M. Parizel, “Vascular disease of the spleen,” Seminars in Ultrasound, CT and MRI, vol. 28, no. 1, pp. 35–51, 2007.

   View at:

   Publisher Site | Google Scholar

6. U. Metser, E. Miller, A. Kessler et al., “Solid splenic masses: evaluation with 18F-FDG PET/CT,” Journal of Nuclear Medicine, vol. 46, no. 1, pp. 52–59, 2005.

   View at:

   Google Scholar

7. A. H. Dachman, “Lymphoma and primary splenic neoplasms,” in Radiology of the Spleen, A. H. Dachman and A. Friedman, Eds., pp. 94–137, Mosby, St. Louis, Mo, USA, 1993.

   View at:

   Google Scholar

8. K. M. Elsayes, V. R. Narra, G. Mukundan, J. S. Lewis, C. O. Menias, and J. P. Heiken, “MR imaging of the spleen: spectrum of abnormalities,” Radiographics, vol. 25, no. 4, pp. 967–982, 2005.

   View at:

   Google Scholar

9. S. A. Mirowitz, J. J. Brown, J. K. T. Lee, and J. P. Heiken, “Dynamic gadolinium-enhanced MR imaging of the spleen: normal enhancement patterns and evaluation of splenic lesions,” Radiology, vol. 179, no. 3, pp. 681–686, 1991.

   View at:

   Google Scholar

10. K. Ito, D. G. Mitchell, K. Honjo et al., “Gadolinium-enhanced MR imaging of the spleen: artifacts and potential pitfalls,” American Journal of Roentgenology, vol. 167, no. 5, pp. 1147–1151, 1996.

    View at:

    Google Scholar

Copyright

Copyright © 2011 Chhavi Kaushik et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Tests for diseases of the spleen

What is the spleen and what are its main functions in the body?

The spleen is an unpaired parenchymal organ of the immune system located in the left hypochondrium behind
stomach. From above, the spleen is covered with a connective tissue capsule, the inner part is white (due to
accumulations of lymphocytes) and red (venous sinuses) pulp. It plays an important role in the functioning
lymphatic and hematopoietic systems.

The most important and studied functions of this organ are as follows:

1. Immune; The spleen takes part in the formation of cells of the lymphatic system –
   lymphocytes. This process is called lymphopoiesis. In addition, in the lymphoid organ, the formation
   antibodies against foreign antigens.
2. Filtration; The spleen is the “filter” through which blood passes and
   there is a recognition and further destruction of old red blood cells – erythrocytes and white
   platelets. At the same time, hemoglobin, released during this process from erythrocytes, breaks down and
   is transformed into bilirubin and iron-containing transport protein – transferrin. Subsequently, transferrin
   enters the bone marrow and releases iron, which goes to the formation of new red blood cells, and bilirubin –
   bile pigment, which is part of bile, is transferred to the liver.
3. Depository; In addition to the formation and destruction of formed elements, in the spleen,
   deposition of blood. More than 30% of platelets are found in the sinuses of the spleen.
4. Hematopoietic; In addition, in the early stages of human development
   (in utero) in the spleen, the formation of erythrocytes and granulocytic leukocytes (neutrophils,
   eosinophils and basophils), which then begin to be produced in the red bone marrow, while
   the spleen is involved only in the formation of lymphocytes and blood monocytes.

What pathologies of the spleen can occur?

Primary lesions of the spleen include direct trauma, primary tumors (very rare), and
congenital absence of this organ. Most often, the spleen is damaged secondarily, that is, under the influence of
any other existing pathology in the body. Such lesions include:
as a result of thrombosis and / or embolism; may be the result of an infectious process;

other inflammatory and not only processes.

What are the clinical signs that suggest spleen disease?

