Spleen cyst in a child and an adult

A spleen cyst is a term that combines a number of pathologies, which are characterized by a common symptom - the presence of a cavity formation in the parenchyma of an organ.

Such a diagnosis is always quite serious and requires immediate medical attention. The fact is that the spleen plays a major role in the human immune system. Therefore, any problems with this organ must be solved immediately, without waiting for the aggravation of the pathology. [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. A similar disease is diagnosed in about 1% of all inhabitants of the planet, and mainly during preventive examinations (due to the hidden clinical picture).

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

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

Both men and women are equally susceptible to the disease, although according to some reports, women still get sick a little more often. Pathology is found in almost all countries of the world. The average age of the sick is 35-55 years. [5]

Causes spleen cysts

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

The main number of spleen pathologies are secondary diseases that result from disturbances from other organs and systems, or any external influences. That is, the causes can be blood diseases, immune pathologies, tumor processes, systemic disorders or traumatic injuries. [6] Often, heart attacks, abscesses, traumatic ruptures, circulatory disorders, and also:

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

After a puncture with a purulent inflammatory process, or after a spleen infarction, in pathologically altered tissues, the likelihood of the formation of cavities increases, in which the gradual formation of walls occurs, and the resulting capsule is filled with serous contents. The cavity element is also formed after severe bruises and wounds, surgical operations on the abdominal cavity, as well as when parasites and their larvae enter the human body.

Risk factors

Risk groups include:

• people living in regions of natural focus of echinococcosis, 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 traumatic professions, or athletes;
• people who regularly consume unwashed berries, herbs, fruits, raw fish or meat;
• workers of livestock enterprises, meat processing workshops, points of slaughter or disposal of animals;
• veterinarians, fur processing workers, fur farms, zoos, skin processing, etc.;
• patients who underwent surgery on the abdominal organs.

Pathogenesis

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

Spleen cysts are conventionally divided into two large categories - these are 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 one is acquired. [8]

From this classification, it becomes clear that congenital pathology occurs, like any developmental defect, during the period of organoforming in the fetus in the mother's womb. More precisely, the violation occurs at the time of the formation of the vascular bed that feeds the spleen. Most likely, the cyst in the spleen in the fetus is caused by genetic causes. It also happens that atypical splenic tissues migrate into the structure of the organ and eventually provoke cystic formation. [9]

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

Symptoms spleen cysts

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

With the development of inflammation, patients note:

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

Gradually, the pain intensifies, 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. During a deep breath, shortness of breath and chest discomfort may occur. In some patients, pain radiates to the left collarbone, shoulder, scapula, with intensification after eating.

For multiple cysts, or for neoplasms with large sizes, disorders of the functions of the abdominal organs are characteristic. In particular, digestion is disturbed, stomach problems appear, nausea and belching are often worried.

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

Cyst in the spleen in an adult

The spleen cyst is a slowly progressive pathology: an acute course is practically not typical for it. That is why, in adulthood, both acquired and congenital formations can be detected, the presence of which a person had not previously imagined. Doctors point out that the problem in most cases becomes a "chance find", especially when it comes to small neoplasms.

Large, voluminous cavities are much easier to identify, since they reveal themselves clinically, causing a violation of organ function, displacing the spleen itself or closely located organs. In such a situation, the big one will voice complaints of discomfort, heaviness in the hypochondrium on the left. However, many cases are known when even large pathological elements are not accompanied by any significant symptomatology. Such a pathology is diagnosed using ultrasound scanning of the abdominal cavity. After confirming the disease, the patient can additionally be sent for computed tomography with the introduction of a contrast agent, or for magnetic resonance imaging. Such diagnostic procedures help 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 inner membrane is well visualized, or the parasite itself. In addition, it is very important to carry out differential diagnostics of an element with a malignant tumor, to assess the dynamics of growth.

Spleen cyst and pregnancy

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

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

The following procedures are mandatory for a woman:

• echography;
• fetometry;
• dopplerometry of uteroplacental and fetal-placental blood flow.

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

Cyst in the spleen in 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 cysts in children? Often the "culprits" are past illnesses - in particular, viral pathologies, infectious mononucleosis, as well as injuries. A considerable percentage of spleen cysts are congenital diseases.

