Spleen cyst in a child and adult

Splenic cyst is a term that unites a number of pathologies, which are characterized by a common symptom - the presence of a cystic formation in the organ parenchyma.

Such a diagnosis is always quite serious and requires immediate medical intervention. The fact is that the spleen plays a major role in the human immune system. Therefore, any problems with this organ must be resolved immediately, without waiting for the pathology to worsen. [ 1 ]

Epidemiology

Splenic cyst is a collective term that means several pathological variations at once with the formation of fluid cavities in the splenic parenchyma. Such a disease is diagnosed in approximately 1% of all inhabitants of the planet, and mainly during preventive examinations (due to the latent clinical picture).

Most often, non-parasitic lesions are detected, which make up 60-70% of all splenic cysts. [ 2 ] Among parasitic lesions, echinococcosis is the leader: it is detected in 60% of cases. [ 3 ]

Approximately 2% of patients report absolutely no symptoms. In 70-80% of cases, there are complaints of periodic abdominal pain, which is sometimes not given much importance. [ 4 ]

Both men and women are equally susceptible to the disease, although according to some data, women are slightly more likely to get sick. The pathology is found in almost all countries of the world. The average age of those affected is 35-55 years. [ 5 ]

Causes splenic cysts

The spleen is an unpaired organ responsible for hematopoiesis, immune defense, and blood supply in the human body. The organ has a flattened oval shape and consists mainly of lymphoid tissue.

The majority of spleen pathologies are secondary diseases that result from disorders in other organs and systems, or from external influences. That is, the causes may be blood diseases, immune pathologies, tumor processes, systemic disorders or traumatic injuries. [ 6 ] Often, the primary source of problems are heart attacks, abscesses, traumatic ruptures, circulatory disorders, as well as:

• abnormal embryonic development of the fetus (formation of cavities);
• closed and open abdominal injuries, surgical interventions;
• acute inflammatory processes caused by severe infections;
• parasitic pathologies. [ 7 ]

After a puncture during a purulent inflammatory process, or after a spleen infarction, the probability of cavities forming in pathologically altered tissues increases, in which walls gradually form, and the resulting capsule is filled with serous contents. A cavity element is also formed after severe bruises and wounds, surgical operations on the abdominal cavity, as well as when parasites and their larvae penetrate the human body.

Risk factors

Risk groups include:

• people living in regions where echinococcosis is naturally found, or simply in rural areas;
• persons who regularly come into contact with farm animals, dogs (yard, domestic, service, hunting, etc.);
• persons in contact with raw meat and fish, with raw internal organs of animals;
• representatives of hazardous professions or athletes;
• people who regularly eat unwashed berries, greens, fruits, raw fish or meat;
• workers in livestock farms, meat processing plants, slaughterhouses or animal disposal facilities;
• veterinarians, fur processing workers, fur farms, zoos, skin processing workers, etc.;
• patients who underwent surgery on abdominal organs.

Pathogenesis

Despite the fact that a spleen cyst is a well-studied disease, specialists cannot clearly answer the question about the cause of the formation of the neoplasm. It is quite possible that the congenital features of the organ play a certain role.

Spleen cysts are conventionally divided into two large categories: true and false neoplasms. This classification was approved back in 1924, that is, almost a hundred years ago. It is generally accepted that a true cyst is congenital, and a false cyst is acquired. [ 8 ]

From the specified classification it becomes clear that congenital pathology occurs, like any developmental defect, during the period of organ formation in the fetus in the mother's womb. To be more precise, the disorder occurs at the time of formation of the vascular bed that feeds the spleen. Most likely, a cyst in the spleen of the fetus is caused by genetic reasons. It also happens that atypical splenic tissues migrate into the structure of the organ and over time provoke cystic formation. [ 9 ]

Acquired pathologies in most cases are represented by traumatic consequences, but many doctors distinguish parasitic diseases into a special, separate category. At the same time, many diagnosed cysts are recognized as idiopathic - that is, specialists cannot determine exactly what factor caused the problem: whether it was external influences or changes within organs and systems.

Symptoms splenic cysts

The clinical picture may vary in intensity, depending on the location of the neoplasm, its size and the degree of compression of other organs and tissues. If the spleen cyst is not large (up to 20 mm), then symptoms are often absent. The first signs appear when an inflammatory process develops, or when compression of nearby structures occurs.