Normally, the spleen is located under the costal arch and is inaccessible to palpation. A healthy person rarely experiences
any sensations and / or pain in the area of ​​​​its projection. This can happen in the case of a strong physical
overvoltage, for example, after running, when there is a large flow of blood into the organ, and the capsule reacts to
stretching. In all other cases, pain is a pathological symptom and may occur due to
compression of the organ, enlargement of the spleen and compression of nearby nerve and vascular branches, etc. Except the pain
An important clinical symptom to watch out for is the size of the spleen. Normal
values ​​fluctuate between 11-13 cm in length and 6-8 cm in diameter, the thickness is no more than 4-5 cm.
An increase in size – splenomegaly – can be observed during infectious processes, tumor neoplasms,
portal hypertension, for which there are a great many reasons, and so on.

Pathologies of the spleen may be accompanied by peripheral edema, as well as effusion in the pleural or abdominal
(ascites) of the cavity, which is most often associated with a primary lesion of the blood outflow system and an increase in pressure in
portal system, for example, in diseases of the liver.

Also, diseases of the spleen are often accompanied by non-specific symptoms, such as weakness, drowsiness,
decreased appetite, decreased attention, etc. In infectious and inflammatory processes, body temperature rises,
with septic lesions, cold clammy sweat may appear.

How to diagnose an organ pathology? What tests are needed to check the spleen?

In the absence of any symptoms from the body, the spleen does not require an unreasonable test. However, in
in case of discomfort in the area of ​​its projection, severe pain, increase in size, appearance
any other symptoms that may indirectly indicate a pathology or be accompanied by changes in
side of this body, you should consult a doctor. The first step is to take a thorough history of
studying all the patient’s complaints, assessing the provoking factors, etc. and physical examination, including percussion,
palpation and auscultation of various organs, if necessary. Then, as prescribed by the doctor for examination
of the spleen and the diagnosis of its pathology, a number of diagnostic procedures are performed, which include both
instrumental and laboratory research methods.

What tests should be done if the spleen hurts?

There is a range of laboratory tests that should be done if a pathology of this disease is suspected.
lymphoid organ, as well as for the diagnosis of other pathologies that could lead to an increase in size and
the appearance of pain. These include:

1. Complete blood count

Complete blood count is extremely important in the diagnosis of spleen pathologies, since functional activity
body is directly related to the production, destruction and deposition of the main blood cells. IN
erythrocytes, platelets, leukocytes of all fractions, hemoglobin, also
evaluate the erythrocyte sedimentation rate (ESR). It is mandatory to study the expanded leukocyte formula
with the determination of the number of both mature cells and blasts. Enlargement of the spleen and, accordingly, characteristic
symptoms in the form of pain and compression of neighboring organs can be observed in malignant blood diseases,
such as myelo- and lymphocytic leukemias. In their diagnosis, the primary role is played by the general analysis with the definition
all types of cells and their ratio. In addition, if an inflammatory process is suspected, which could lead to
are changes in the spleen area, in the general analysis, an increase in leukocytes with a shift to the left (that is,
with an increase in the number of immature forms) and the acceleration of ESR. Also, the analysis allows to suspect hemolytic
anemia, which is characterized by a decrease in the content of red blood cells, hemoglobin and an increase in the number of young
erythrocytes – reticulocytes.

If hemolytic anemia is suspected, a peripheral blood smear on a slide with
subsequent study of the composition and shape of cells under a microscope.

2. Biochemical blood test

the main processes occurring in the body, and the functional activity of a particular organ system. Changes
spleens can be observed, for example, with venous blood stasis due to problems with the liver. for liver disease and
destruction of hepatocytes may indicate increased levels of liver enzymes – AST, ALT, gamma-GT, alkaline
phosphatase in blood plasma, a decrease in the amount of protein. In addition, elevated levels of total and direct bilirubin
can also characterize liver disease.

