Editing Splenic solid lesions


== '''Benign''' ==

* '''Inflammatory'''
** '''Sarcoidosis'''
* '''Congenital'''
** '''Lymphangioma'''
*** Rare, benign, slow-growing
*** Mainly seen in childhood
*** Endothelium-lined cysts
*** Present as splenomegaly secondary to cyst enlargement
*** Lymphangiosarcoma can be found within the lesion
*** Splenectomy appropriate
** '''Primary cyst'''
* '''Acquired'''
** '''False cyst'''
** '''Infarction'''
* '''Vascular'''
** '''Haemangioma'''
*** Most common
*** Usually incidental
*** Usually solitary
*** Mostly <2cm (larger lesions associated with rupture)
*** Can be classified as either cavernous haemagioma or capillary haemangioma
** '''Hamartoma'''
*** Malformed splenic red pulp elements without organised lymphoid follicles
*** Usually <3cm
*** Spontaneous rupture has been described, but mostly not
*** Frequently splenectomy is necessary for a definitive diagnosis
** '''Littoral cell angioma'''
*** Multiple nodular masses leading to splenomegaly and hypersplenism
*** Usually seen as multiple masses of varying sizes that isodense on noncon CT, hypodense on early portal phase, isodense an delayed phase
** '''Sclerosing angiomatous nodular transformation (SANT)'''
* '''Infectious'''
** '''Pyogenic abscess'''
** '''Fungal abscess'''
** '''Tuberculosis'''
** '''Hydatid cyst'''

== '''Malignant''' ==

* '''Lymphoma'''
** See section on 'splenectomy for haematologic diseases'
* '''Angiosarcoma'''
** Highly aggressive, poor prognosis
** Splenomegaly is common, and spontaneous rupture occurs in up to 25%
** Liver mets commonly found at presentation
** Can also present with haemolytic anaemia, ascites, or pleural effusions
** Linked with environmental exposures - thorium dioxide and monomeric vinyl chloride
* '''Haemangiopericytoma'''
* '''Splenic metastasis'''
** Most commonly '''melanoma, breast, lung'''
** Can also see '''ovarian''', and rarely '''pancreatic, colon, stomach'''
** Radiological appearance variable
** Can see implants in serosal surface in '''peritoneal carcinomatosis'''
** Splenectomy can provide palliation of splenomegaly symptoms and prevent rupture, for carefully-chosen patients
** (relatively uncommon, maybe because of a lack of afferent lymphatics, but are found in up to 7% of cancer patients at autopsy)

== '''Indeterminate''' ==

* '''Inflammatory pseudotumour (inflammatory myofibroblastic tumour)'''
** Uncertain aetiology
** Mainly incidental
** Spindle cell proliferation admixed with abundant inflammatory cells
** Most cases >10cm in diameter
** CT: hypodense mass with delayed enhancement, with a central scar without enhancement
** Final diagnosis usually made after splenectomy

[[Category:Spleen]]