As inflammation develops, patients note:

• feeling of weakness, dizziness, sometimes nausea;
• periodic aching, dull pain syndrome from the left hypochondrium.

Gradually, the pain intensifies, and the digestive process may be disrupted. In the spleen area, a feeling of heaviness and discomfort increases, breathing becomes difficult, and a dry cough appears. Shortness of breath and a feeling of discomfort in the chest may occur during a deep breath. Some patients experience pain radiating to the left collarbone, shoulder, and shoulder blade, with an increase after eating.

For multiple cysts or for a neoplasm with large dimensions, disorders of the abdominal cavity organs are characteristic. In particular, digestion is disrupted, problems with the stomach appear, nausea and belching are often a concern.

The addition of a purulent-inflammatory process makes itself known by an increase in body temperature, chills, and general discomfort. [ 10 ]

Cyst in the spleen in an adult

A spleen cyst is a slowly progressing pathology: acute course is almost uncharacteristic for it. That is why in adulthood, both acquired and congenital formations can be detected, the presence of which a person had not previously assumed. Doctors point out that the problem in most cases becomes an "accidental finding", especially when it comes to small neoplasms.

Large, voluminous cavities are much easier to detect, since they reveal themselves clinically, causing a violation of organ function, displacing the spleen itself or nearby organs. In such a situation, the large will voice complaints of discomfort, heaviness in the hypochondrium on the left. However, there are many cases when even large pathological elements are not accompanied by any significant symptoms. Such pathology is diagnosed using ultrasound scanning of the abdominal cavity. After confirming the disease, the patient may be additionally referred for computed tomography with the introduction of a contrast agent, or for magnetic resonance imaging. Such diagnostic procedures help to determine the localization of the object, find out the size, relation to the splenic pedicle, where the vessels pass. It is important for the doctor to evaluate this information, since the need for surgical intervention and the features of its implementation depend on it. Magnetic resonance imaging allows you to understand whether we are talking about a parasitic invasion: during the procedure, the secondary and internal membrane, or the parasite itself, are well visualized. In addition, it is very important to conduct differential diagnostics of the element with a malignant tumor and assess the growth dynamics.

Spleen cyst and pregnancy

During a screening ultrasound examination of pregnant women, diseases of other organs are often detected that can affect the course and outcome of the gestation process, or even become an indication for termination of pregnancy. If a cyst is detected during an examination, the doctors' further actions depend on an assessment of the likelihood of complications, such as:

• rupture of the cystic capsule;
• intracystic hemorrhage;
• organ rupture, etc.

The following procedures are mandatory for women:

• ultrasound;
• fetometry;
• Doppler ultrasound of uteroplacental and fetoplacental blood flow.

The methods of choice for treating diseases of the abdominal cavity, pelvic organs and retroperitoneal space in women during pregnancy are minimally invasive interventions under ultrasound control. In case of large neoplasms, cystic drainage with ultrasound control according to Seldinger is performed, with aspiration of the contents and its subsequent cytological analysis.

Cyst in the spleen of a child

In children, a spleen cyst can develop at completely different age stages: from the first few years of life to adolescence.

What triggers the appearance of cysts in children? Often, the "culprits" are past illnesses - in particular, viral pathologies, infectious mononucleosis, and injuries. A considerable percentage of spleen cysts are congenital diseases.

Such neoplasms are not always an indication for surgical intervention. Treatment tactics depend on the size of the cyst, on the existing complaints and symptoms. Currently, operations in childhood are performed using laparoscopic techniques, which allow for high-quality removal, ease of the postoperative period and accelerate rehabilitation. [ 11 ]

For children, it is especially important to preserve the spleen, which ensures the immune status of the growing organism. Therefore, whenever possible, doctors select the most gentle treatment.

Cyst in the spleen of a newborn

Most often, spleen cysts in the neonatal period are detected accidentally - for example, during a preventive ultrasound examination. There are usually no external manifestations of pathology, surgical removal is not resorted to, choosing a wait-and-see tactic: surgery is prescribed only for large neoplasms, when there is a threat of improper functioning of the organ and nearby structures.

The spleen is responsible for immune protection, forming and maintaining it in the child. At the moment, it is already known that it is in this organ that antibodies are formed to various pathogenic microorganisms that enter the bloodstream. In addition, the spleen takes part in the hematopoietic process and the synthesis of a specific protein substance - a peptide that damages bacterial cells.

