From the Guidelines
Numerous simple splenic cysts are typically benign and do not require immediate treatment, but rather observation with periodic imaging to monitor for any changes in size or symptoms. When considering the management of simple splenic cysts, it's crucial to prioritize the patient's morbidity, mortality, and quality of life. The evidence from the provided study 1 focuses on adnexal masses and ovarian cysts, but the principles of managing simple cysts can be applied to splenic cysts in terms of the approach to benign-appearing lesions. The key points to consider in managing simple splenic cysts include:
- Size of the cysts: Cysts less than 5 cm are generally considered to be at low risk for complications and may not require immediate intervention.
- Symptoms: Asymptomatic cysts can often be monitored, while symptomatic cysts may require treatment to alleviate symptoms such as pain or early satiety.
- Concerning features: Cysts with features suggestive of malignancy or potential for rupture may require more urgent intervention. Given the benign nature of most simple splenic cysts, observation with periodic ultrasound monitoring every 6-12 months is a reasonable approach for small, asymptomatic cysts. However, for larger cysts or those causing symptoms, intervention such as percutaneous aspiration with sclerotherapy, laparoscopic unroofing/fenestration, or partial splenectomy may be necessary to improve the patient's quality of life and prevent potential complications. It's essential to individualize the management plan based on the patient's specific clinical presentation and preferences.
From the Research
Numerous Simple Splenic Cysts
- Numerous simple splenic cysts are relatively rare clinical entities and are often diagnosed incidentally upon imaging conducted for a variety of clinical complaints 2.
- The treatment of non-parasitic splenic cysts has historically been dictated by two primary factors: the presence of symptoms attributable to the cyst and cyst size greater or less than 5 cm 2.
- However, the premise of recommending operative intervention based on size is not firmly supported by the literature, and observation of asymptomatic splenic cysts is safe regardless of size 2.
- Asymptomatic cysts have been found to have a negative overall growth rate, and percutaneous drainage has a high recurrence rate 2.
- Enlarging cysts may be prone to gravitational effects, and prophylactic treatment should be considered in such cases 3.
Management of Simple Splenic Cysts
- For bigger cysts, either open or laparoscopic partial splenectomy is the procedure of choice 4.
- Laparoscopic-cystectomy/partial decapsulation/unroofing procedures have unacceptably higher recurrence rates and hence should not be recommended 4.
- Smaller cysts (< 5 cm diameter) can be treated conservatively with regular ultrasound follow up, but if they become symptomatic or progress in size, surgical intervention is indicated 4.
- Sclerotherapy has been described as a treatment option for nonparasitic pediatric splenic cysts, with a decrease in the size of the cyst or complete ablation in 89.5% of patients 5.
Diagnostic and Therapeutic Challenges
- Splenic cysts present a diagnostic and therapeutic challenge due to their varied etiologies and clinical manifestations 6.
- Diagnostic modalities, including imaging and histopathology, facilitate accurate classification and inform subsequent management decisions 6.
- Various surgical techniques, including laparoscopic and spleen-preserving approaches, have been employed with favorable outcomes 6.