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Background: Solid and cystic splenic masses discovered on imaging studies often pose diagnostic and management dilemmas. This study analyses a large series of splenectomies to identify preoperative factors associated with malignant splenic masses.
Methods: Pathology records at a single institution were reviewed for all splenectomies. Those performed as a component of a larger resection, for lymphoma staging, or debulking for a surface malignancy were excluded. Demographic and clinicopathologic factors were obtained. Univariate and multivariate analyses identified factors associated with an increased risk of malignancy.
Results: Between 1986 and 2012, 2,745 patients underwent splenectomy. 148 were performed for splenic lesions identified on abdominal scans. The indication for resection included suspicious imaging characteristics such as heterogeneity or growth over time (120, 81%), a cancer history (113, 76%), and/or symptoms (39, 26%). The majority of patients underwent a preoperative CT (138), although PET (25), MRI (23), and ultrasound (8), were also included in patient evaluations. Among the resected spleens, the majority had a malignant mass (93, 63%). 90% were parenchymal metastases, including ovarian cancer (39, 42%), followed by melanoma (14, 15%) and colorectal cancer (9, 10%). While the majority of the patients with malignant splenic lesions had a previous history of cancer (85 of 93; 91%), among those patients without a previous history of cancer (n=35), most had benign lesions (77%). On multivariate analysis of several clinicopathologic factors, a previous history of cancer was the only independent predictor of malignancy in the splenic lesion (odds ratio 6.3; 95% CI, 2.32-16.97; p=0.00). Imaging described as "suspicious for malignancy" by the radiologist (e.g. by virtue of heterogeneity) or lesions that enlarged on interval scans did not correlate with malignancy in the spleen.
Conclusion: While the spleen is an uncommon site of malignant disease, resected splenic masses are frequently malignant, especially in patients with a previous history of cancer.
Factors Associate with Malignancy in Resected Splenic Masses

	Univariate			Multivariate
Variable	Odds Ratio	95% CI	P-value	Odds Ratio	95% CI	P-value
Sex (M v. F)	0.424	0.2-0.8	0.018	0.472	0.21-1.06	0.70
Age	1.018	0.99-1.04	0.098
Symptomatic	0.593	0.24-1.45	0.253
Previous history of cancer	10.2	4.17-25.1	0.000	6.28	2.32-16.97	0.000
Imaging "suspicious for malignancy"	1.24	0.54-2.85	0.601
Increasing size	0.745	0.32-1.71	0.489