To avoid complications, surgeons must do everything possible to preserve the organ. Splenectomy is performed only if there are compelling indications, and then only at a more mature age.

Forms

There are three main variants of spleen cyst development: parasitic, true and false. A false spleen cyst is formed as a result of a specific reaction of the spleen tissues to an inflammatory reaction caused by injuries, acute circulatory disorders in the organ.

True and false neoplasms are non-parasitic pathologies, that is, those whose development is not provoked by the invasion of parasites into the body. [ 12 ]

Parasitic cyst of the spleen is most often represented by echinococcosis, cysticercosis, less often - alveococcosis. Parasites penetrate the organ with blood - hematogenous route. Lymphatic penetration is also possible, but extremely rare. The development of echinococcosis is usually slow, gradual, occurring for several years without any special symptoms. Over time, the spleen greatly increases in size, displacing nearby organs, while the splenic parenchyma atrophies. The appearance of other pathological signs is associated with the reaction of other organs to cystic growth.

Echinococcal cyst of the spleen is most often found in people involved in agriculture and veterinary medicine. At the same time, echinococcus can affect not only the spleen, but also the liver, lungs, and brain.

A less common parasite that causes a similar pathology is the blood fluke of the genus Schistosoma, the causative agent of schistosomiasis.

Schistosomiasis splenic cyst is characterized by dermatitis (when parasites enter the skin), fever, intoxication, splenomegaly, eosinophilia, intestinal and urogenital system damage. Symptoms of the disease are associated mainly with the immune-allergic reaction of the body to the parasitic invasion.

Non-parasitic splenic cysts occur less frequently than parasitic ones. True formations have connective tissue walls, with an internal lining of endothelium or epithelium. A false neoplasm lacks such a lining and is represented only by a connective tissue wall. However, such a distinctive feature is quite conditional, since under certain conditions the endothelial lining is prone to atrophy.

A congenital splenic cyst is always true, it develops against the background of a disorder of embryogenesis caused by a certain defect. A false cyst is acquired, arising as a result of traumatic injuries, hematomas, infections (typhoid, malarial), or as a result of organ infarction.

A true splenic cyst can develop at different rates and is manifested by mild dull pain with a feeling of heaviness on the left side under the ribs. The pain often radiates to the left shoulder and shoulder girdle, to the scapula. As the volume of the formation increases, the symptoms worsen, since neighboring organs are displaced.

Simultaneous formation of neoplasms in several organs at once is more typical for advanced parasitic invasion. For example, a liver and spleen cyst may be combined in one organism. In such a situation, pathological objects have a number of common features, such as slow growth, prolonged latent course, which complicates differential diagnostics. It is very important to find out the origin of the cystic element as accurately as possible and establish its main characteristics.

The term posttraumatic hematoma is associated not only with trauma, but also with spontaneous bleeding in patients with hemorrhagic diathesis or with long-term use of anticoagulants. At the very beginning, the hematoma has the appearance of an anechoic fluid accumulation, which can acquire echogenicity when forming blood clots. Later, after the hematoma liquefies, a subcapsular cyst of the spleen with a heterogeneous structure can be detected. Such formations take the configuration of the organ and are prone to rupture and bleeding. [ 13 ]

A multi-chamber spleen cyst is most often parasitic (acquired) or epidermoid (congenital). At first, these are single small simple spleen cysts with clearly defined cavities. But over time, they increase in size, their structure becomes more complex, and calcification occurs. Membranes and partitions may appear in the capsules, and multiplicity or multi-chambering is observed in approximately 20% of cases.

Pseudocysts are similar to most known congenital cystic neoplasms. Their true origin can only be determined by histological examination, since they lack an epithelial or endothelial layer. [ 14 ] The main cause of their appearance is traumatic injuries, hemorrhages or tissue ruptures, although patients themselves do not always indicate a history of trauma. There are also descriptions of pseudocysts, the development of which is due to organ infarction, which is especially characteristic of patients with sickle cell anemia. Such formations, as a rule, have one chamber surrounded by a smoothed, clearly defined wall; they are single, without signs of calcification. [ 15 ]

Complications and consequences

Complications of spleen cysts can be divided into two groups:

• caused by pathology developing directly in the cystic formation (hemorrhage, rupture, suppuration);
• associated with pressure on nearby organs (obstruction of the digestive tract, mechanical obstruction, endocrine disorders).