Hemolytic
anemia, in which untimely (early 120 days after formation) active destruction occurs
blood erythrocytes. There are many reasons for hemolytic anemia. Destruction does not always occur in the spleen,
intravascular hemolysis is also possible, in which the spleen is not involved in the process and remains normal
size to fulfill its function. In this case, any hemolysis is accompanied by an increase in the amount in the blood plasma
total bilirubin due to the fraction of indirect, and in the case of intravascular hemolysis in the blood also increases
hemoglobin level, which is not typical for extravascular (intracellular).

The level of the enzyme lactate dehydrogenase (LDH) is important to assess. Its rise is not specific,
however, in combination with other markers, it may indicate any pathology. The enzyme is represented by 5
isoforms, among which LDH2 can increase in pathologies of the lymph nodes and spleen. Enzyme Growth
observed in tumor processes, including blood diseases, with viral lesions of the spleen and
lymph nodes, pathologies of other organs.

In addition to the above blood parameters, other components are subject to examination:

• glucose, an increase in the concentration of which makes it possible to suspect diabetes mellitus;
• metabolic products excreted by the kidneys – creatinine and urea, characterizing the work of the urinary
  systems;
• uric acid rising in gout;
• electrolytes – sodium, potassium, chlorine;
• and others if necessary.

Blood tests for viral and bacterial infections

Changes in the spleen can cause many infectious diseases. A sharp increase in its size can
occur when infected with the Epstein-Barr virus, belonging to the herpesvirus family (type 4) and causing
Infectious mononucleosis. Cytomegalovirus infection, viral hepatitis B can have an effect on the spleen
and C, in which in the later stages often there is a stagnation of blood in the organ. In addition, changes in the spleen
can be observed with brucellosis, abdominal tuberculosis, parasitic infections, for example, echinococcosis, with
in which the formation of a cyst in the organ is possible, with malaria, etc. The formation of abscesses of the spleen is possible with
serious infectious and inflammatory processes.

PCR is performed to identify the causative agent of the infection that allegedly caused changes in the lymphoid organ
diagnosis and serological testing.

Polymerase chain reaction (PCR) is a high-tech method based on the detection
the genetic material (DNA or RNA) of a pathogen in body fluids. The serological method is based
on the assessment of the number of antibodies (immunoglobulins) of various classes to a specific antigen. Height
class M immunoglobulins indicates an acute process, class G immunoglobulins are produced after 2-4 weeks
after infection and can persist for a long time in the blood.

Immunological examination

An immunogram is prescribed by a doctor in cases where there is a suspicion of a decrease in cellular and humoral
immunity: with autoimmune diseases, frequent viral and bacterial infections, as well as with oncological
diseases – lymphocytic leukemia, lymphomas. Assess the total number of lymphocytes, their individual subpopulations,
immunoglobulins of different classes, the level of circulating immune complexes. Changes can be seen with
diseases of the spleen with a decrease in its functional activity. However, the analysis does not indicate the cause
organ damage.

If necessary, the doctor may order other laboratory tests, such as general and biochemical
urine tests, blood tests to evaluate the coagulation system, and others.

Diagnosis of diseases of the spleen by blood tests is almost impossible, but they allow one to suspect
what are the functional and morphological changes of the organ associated with. The most common pathology of the spleen itself
are tumor processes that are diagnosed primarily by instrumental methods – ultrasound, CT and
MRI. An ultrasound examination can reveal a violation of blood flow in the organ and the large vessels that feed it,
changes in the parenchyma, the presence of formations – cysts, nodes, hemangiomas, etc., congenital anomalies can be detected
(for example, an additional lobule), the size of the organ is also estimated.

In case of surgical treatment and removal of the organ, its further histological examination is possible
in order to accurately verify the nature of education. The sampling of material for research is also possible with
aspiration biopsy.

Do not forget that changes in the spleen – pain, enlargement, etc. can be the cause of another
pathology, and not directly the disease of this parenchymal organ. Diagnose pathology and prescribe
its treatment can only be a medical specialist. Do not attempt to interpret lab results yourself.
research. Only the attending physician can correctly interpret the result, based on clinical
manifestations, results of laboratory tests and conclusions of instrumental diagnostic methods.

