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Purpose:
To observe the natural history of splenic cysts and evaluate their management options.
Methods:
One hundred and eighty-two patients were identified from an IRB-approved database search with radiologic evidence of a splenic cyst over an 11-year period. We subdivided these patients into those who underwent intervention and those who did not. The patients who were observed with serial imaging were further divided into those whose cyst size was greater or less than 5 cm. All patient records were reviewed for history, diagnostic studies, operative intervention and outcomes.
Results:
In the current study, 182 patients were diagnosed with a splenic cyst and eight (4.4%) were included in the intervention group. In this group, all were female with mean age and cyst size of 27 years and 7.3 cm respectively. Five of these patients underwent percutaneous aspiration as a first intervention, all of which eventually were operatively resected or drained. Pathologic examination of resected specimens demonstrated benign lesions in all cases.
The non-intervention group was comprised of 174 patients who were stratified by cyst size greater or less than 5 cm. One hundred and fifty-one patients had a cyst size less than 5 cm. The male to female ratio was 1:1.6 and the average age and cyst size were 56 years and 1.7 cm respectively. Seventy-seven of these patients underwent follow up imaging over a mean period of 29 months. Average cyst size decreased to 1.5 cm yielding a growth rate of -0.23 cm/month. There were no complications related to the presence of the cyst during the observation period.
Twenty-three patients had a cyst size greater than 5 cm. The male to female ratio was 1:3 and the average age and cyst size were 50 years and 7.8 cm respectively. Sixteen of these patients underwent follow up imaging over a mean period of 45 months. Average cyst size decreased to 7.4 cm yielding a growth rate of -0.04 cm/month. One patient, a 95 year-old female, with a stable cyst size at 15 months follow up later presented with a ruptured cyst and died during the same admission. Her cause of death was not confirmed to be related to cyst rupture.
Conclusions:
This study presents the largest single series to date of patients with splenic cysts managed by aspiration, operative intervention, or observation. We noted, as have others, that percutaneous drainage has a high recurrence rate. In addition, we did not find any malignant lesions in the operative specimens and noted a negative growth rate in those cysts that were followed with serial imaging. Our data suggest that the management of splenic cysts should be comprised of reserving aspiration for those who are not surgical candidates, resecting lesions that are truly symptomatic and observing those that are not, regardless of size.