Splenic cyst is a rare condition, but if it occurs, it can trouble a lot. So, let us learn about all the symptoms, types, diagnosis and treatment of Splenic cyst in this article.
Structure and Functions of spleen:
Spleen is a body part or organ in the upper left part of the abdomen. The spleen is a small organ and is usually only 4 inches in size. Spleen is guarded by ribs and is located just above the stomach.
Image source: webmd.com
A normal spleen is soft and purple. Spleen consists of two different types of tissues, red tissues which filters the impure blood and removes damaged RBCs and the white pulp tissues which help in developing the immunity.
Spleen performs multiple roles in the body like filtering the blood, controlling the RBC count in the body and acting as a storage house for platelets and white blood cells. Spleen also helps to fight specific bacteria that induce pneumonia and meningitis. (1)
Splenic Cysts, Spleens that have cystic lesions on them cause a lot of disorders in the body affecting many natural processes.
The splenic cyst is a sporadic disorder, and there are only 800 cases of splenic cysts diagnosed worldwide. The traditional approach of treatment includes removal of the spleen, but since the critical functions spleen performs in the body are known now, better techniques of therapy have been developed.
Types of Splenic cysts based on causes:
There are various types of splenic cysts depending on the sizes, location as well as the features like metastasis. Some of the types of cysts citing the causes of the splenic cysts include: (2)
- Primary or true cysts (which are mostly present under the skin)
- Pseudocysts (these are the cysts which are serum like or which rupture the blood vessels)
- Vascular cysts (which are formed after the death of tissues)
- Cystic neoplasms (which are formed due to lymph cancer or metastatic cancer of other organs)
Most of the splenic cysts don’t show any symptoms and usually don’t cause any harm to the normal functioning of the body. The cysts are typically diagnosed incidentally using radio imaging techniques. Now as there are good progress and development in the radiological methods and procedures, the diagnosis of splenic cysts has increased drastically.
The symptoms and signs of Splenic Cyst include:
- Pain in the abdomen
- Spleen swelling
- Compression of surrounding organs
- Nausea
- Vomiting
- Diarrhoea
- Effect on the cardiorespiratory system includes pain, shortness of breath and coughing.
Classification of Splenic Cysts:
Martin discovered the various types of splenic cysts. These include:
Primary cysts:
These are characterised by splenic cysts having an outer epithelial layer of tissues. These splenic cysts can be parasitic or non-parasitic. Primary splenic cysts are further classified into various subtypes which include:
Congenital:
Congenital splenic cysts comprise of 1/4th of the Primary splenic cysts, and their occurrence is more common in case of a younger generation. These cysts, in general, don’t show any physical signs and have better chances of getting cured.
Dermoid cysts:
These are found in outer skin lining like hairs, sebaceous glands, sweat glands etc.
Pseudocysts:
These are without epithelial lining and are much smaller than the real splenic cysts. There is blood and debris present inside these. They are a dense mass of fibrous tissues which are hardened and don’t have an outer lining.
Vascular Cysts:
Peliosis: It is a disease which is characterised by many cysts which contain blood and are present near the functional tissues. This disease usually affects the liver or other major organs. Although the disease is asymptomatic, it is often characterised by destruction of the body tissues and organs.
So in case, peliosis is found anyone organ, it should be checked in nearby tissues as well. Some of the toxins and drugs have been found to be the causative agents of Peliosis
Cystic Neoplasms:
They are further of three types:
Lymph node cancer: Splenic lymph cancer constitutes a small part of lymph cancer
Hemangiomas: This type of splenic cysts occur in the blood
Lymphangiomas: These type of splenic cysts are found in the lymph and lymph nodes
Metastases:
Splenic metastasis of the cysts occurs in the last stage. Tumours spreading out from the other body parts may spread to the spleen.
Diagnosis of the Splenic Cysts includes:
Imaging test: It is challenging to distinguish between the structure and their size using the various techniques available.
A plain radiograph can indicate the presence of solid mass or a calcified substance in the upper left part of the abdomen.
