What are the implications of having a splenic hemangioma, hepatic (liver) cyst, and kidney (renal) cyst?

From the Guidelines

Splenic hemangioma, hepatic cyst, and kidney cyst are all benign lesions that often require no specific treatment if asymptomatic, and their management should prioritize a conservative approach to minimize morbidity and mortality while maintaining quality of life. For splenic hemangioma, observation is typically recommended for lesions smaller than 4 cm, with imaging follow-up every 6-12 months 1. Surgical intervention (splenectomy or partial splenectomy) is only considered for larger lesions (>4 cm), symptomatic cases, or when there's concern for rupture. Hepatic simple cysts generally require no treatment unless they cause symptoms like abdominal pain or become very large, as indicated by the EASL clinical practice guidelines on the management of cystic liver diseases 1. For symptomatic hepatic cysts, options include percutaneous aspiration with sclerotherapy or surgical deroofing (fenestration), with the choice of treatment depending on the size and location of the cyst, as well as the patient's overall health status 1. Similarly, simple kidney cysts typically need no intervention unless they cause pain, obstruction, or hypertension. For symptomatic kidney cysts, percutaneous aspiration with or without sclerotherapy may provide relief, although the decision to intervene should be made on a case-by-case basis, taking into account the potential risks and benefits of treatment 1. All three conditions should be monitored periodically with ultrasound or CT imaging to ensure stability, and any changes in symptoms or imaging findings should prompt a re-evaluation of the treatment plan. The management of these lesions should prioritize a conservative approach, minimizing the risk of complications and preserving quality of life, as supported by the most recent and highest quality studies, including the KDIGO 2025 clinical practice guideline for the evaluation, management, and treatment of autosomal dominant polycystic kidney disease (ADPKD) 1. Key considerations in the management of these lesions include:

• The size and location of the lesion
• The presence of symptoms, such as pain or obstruction
• The patient's overall health status and risk factors for complications
• The potential risks and benefits of treatment, including the risk of infection, bleeding, or other complications
• The need for ongoing monitoring and follow-up to ensure stability and detect any changes in the lesion or symptoms. In general, a conservative approach is recommended for asymptomatic lesions, with intervention reserved for symptomatic cases or those at high risk of complications.

From the Research

Splenic Hemangioma

• Splenic hemangioma is a rare disorder but remains the most common benign neoplasm of the spleen 2.
• It often has a latent clinical picture; however, spontaneous rupture has been reported to occur in as many as 25% of this patient population 2.
• Small splenic lesions, which meet the radiologic criteria for hemangiomas, may be safely observed 2.

Hepatic Cyst

• Hepatic hemangiomas are benign tumors of the liver consisting of clusters of blood-filled cavities, lined by endothelial cells, fed by the hepatic artery 3.
• The vast majority of hepatic hemangiomas are asymptomatic, most often being discovered incidentally during imaging investigations for various unrelated pathologies 3.
• Hepatic hemangioma is the most common benign liver tumor and it is usually found incidentally during radiological studies 4.

Kidney Cyst

• Cysts arising from the kidney are more common than those arising from the spleen 5.
• There is no specific information available in the provided studies about kidney cysts, but it is mentioned that cysts arising from the kidney are more common than those arising from other organs such as the spleen 5.

Diagnosis and Management

• Ultrasound is an effective modality for the study of splenic cysts because it is able to distinguish between cystic and solid lesions 6.
• The diagnosis of hepatic hemangioma can be established by the identification of hallmarks in several imaging studies 4.
• Treatment for splenic hemangioma most often consists of splenectomy, while symptomatic hepatic hemangioma patients can be managed surgically or with other non-surgical modalities 2, 4.