Cystic suppuration is accompanied by signs of acute splenic inflammation.

Perforation when the capsule ruptures occurs into the abdominal cavity with the development of peritonitis of varying severity.

Some experts point to the possibility of malignancy of a true splenic cyst, but in clinical practice this rarely happens. However, epidermoid neoplasms can undergo dysplasia and malignancy with the development of squamous cell carcinoma, although this unfavorable consequence is also rarely detected. The causes of rare malignancy are still being studied. Presumably, the organ produces specific antitumor structures, or tumor cells are quickly absorbed by phagocytes, or the saturated blood and lymphatic system of the spleen plays a role. [ 16 ]

Often, the liver and other organs are affected simultaneously with the spleen.

Why is a spleen cyst dangerous?

A cystic formation is a kind of capsule filled with liquid. If its diameter does not exceed 20 mm, then there is usually no pain or any other symptoms. But if the spleen hurts, the cyst in such cases is already large or multiple. The clinical picture will be varied:

• constant or paroxysmal pain on the left side in the hypochondrium;
• a feeling of pressure and distension, especially after eating, heaviness, nausea, belching;
• sometimes - cough, difficulty breathing, unpleasant tingling when trying to take a deep breath.

However, the pathology is dangerous not only because of the appearance of pain and discomfort, digestion and breathing disorders. Rupture of the spleen cyst with the development of the state of "acute abdomen", purulent-inflammatory complications, bleeding into the abdominal cavity, general intoxication syndrome - all these are serious and formidable problems, with a high risk of death. Fortunately, such consequences occur relatively rarely. However, all existing risks should be taken into account for further timely response. [ 17 ], [ 18 ]

Diagnostics splenic cysts

Patients with suspected spleen cysts or other diseases affecting the abdominal organs must be examined by a surgeon. The doctor will examine and question the patient, conduct palpation and percussion diagnostics, thanks to which he will be able to suspect a particular problem. To clarify the diagnosis, the following studies will be additionally prescribed:

• general and biochemical blood tests;
• general urine analysis;
• serum bilirubin test;
• thymol test, study of total protein and protein fractions, aminotransferases, alkaline phosphatase, prothrombin;
• serological reactions to echinococcosis (enzyme-linked immunosorbent assay);
• ultrasound examination of abdominal organs;
• radiography (if indicated – magnetic resonance imaging or computed tomography).

Instrumental diagnostics most often include ultrasound examination and multispiral computed tomography with the use of contrast.

The ultrasound diagnostic method is especially widespread today, which is due to its availability and simultaneous information content. As for the spleen, this organ is well visualized on ultrasound in the vast majority of cases. Normally, its parenchyma is more echogenic than that of the adjacent kidney, and is approximately the same in echogenicity as liver tissue. Normal organ sizes: length 8-13 cm, thickness up to 4.5 cm (maximum - 5 cm).

A spleen cyst on ultrasound may have different appearances, depending on the characteristics of the pathology:

• the wall of a true neoplasm consists of connective tissue, with an epithelial or endothelial layer lined inside;
• The wall of the false neoplasm does not have an epithelial lining.

The congenital element has the same appearance as simple cystic formations in any other part of the body. They are sharply limited, without clearly defined walls. In most cases, there is an acoustic shadow: in the absence of infectious complications and hemorrhages, there is no internal echo. Formations can be a consequence of hematomas, when they encapsulate. To assess the growth rate of the pathological element, dynamic ultrasound monitoring is repeated after 2-3 months, with a subsequent decision on the need for surgical intervention.

Parasitic objects are most often represented by echinococcosis: their echo picture usually does not differ from liver cysts. [ 19 ]

Computer tomography is prescribed after ultrasound examination – mainly to exclude degeneration into a cancerous tumor. A splenic cyst is visible on CT as a pathological cavity consisting of a thin membrane, practically devoid of a vascular network and therefore not responding to the introduction of contrast agents. [ 20 ] Native examination is usually sufficient to assess the configuration, size, and location of the capsule. Computer tomography helps to examine the cystic cavity, to determine its parasitic or non-parasitic etiology: a sign of parasitic affiliation is considered to be partial or complete calcification of the capsular walls, a tendency to multi-chamber. [ 21 ]

Splenic cysts on MRI of the abdominal cavity have all the typical characteristics: bright on T2-weighted MRI and hypointense on T1-weighted MRI. The neoplasms are clearly defined, with a homogeneous structure. Abscesses, unlike simple cystic formations, are not as bright on MRI, have uneven and unclear boundaries. In case of organ injury, blood is detected, the visualization of which depends on the statute of limitations. Infarction, as a result of thromboembolism, is considered as a wedge-shaped lesion with clearly defined edges.

