Rare Malignant Lesions of the Spleen: Epidermoid Cyst with Malignancy and Metastasis

Yulia Stepanova 1 Dmitry Ionkin 2 Maksalina Alimurzaeva 1 Dmitry Kalinin 3
1Radiology, A.V. Vishnevsky Institute of Surgery, Russia
2Abdominal Surgery, A.V. Vishnevsky Institute of Surgery, Russia
3Pathology, A.V. Vishnevsky Institute of Surgery, Russia

Morphology of focal spleen lesions is given quite a lot of attention in the medical literature. Most authors distinguish malignant and benign spleen tumors. The greatest attention is paid to tumors of hematopoietic origin. The authors indicate the possibility of malignant degeneration of benign spleen lesions very often, however their own cases usually not represented. Descriptions of metastatic lesion of the spleen are extremely rare.

PURPOSE: To analyze the frequency of occurrence and features of diagnostics and treatment of rare malignant lesions of the spleen.

MATERIALS AND METHODS: In A.V. Vishnevsky Institute of Surgery 378 patients with focal spleen lesions of various morphological forms were treated in 1980 - 2017, there’re 380 lesions (two lesions of different morphological forms were revealed in two patients) There’re 13 clinical cases of rare malignant forms of focal spleen lesions: the epidermoid cyst with malignancy - 1; metastases in the spleen - 12. All patients underwent ultrasound, CT and/or MRI. All patients were operated on, lesions were morphological verified.

RESULTS: The epidermoid cyst. Multicystic spleen lesion was detected in a 64-year-old female with a rather pronounced clinical picture (pain in the left hypochondrium, enlarged spleen). The size of the largest cyst was 9x8 cm. The lesion had septas of different thicknesses with calcifications and contrast enhancement in the local part of the thickened septum.

Spleen metastases take a special place both from the point of view of their rarity and from the position of not fully understood mechanisms of their occurrence. We encountered 12 (3.2%) cases of spleen metastases (ovarian cancer - 4, colorectal cancer - 2, 1 case of retroperitoneal polymorphic cell sarcoma, hepatocellular carcinoma, pancreatic, duodenal, stomach and thyroid gland cancer). The radiology patterns of metastases may be different, which is due to the different radiology patterns of the primary tumor and the possible change in its structure as it grows. This situation complicates the differential diagnosis of focal lesions.

CONCLUSION: If any solid spleen lesion is detected, differential diagnosis with a malignant tumor process should be carried out, despite the relative scarcity of such lesions (both primary and secondary). Oncological vigilance is also necessary in case of detection of fluid cystic lesions. It’s impossible to neglect urgent cytological and histological studies during the operation. It’s also important and final morphological study, both for the installation of the final diagnosis, and for determining the further tactics of managing the patient.

Yulia Stepanova
Yulia Stepanova