Such neoplasms are not in all cases indications 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 a laparoscopic technique, which allows for high-quality removal, facilitates the postoperative period and accelerates rehabilitation. [11]

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

Cyst in the spleen in a newborn

Most often, spleen cysts during the neonatal period are detected by chance - for example, during a preventive ultrasound examination. There are usually no external manifestations of pathology, they do not resort to surgical removal, choosing a wait-and-see tactic: the operation is prescribed only for large neoplasms, when there is a threat of malfunctioning of the organ and nearby structures.

The spleen is responsible for the immune defense, forming and maintaining it in the child. At the moment, it is already known that it is in this organ that antibodies are formed against 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 their best to preserve the organ. Splenectomy is performed only if there is compelling evidence, and even then at a more mature age.

Forms

There are three main options for the development of a spleen cyst: parasitic, true and false. A pseudo cyst of the spleen is formed as a result of a peculiar reaction of the splenic tissues to an inflammatory reaction provoked by injuries, acute circulatory disorders in the organ.

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

The parasitic cyst of the spleen is most often represented by echinococcosis, cysticercosis, less often - alveococcosis. The parasites enter the organ with the blood - hematogenous. Lymphogenous ingestion is also possible, but extremely rare. The development of echinococcosis is usually slow, gradual, lasting for several years without any special symptoms. Over time, the spleen greatly increases in size, pushing back 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 engaged in agriculture and veterinary medicine. In this case, echinococcus is able to infect not only the spleen, but also the liver, lungs, and brain.

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

A schistosomal cyst of the spleen is characterized by dermatitis (when parasites enter the skin), fever, intoxication, splenomegaly, eosinophilia, damage to the intestines and the urogenital system. The symptomatology of the disease is mainly associated with the immune-allergic reaction of the body to the parasitic invasion.

Nonparasitic cysts of the spleen are less common than parasitic cysts. True formations have connective tissue walls, with an inner lining of endothelium or epithelium. A false neoplasm is devoid of such a lining and is represented only by a connective tissue wall. However, such a distinctive feature is rather arbitrary, since under certain conditions the endothelial lining is prone to atrophy.

A congenital spleen cyst is always true, it develops against the background of a disorder of embryogenesis due to a certain defect. A pseudocyst is acquired, resulting from traumatic injuries, hematomas, infections (typhoid, malarial), or as a result of organ infarction.

A true spleen cyst can have a different rate of development and is manifested by mild dull pain with a feeling of heaviness on the left under the ribs. The pain often radiates to the area of the left shoulder and shoulder girdle, to the scapula. As the volume of education increases, the symptomatology worsens, since neighboring organs are pushed aside.

The simultaneous formation of neoplasms in several organs at once is more characteristic of a neglected parasitic invasion. For example, a cyst of the liver and spleen can 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 diagnosis. It is very important to as accurately as possible find out the origin of the cystic element and establish its main characteristics.

The term post-traumatic hematoma is associated not only with trauma, but also with spontaneous bleeding in patients with hemorrhagic diathesis, or with prolonged use of anticoagulants. At the very beginning, the hematoma looks like an anechoic fluid accumulation, which can acquire echogenicity during the formation of blood clots. Later, after liquefaction of the hematoma, a subcapsular cyst of the spleen with a heterogeneous structure may be found. Such formations take on the configuration of the organ and are prone to rupture and bleeding. [13]

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

Pseudocysts are similar to most known congenital cystic neoplasms. It is possible to determine their true origin only in the course of histological examination, since they are devoid of an epithelial or endothelial layer. [14] The main reason for their appearance is traumatic injuries, hemorrhages or tissue ruptures, although the 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:

• due to 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 with rupture of the capsule occurs in the abdominal cavity with the development of peritonitis of varying severity.

Some experts point to the likelihood of a true spleen cyst malignancy, but this rarely happens in clinical practice. But epidermoid neoplasms can undergo dysplasia and malignancy with the development of squamous cell carcinoma, although this adverse effect is also rarely found. The causes of rare malignancy are still being studied. Presumably, the development of specific antitumor structures occurs in the organ, or tumor cells are quickly absorbed by phagocytes, or the saturated circulatory 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?

The cystic formation is a kind of capsule filled with liquid. If its diametrical size does not exceed 20 mm, then pain and any other symptoms are usually absent. 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;
• feeling of pressure and fullness, especially after eating, heaviness, nausea, belching;
• sometimes - cough, shortness of breath, unpleasant tingling sensation when trying to take a deep breath.

