Conditions in this group
This group includes hemangioma, hamartoma, lymphangioma, inflammatory pseudotumor, primary splenic tumors, angiosarcoma, lymphoma, and splenic metastases.
How they develop and how they are diagnosed
Most focal lesions are discovered incidentally. Benign lesions, such as hemangioma, often cause no symptoms. Malignant lesions are less common and may be associated with weight loss, fever, night sweats, splenomegaly, or abnormal blood tests.
Imaging assessment with CT or MRI is central. Previous studies are compared, and a history of malignancy, the presence of lymph nodes, and blood tests are evaluated. In selected cases, PET/CT may be used or biopsy may be required. The decision to perform a biopsy is made carefully because of the risk of bleeding.
Treatment
Typical benign and asymptomatic lesions can be monitored. Surgical treatment is considered when there is diagnostic uncertainty, growth, symptoms, risk of bleeding, or suspicion of malignancy. In lymphoma or metastatic disease, treatment is usually determined in a multidisciplinary team, and splenectomy has a selected diagnostic or therapeutic role.
Frequently asked questions
Is every splenic lesion malignant?
No. Most incidental lesions are benign, but they need to be characterized correctly.
Is a biopsy always needed?
No. Imaging is often sufficient. Biopsy or splenectomy is selected only when it will safely change the diagnosis or treatment.
Can splenectomy be performed with a minimally invasive technique?
In many elective cases, yes. The choice depends on size, anatomy, and the likelihood of malignancy.
When to seek medical attention
Many splenic lesions are found by chance and are harmless. See a doctor promptly for persistent or worsening pain in the upper left abdomen, early fullness after small meals, unexplained weight loss, drenching night sweats, fever without an infection, or a lump under the left ribs. Sudden severe pain or faintness needs emergency care, because a lesion can occasionally bleed.
What the assessment involves
Ultrasound and contrast CT or MRI describe the lesion: its size, whether it is solid or fluid-filled, how it takes up contrast, and whether it is single or multiple. The pattern often identifies a benign lesion such as a hemangioma. Blood tests and a review of your history, including any known cancer or blood disease, complete the picture. Other scans, such as PET-CT, are used when lymphoma or spread from another cancer is suspected.
A needle biopsy of the spleen carries a real risk of bleeding and is used only selectively. When a lesion remains uncertain or is suspicious, removal of the spleen may be both the diagnosis and the treatment.
Treatment and follow-up
Benign lesions without symptoms, such as most hemangiomas, are usually monitored with imaging at intervals agreed with the surgeon. Surgery is considered for growing or symptomatic lesions, lesions that cannot be identified, and suspected cancer. If cancer is found, the plan is made together with hematology and oncology colleagues, and depends on the exact diagnosis. After splenectomy, the vaccination and fever advice in the splenectomy article applies.
More questions about splenic lesions
What are the most common cancers of the spleen?
Lymphoma is the most frequent. Primary splenic tumors other than lymphoma are rare, and spread from another cancer to the spleen is uncommon.