You can take tests to check the spleen at the DCLI laboratory in Moscow. We will gladly answer all your questions.
regarding laboratory research. Be healthy!

Neoplasms of the spleen – causes, symptoms of the disease, diagnosis and methods of treatment

Hepatitis

Lymphoma

Hemangioma

Sarcoma

Teratoma

Lipoma

Cyst

9508

November 18th

Neoplasms of the spleen: causes, symptoms, diagnosis and treatment.

The spleen is an unpaired organ, mainly consisting of lymphoid tissue, responsible in the human body for hematopoiesis, immunity and blood supply. Neoplasms of the spleen are focal growths of morphologically altered tumor tissue in the parenchyma of the spleen.

The most common pathology of the spleen are cysts – cavities filled with fluid and separated from the surrounding tissues by a capsule. Benign tumors of the spleen include hemangiomas (tumors of vascular origin), lymphangiomas, lymphomas (tumors of lymphoid tissue), endotheliomas, hamartomas, fibromas.

Systematization of tumors of the spleen is carried out taking into account their morphological structure, the degree of aggressiveness, the location of the main focus. With the development of a tumor from the lienal tissues (spleen tissues), the absence of a systemic lesion of lymphoid formations and bone marrow, they speak of primary splenic neoplasms. Primary tumor lesions of the organ in most cases are detected in women at a young and middle age. The prevalence of primary tumors in the population is very low and does not exceed 0.003%. The mass of tumor tissue ranges from 20 g to 5 kg.

Secondary processes are more common, specific changes in the parenchyma of the organ are determined in 90% of patients with Hodgkin’s lymphoma, up to 10% of malignant tumors can metastasize to the spleen. Secondary tumors are the result of diseases of other organs and systems, including blood diseases, immune pathologies, tumors, systemic diseases or damage (injury) to the spleen. These include: spleen infarction, torsion of the spleen pedicle, spleen abscess, splenic rupture, spleen cyst, benign and malignant tumors of the spleen.

Causes of tumors of the spleen

Causes of primary tumor transformation of spleen tissues have not been finally established. In secondary neoplasms, the process is provoked by a systemic lesion of the lymphoid tissue or metastatic spread of cells. There is no exact evidence confirming the hereditary nature of neoplasia. According to experts, the possible etiological factors of primary and secondary splenic neoplasms are:

Impact of damaging factors . Pathological proliferation of spleen tissues can occur under the influence of ionizing radiation, infectious agents, viruses with oncogenic effects. In addition, the development of neoplasia is sometimes associated with the influence of polyaromatic hydrocarbons and nicotine, which have carcinogenic potential. Sometimes the disease occurs against the background of ischemia or direct damage to the parenchyma of the spleen in trauma, as well as due to parasitic damage to the organ.

Presence of extrasplenic tumors . Secondary tumor change is characteristic of malignant lymphoproliferative processes – lymphogranulomatosis, reticulosarcoma, lymphocytic leukemia. In some cases, damage to the spleen is the only manifestation of these cancers. Metastases to the spleen are rare.

Classification of diseases

The existing classifications of spleen cysts are a modification of R. Fowle’s classification (1940), which gives an idea of ​​the diversity of the origin of splenic cysts:

The most complete classification of tumors of the spleen was presented by L. Morgenstern in 1985:

I. Tumor-like changes:

a) non-parasitic cyst,
b) hamartoma.

II. Vascular tumors:

a) benign:

• hemangioma,
• lymphangioma,
• hemangioendothelioma,
• hemangiopericytoma;

c) malignant:

• hemangiosarcoma,
• lymphangiosarcoma,
• hemangioendothelial sarcoma,
• malignant hemangiopericytoma.