However, pathology is dangerous not only by the appearance of pain and discomfort, impaired digestion and breathing. Rupture of the spleen cyst with the development of a 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 are relatively rare. However, all the existing risks should be taken into account for further timely response. [17], [18]

Diagnostics spleen cysts

Patients with suspected spleen cysts or other diseases affecting the abdominal organs must be examined by a surgeon. The doctor will examine, interview the patient, conduct palpation and percussion diagnostics, so that he can suspect a particular problem. Already to clarify the diagnosis, the following studies will be additionally assigned:

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

Instrumental diagnostics is most often represented by ultrasound examination and multispiral computed tomography using contrast enhancement.

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

The spleen cyst on ultrasound can have a different appearance, depending on the characteristics of the pathology:

• the wall of a true neoplasm consists of connective tissue, with an epithelial or endothelial layer laid out 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 the result of hematomas, when they are encapsulated. To assess the growth rate of the pathological element, dynamic ultrasound observation is repeated after 2-3 months, with a further decision on the need for surgical intervention.

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

Computed tomography is prescribed after the ultrasound scan - mainly to exclude degeneration into a cancerous tumor. The spleen cyst on CT is visible as a pathological cavity, consisting of a thin membrane, practically devoid of the vasculature and therefore does not respond to the introduction of contrast agents. [20] To assess the configuration, size, location of the capsule, a native examination is usually sufficient. Computed tomography helps to examine the cystic cavity, to find out its parasitic or nonparasitic etiology: a sign of parasitic affiliation is partial or complete calcification of the capsular walls, a tendency to multi-chamber. [21]

The spleen cyst on MRI of the abdominal cavity has all the typical characteristics: bright on T2-weighted MRI and hypointense on T1-weighted MRI. The neoplasms are clearly limited, with a homogeneous structure. Abscesses, unlike simple cystic formations, are not so bright on MRI, they have uneven and indistinct boundaries. In case of organ injury, blood is detected, the visualization of which depends on the limitation period. A heart attack, as a result of thromboembolism, is seen as a wedge-shaped focus with clear delineated edges.

Differential diagnosis

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

As a rule, ultrasound examination of the spleen allows not only to correctly diagnose, but also to differentiate pathologies, timely suspecting diseases of the blood and liver.

Treatment spleen cysts

In case of periodic or persistent abdominal pain from the left hypochondrium, it is imperative to seek medical help. A spleen cyst can be detected during a routine examination or routine examination.

The identification of a pathological formation should be associated with the determination of its features: size, organ belonging, etc. The correct and complete diagnosis depends on how correctly the treatment tactics will be chosen. For example, in case of parasitic invasions, therapy will be aimed at neutralizing and expelling "uninvited guests" from the body.

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

If the doctor indicates the need for surgical treatment , then the operation can be urgent or planned. An urgent operation is said when the capsule ruptures, suppuration or bleeding occurs. A planned operation is prescribed in the presence of constant pain and disorders from the side of nearby organs.

Prevention

Given the difficulty of predicting the results of treatment of a spleen cyst, an important point is the issue of preventing this pathology. But, unfortunately, experts cannot provide an approved scheme for such preventive measures.

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

General preventive measures are:

• healthy and active lifestyle, avoidance of hypodynamia;
• good nutrition with quality food, the use of a sufficient amount of drinking water, as well as essential vitamins and minerals;
• timely visits to doctors, regular examinations to identify pathology in organs at the initial stage of development.

Another important link is the prevention of post-splenectomy 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 from other organs. If a single small neoplasm is diagnosed in a patient, the stable existence of pathology is traced without a tendency to increase and suppuration, then the prognosis can be considered favorable.

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

If the patient had to remove the spleen to treat the disease, then 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, it is recommended to vaccinate against the most common pathogens of post-splenectomy sepsis. Vaccines are administered two weeks before a planned spleen removal operation, or two weeks after an emergency intervention. A long postoperative course of antibiotic therapy also gives its effect, but is associated with a number of negative side effects. Most experts advise antibiotic treatment for life or for the first 24 months after splenectomy. However, in some cases, the patient's condition is systematically monitored, with the use of antibiotics for the slightest indication (for example, at the first cold symptoms).

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