Analysis of Patients Undergoing Splenectomy for Spleen Masses

Aims: Spleen masses, which are discovered on imaging studies, usually create difficulty in diagnosis and treatment. Except for lymphomas involving the spleen, primary and secondary neoplasms are rare and discovered by chance. This study analyses a series of splenectomies in a surgical clinic to evaluate the management of incidentally diagnosed splenic masses.

Study Design: This retrospective study included patients operated for spleen masses between 2010 and 2021. Patients with a history of lymphoproliferative disease and splenectomy performed as part of a larger resection were excluded.

Methodology: The patients were divided into three groups, i.e. cystic, benign and malignant, based on the results of pathological examinations. The groups were compared in terms of age, gender, tumor size, and previous history of malignancy.

Results: Splenectomy was performed in 512 patients in 11 years, 62 of whom had solid and cystic lesions detected on imaging. Thirty-five patients (56,5%) were female and the median age was 40 years (range: 18-80 years). Forty-four patients (71%) had distinct symptoms. Radiological evaluations of all the patients were made. Diagnostic biopsy could not be performed in any of the patients. The final pathological examination showed cysts in 38 patients (61,3%), benign lesions in nine patients (14,5%) and malignant lesions in 15 patients (24,2%). Out of 15 patients with malignant lesions, one patient had Hodgkin’s lymphoma, four patients had diffuse large B cell lymphoma and ten patients had metastatic tumors. There was a significant difference in age between the groups and the malignant group was older (p = 0.017). The size of the lesions also significantly differed and the malignant lesions had a significantly smaller diameter (p = 0.014). A significantly higher rate of the malignant group had a previous history of cancer (p˂0,001).

Conclusion: Spleen neoplasms are masses that are difficult to diagnose. Most of them are asymptomatic and are found after splenectomies by coincidence. Splenectomy can be utilized as both a diagnostic and curative method. It should be kept in mind that the lesions detected in the spleen in patients with a history of malignancy can be metastatic.