Differential diagnosis

In the course of differential diagnostics, it is first necessary to clarify the localization and organ affiliation of the neoplasm, then to distinguish it from a tumor, a purulent process, tuberculosis, etc. Most often, difficulties arise with large-sized liquid formations - especially if they are in contact with several organs at the same time. It is also difficult to differentiate multi-chamber formations with heterogeneous contents, tissue inclusions, irregularities and unclear contours on an ultrasound or tomographic image. [ 22 ]

As a rule, an ultrasound examination of the spleen allows not only to make a correct diagnosis, but also to differentiate pathologies, promptly suspecting blood and liver diseases.

Treatment splenic cysts

If you have periodic or constant abdominal pain on the left side of your abdomen, you should definitely seek medical help. A spleen cyst can be detected during a routine check-up or examination.

The detection of a pathological formation must be associated with the determination of its characteristics: size, organ affiliation, etc. The correct and complete diagnosis determines how correctly the treatment tactics will be chosen. For example, in case of parasitic invasions, therapy will be aimed at neutralizing and expelling the "uninvited guests" from the body.

In some cases, surgery may be required, and if the tumor is small in size and without complications or clinical symptoms, a decision is often made on further observation tactics, with a visit to the doctor and a control ultrasound examination 1-2 times a year.

If the doctor indicates the need for surgical treatment, the operation can be urgent or planned. Urgent surgery is when the capsule ruptures, suppuration or bleeding occurs. Planned surgery is prescribed in the presence of constant pain and disorders of nearby organs.

Prevention

Given the difficulty of predicting the results of treatment of spleen cysts, an important point is the issue of prevention of this pathology. But, unfortunately, specialists cannot provide an approved scheme of such preventive measures.

First of all, family doctors should inform their patients about the danger of abdominal injuries and damage, about the need to seek medical help at the first painful symptoms. Numerous studies indicate that a considerable number of patients do not know about the existence of a spleen cyst, even despite the existing pathological signs, since they are not aware of the risks of developing serious complications. In some countries, protocols of recommendations for patients have been developed: such protocols include maximum education of people regarding prevention and initial symptoms of the development of adverse effects.

General preventive measures include:

• healthy and active lifestyle, avoiding physical inactivity;
• a balanced diet of quality food, drinking enough water, as well as essential vitamins and minerals;
• timely visits to doctors, regular examinations that allow identifying pathology in organs at an early stage of development.

Another important link is considered to be the prevention of postsplenectomy complications caused by organ removal.

Forecast

The prognosis for patients with a splenic cyst is ambiguous: the outcome depends on the location, volume of the cyst, the multiplicity of pathological formations, the presence of complications and disorders in other organs. If the patient is diagnosed with a single small neoplasm, the stable existence of the pathology is observed without a tendency to increase and suppuration, then the prognosis can be considered favorable.

If the development of an inflammatory process is noted, and the cystic elements become multiple or increase in size, there is a risk of a capsule rupture with the subsequent appearance of a serious life-threatening condition.

If the patient had to have their spleen removed to treat the disease, the prognosis may also be different. Due to a malfunction of the immune system, the likelihood of developing infectious diseases increases significantly. In some cases, vaccination against the most common pathogens of post-splenectomy sepsis is recommended. Vaccines are administered two weeks before the planned spleen removal surgery or two weeks after the emergency intervention. A long postoperative course of antibiotic therapy also has an effect, but is associated with a number of negative side effects. Most specialists recommend lifelong antibacterial treatment or for the first 24 months after splenectomy. However, in some cases, the patient's condition is systematically monitored, with antibiotics used at the slightest indication (for example, at the first cold symptoms).

Doctors consider the optimal situation to be when a spleen cyst can be removed by organ-preserving surgery or by autotransplantation of splenic tissue.