III. Lymphoid tumors:

a) Hodgkin’s disease,
b) non-Hodgkin’s lymphoma,
c) plasmacytoma,
d) lymph-like diseases:

• macrofollicular pseudolymph (Castleman tumor),
• localized reactive lymphoid hyperplasia,
• inflammatory pseudotumor.

IV. Non-lymphoid tumors:

a) lipoma, angiolipoma, myelolipoma,
b) malignant fibrous histiocytoma,
c) fibrosarcoma,
d) leiomyosarcoma,
e) malignant teratoma,
e) Kaposi’s sarcoma.

Symptoms of neoplasms of the spleen

With small tumors, the disease is asymptomatic for a long time with minimal clinical manifestations. The patient has a syndrome of “small signs”: fatigue, weakness, deterioration in performance, loss of appetite, depression, weight loss. As the tumor progresses (up to the rupture of the spleen), the patient begins to experience constant pain, heaviness in the left hypochondrium, a feeling of fullness, asymmetry and enlargement of the abdomen, prolonged subfebrile temperature, pain in the left abdominal cavity. Sometimes the pain radiates to the left shoulder girdle and shoulder. With a significant increase in the size of the spleen and involvement of neighboring organs in the process, urination disorders, arterial hypertension that is not amenable to drug therapy, and edema of the lower extremities can be observed.

Diagnosis of neoplasms of the spleen

Diagnosis of tumors of the spleen in most cases is difficult due to poor clinical symptoms of this disease. Neoplasms are most often discovered by chance during preventive examinations. The examination plan for a patient with suspected splenic tumor includes the following instrumental and laboratory methods:

• Ultrasound examination of the abdominal organs allows visualizing the structure of the parenchyma, assessing the size and topography of the organ. Sometimes ultrasound dopplerography of the spleen is additionally prescribed, according to the results of which it is possible to judge the blood supply to suspicious nodes, the blood flow velocity in the splenic arteries, veins.
• Computed tomography of the abdominal cavity with bolus intravenous contrast agent helps to distinguish the unchanged parenchyma from tumor foci that do not accumulate contrast. Computed tomography is highly informative and provides detection of tumors in 95% of cases.

Contrast injection

The contrast agent is administered intravenously.

RUB 4,590

Sign up

Celiacography, in which the introduction of contrast with the performance of a series of x-rays allows you to assess the condition of the arteries of the abdominal organs. In the presence of tumors on the radiograph, an avascular area or newly formed vessels in the area of ​​the projection of the spleen, a pronounced displacement of large arteries and veins are found.

Histological examination of biopsy material and material obtained during surgical interventions (endoscopic material; tissues of the female reproductive system; skin, soft tissues; hematopoietic and lymphoid tissue; bone and cartilage tissue)

Taking biomaterial is paid separately.

According to the requirements of clause 17 of the Rules for conducting pathological and anatomical studies, approved. Order of the Ministry of Health Ro. ..

Up to 9working days

Available with home visit

2 880 RUB

Add to cart

Which doctors to contact

Spleen tumors are diagnosed and treated by general practitioners,
oncologists,
surgeons,
doctors of ultrasound diagnostics, doctors of radiation diagnostics.

Treatment of tumors of the spleen

If there are no serious contraindications for surgery, the tumor of the spleen is removed by surgery. When choosing a surgical approach, the morphological structure of neoplasia, its size, location, and relationship with surrounding organs are taken into account.

If the tumor of the spleen is of a secondary nature and has arisen against the background of any oncological process in other organs and tissues, the treatment of the underlying disease will also be required. The volume of the operation and the method of surgical intervention depend on the size, location (central, peripheral), on the severity of the patient’s condition due to concomitant therapeutic pathology. For the treatment of tumors, organ resection, splenectomy are performed; in case of malignant lesions in the postoperative period, chemotherapy is performed.

