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Occasionally, a splenic mass is found incidentally on abdominal computed tomography (CT). To determine the frequency of malignancy among such masses, Boston researchers conducted this single-center retrospective study of 379 patients who had splenic masses identified on abdominal CT during a 7-year period and who had sufficient follow-up to conclude confidently whether masses were benign or malignant. Patients were divided into three groups:
145 patients had histories of malignancy. In 49 of these patients (13 with lymphoma and 36 with other metastatic cancers), their splenic masses were considered to be malignant. Most patients with metastases had obvious involvement of at least two other organs.
29 patients had either constitutional symptoms or left upper quadrant pain, but no history of malignancy. Eight of these patients ultimately were diagnosed with lymphoma, six of which had other areas of lymphadenopathy.
205 patients (the “incidental” group) had no history of malignancy and no constitutional symptoms or left upper quadrant pain. Only two were diagnosed with malignancy (1 lymphoma, 1 ovarian cancer), and both had additional abdominal CT findings suggesting malignancy. Two other patients with enlarging lesions during follow-up underwent splenectomy, which revealed sclerosing angiomatoid nodular transformation (a benign vascular neoplasm) in both cases.
Siewert B et al. The incidental splenic mass at CT: Does it need further work-up? An observational study. Radiology 2018 Apr; 287:156. (https://doi.org/10.1148/radiol.2017170293)
Comment
In this study, no patient who had an incidental splenic mass — and no synchronous mass elsewhere — ultimately was diagnosed with malignancy. The authors conclude that “additional imaging or follow-up is not warranted in such cases.” Most benign lesions are hemangiomas, cysts, hamartomas, lymphangiomas, and granulomas.