Cysts, tumors and abscesses of the spleen

Question 1

What percentage of splenic cysts are parasitic?

Answer 1

5%

Question 2

Most common parasitic organism found in splenic cysts

Answer 2

Echinococcus granulosus

Question 3

Treatment of parasitic splenic cysts

Answer 3

Medical management followed by splenectomy

Question 4

CT appearance of nonparasitic splenic cysts

Answer 4

Solitary cyst with occasional wall calcifications

Question 5

Accounts for 90% of all nonparacystic cysts

Answer 5

Epidermoid cysts

Question 6

Etiology of most secondary splenic cysts or pseudocysts

Answer 6

Trauma

Question 7

When is surgical intervention indicated for splenic cysts?

Answer 7

Size greater than 5 cm, or symptomatic

Question 8

Why can noninfectious cysts less than 5 cm be managed nonoperatively?

Answer 8

Often resolve on their own

Question 9

Surgical options for intervention for splenic cysts

Answer 9

unroofing cyst, complete or partial splenectomy or fenestration

Question 10

How much spleen must remain to preserve splenic function?

Answer 10

25%

Question 11

Most common malignancy involving the spleen?

Answer 11

Non Hodgkin’s lymphoma

Question 12

Does splenectomy affect survival in NHL

Answer 12

No. There is no increase in survival

Question 13

What percentage of patients with stage I or II Hodgkin’s lymphoma have splenic disease?

Answer 13

Up to 35%

Question 14

What benefit does splenectomy give patients with CLL?

Answer 14

No increase in survival, but reduction in transfusion requirements, and lowers lymphocyte count.

Question 15

What is the role of splenectomy in myelofibrosis?

Answer 15

Plays a palliative role, reducing transfusion requirements and improving quality of life. Myelofibrosis is universally fatal, with a mean survival of 5 years.

Question 16

Cancers known to metastasize to the spleen

Answer 16

Breast, Lung, Melanoma, Ovarian/Endometrial, Gastric, Colonic and prostate

Question 17

What percentage of patients with NHL have splenic involvement?

Answer 17

40%

Question 18

Most common benign tumor of the spleen

Answer 18

Hemangioma

Question 19

Risks of splenic hemagiomas

Answer 19

Rupture and hemorrhage

Question 20

Splenic lymphangiomas are associated with similar lesions in what other locations?

Answer 20

lymphangiomas of the liver, lung, skin and bone

Question 21

Treatment of malignant splenic lesions

Answer 21

Splenectomy

Question 22

When do benign splenic tumors require surgical treatment?

Answer 22

To alleviate symptoms or confirm a diagnosis

Question 23

Causes of splenic abscess?

Answer 23

Hematogenous spread from distant primary septic focus (endocarditis, intraabdominal infections, pyelonephritis), IV drug use, or secondary after trauma.

Question 24

Most common cultured bacteria in splenic abscesses

Answer 24

Staphylococcus and Streptococcus

Question 25

What organisms are more common in immunocompromised individuals with splenic abscesses?

Answer 25

Candida and Aspergillosis (8%).

Question 26

What is the definitive treatment for splenic abscesses?

Answer 26

Splenectomy

Question 27

What are the failure rates in percutaneous drainage of splenic abscesses?

Answer 27

50-60%

Question 28

If unable to administer vaccinations prior to surgery, when should they be given post splenectomy?

Answer 28

2 weeks post splenectomy

Question 29

When is inicidence of OPSS highest postoperatively?

Answer 29

One year post splenectomy

Question 30

What is advocated for the first one to two years post splenectomy in high risk patients?

Answer 30

Prophylactic antibiotics (ususally pencilliins)