Further, Ultrasound can help in characterising solid and cystic lesions. Ultrasound shows splenic cysts a solid substance. Separations, irregular walls or formations of the cysts can be seen in an ultrasound. It is essential to recognize calcification as it helps in differentiating it from other different spleen disorders
CT scan further helps in better diagnosis of the cystic lesions. It shows the cysts in greater detail aiding in the better diagnosis of the cyst. Tomography is another technique used for diagnosis and is more sensitive than ultrasound and in the identification of partitions within cysts.
MRI is also performed on some patients for diagnosis. However, angiography has been found as the best technique to differentiate cysts into avascular and a solid malignant mass.
A study was performed to see if the size of the splenic Cyst affects the management of non- parasitic cysts. The study was conducted on 115 patients who were having splenic cysts which were asymptomatic. The cysts were also observed for various treatment options which include percutaneous drainage, aspiration and resection etc.
It was observed that asymptomatic splenic cysts are safe irrespective of the size of the cysts. They were found to have high recurrence rate even after percutaneous drainage. It was concluded that these cysts are entirely safe and aspiration technique should be explicitly used where the patients are not ready for surgeries. (3)
Treatment of splenic Cysts:
Splenic cysts which don’t show any symptoms or are smaller in size don’t require any treatment. So the treatment is done only for the cysts which are large. The treatment of Splenic Cyst includes removal of the Spleen from the body.
Laparotomy which is making a big incision in the abdomen of the person and getting access to the stomach is used along with splenectomy which involves removal of spleen and is used for the treatment. There are high post-operative risks; As a result, surgery is done when the size of splenic cyst is large. Especially high care is required for children and young adults.
These days conservative treatment options are used more which includes percutaneous aspiration.This treatment involves making a thin cut using a needle, catheter etc. and letting the fluid out of the sac. Sclerosis of the cyst is also done as one of the treatment options. But usually, this is done for smaller cysts and not for the more prominent Splenic Cysts.
Treatment of the splenic cyst involves techniques like the removal of epithelial lining, Removal of some part of the spleen and the cyst around and the complete removal of the spleen. Partial splenectomy includes preserving of at least 1/4th of the tissue and also avoiding any chance of recurrence.
The partial splenectomy is used in cases where the cyst is located on the outer periphery, and the cyst can be easily removed from the spleen. The incision and the hemostasis, in this case, are done using cautery and monopolar scissors.
The most advanced technique is ‘cystotomy’ which is currently under research, this includes even lesser lesions; the method is under study and might be the future treatment option.
It is essential to remove the affected part of the spleen to avoid any chances of regrowth.
All the treatments include a minor or a major operation which involves the risk of bleeding, rupture of any nearby organ or an infection to the adjacent body parts.
In one of the study, the analysis was done on 16 patients diagnosed with splenic cysts. The treatment options were validated in this. The research showed that open splenectomy whether partial or complete is a better choice of treatment. It was also proven that surgical treatment is a better option for treatment of symptomatic cysts rather than the use of medical treatment. It was also found that patients also don’t need to have any follow up after surgery (4)
Splenic cysts which are larger than five cms and have symptoms associated with them need to be treated surgically. The surgery could involve partial removal of the spleen or complete removal of the spleen.
The choice would depend on the size of the splenic cyst and the location of the splenic cyst. Usually, Partial splenectomy using a laparoscope is a preferred choice. Partial splenectomy also has an advantage of being a minimally invasive surgery which would help in faster and smooth recovery for the patient.
In case of complete spleen removal, it is essential to have vaccinations done against certain bacteria which include H. influenza and S Pneumonia as the removal of spleen increases body’s vulnerability towards these diseases. (5)
References:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699073/
- http://www.scielo.br/scielo.php?pid=S0100-69912010000600011&script=sci_arttext&tlng=en
- https://link.springer.com/article/10.1007/s11605-014-2545-x
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062182/
- https://www.webmd.com/digestive-disorders/picture-of-the-spleen#2
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