Recommended interventions are:

• Resection of the spleen. Organ-preserving operations are performed only to remove small benign tumors.
• Splenectomy. Removal of the spleen is necessary for massive benign neoplasia that affected most of the pulp, malignant processes. A less traumatic laparoscopic method of operation is preferred. Patients with malignant tumors after surgery are prescribed chemotherapy.
• Treatment of tumors that have arisen as part of lymphoproliferative processes or metastatic lesions of the spleen is carried out according to relevant medical protocols and involves the appointment of radiation, targeted, chemotherapy.
• The question of removal of the spleen in each case is decided individually, in some patients splenectomy has a positive effect on the course of the underlying disease.

Complications

When tumors grow in the body, a number of biochemical parameters change. The accumulation of products of nitrogen metabolism can cause renal failure, the combination of hypocalcemia and hypokalemia provokes a slowing of the heart rate up to asystole. The most severe complication of spleen tumors is the spread of malignant cells by lymphogenous, hematogenous, contact routes with the formation of metastases in other organs. Often, with malignant neoplasia, hemorrhagic pleurisy, ascites, cachexia (extreme exhaustion of the body) are observed. The disease can be complicated by rupture of the spleen with profuse internal bleeding, life-threatening patient and requiring urgent surgical care.

Prevention of neoplasms of the spleen

Methods of specific prevention have not yet been developed, but when the first symptoms appear, you should consult a specialist. In benign processes, removal of the tumor usually allows a complete cure of the patient. Timely diagnosis and adequate combined treatment of malignant neoplasms of the spleen in the early stages significantly increases the favorable prognosis and chances of recovery.

Some studies have found an association between chronic hepatitis C and B-cell non-Hodgkin’s lymphoma. Taking steps to prevent hepatitis C can help patients reduce their risk of the disease.

Sources:

1. Abdominal surgery: A practical guide in two volumes / Grigoryan R.A. – 2006.
2. Surgical diseases / edited by Kuzin M.I. – 2002.
3. Puchkov K.V., Puchkov D.K. Results of laparoscopic operations on the spleen // VI Congress of Moscow surgeons “Emergency and specialized surgical care”. Congress materials. June 10–11, 2015 Moscow. – M .: Publishing house “Alt Consul”. – 2015. – S. 74–75.
4. Minutes of the joint meeting of the Abdominal Radiology Section of the Moscow Society of Medical Radiologists and the Section of Radiation Diagnostics in Pediatrics dated December 21, 2011. Radiological diagnosis of focal lesions of the spleen. Yu.A. Stepanova, G.G. Karmazanovsky, D.A. Ionkin, A.B. Shurakova, A.I. Shchegolev, E.A. Dubova. FSBI “Institute of Surgery named after A.I. A.V. Vishnevsky. Ministry of Health and Social Development of Russia, Moscow.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Recommendations

• Ovarian dysfunction

  7077

  June 20

• Sciatic neuralgia

  7198

  June 20

• Endophthalmitis

  7062

  June 19

Show more

Syphilis

Fungus

Hepatitis

Herpes

Glomerulonephritis

Glomerulonephritis: causes, symptoms, diagnosis and treatment.

More

Diarrhea

Jaundice

Hepatitis

Liver cancer

Liver cancer: causes, symptoms, diagnosis and treatment.

More

Allergy

Nasal injury

Sinusitis

Mucocele

Mucocele is a benign cyst-like distension of the paranasal sinuses, leading to the accumulation of mucus in the paranasal sinuses and deformity of the bones structures.

More

Hemorrhage

Bleeding

Ovarian infarction

Ovarian rupture

Hematoma

Ovarian apoplexy

Apoplexy is a sudden hemorrhage in the ovary, accompanied by a violation of the integrity of its tissue and bleeding into the abdominal cavity.

More

Lymphogranulomatosis

Lymphoma

Granuloma

Profuse sweating

Fever

Intoxication

Hodgkin’s disease (Hodgkin’s lymphoma)

Hodgkin’s disease: causes, symptoms, diagnosis and treatment.