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Is It Common To Have Complex Lesion In Spleen And Left Lower Pole Parapelvic Cyst?

Posted on Sat, 28 Dec 2013

Question: Hi, Can you explain a little more about this result. My Dr doesn't seem at all concerned. Trying not to panic but is freaking me out a little. There is a complex lesion in the spleen measuring 1.0 x 0.9 0.9 cm. . There is no hydronephrosis. There is a simple left lower pole parapelvic cyst which measures 1.4 x 0.9 x 1.0 cm. Conclusion - Hypoechoic splenic lesion, complex cyst versus hemangioma. Advise a follow-up examination in 3-6 months for stability. What is a complex cyst and the lession? Is this something that should be biopsied or have an MRI? Would you advise the same course of action as in waiting 6 months to check? Also are cysts on spleens quiet common? Thx for your time.

Answered by Dr. Dr. Ivan Romich (1 hour later)

Brief Answer: Hi and welcome to XXXXXXX Detailed Answer: Thanks for the query. Splenic cysts are not very common,unlike liver or kidney cysts( for example,kidney cysts are found in 30% of people aged +40 and this 1cm kidney cyst is absolutely nothing to be worried). Splenic cyst,as I said is less common(but 1cm cyst are found in 7-10% of healthy people aged 40+) and it can be primary epithelial(epidermoid) cyst or pseudocyst(usually found as postraumatic cyst after injury). There are also parasite cysts and splenic tumors but those 2 are rare and it would have some other ultrasound features. Pseudocysts are usually much bigger than 1cm and you would remember injury so probably this is the cyst which is the most common type of splenic cyst. This is benign splenic cyst,usually found on some routine ultrasound or CT scan. Prognosis is very good and in most patients,treatment is not necessary at all. The algorithm is simple: treatment is not indicated until cyst become symptomatic or reach at least 5cm or there is a risk of malignancy. The size 1x1cm is actually very small cyst and there is no way that it can cause any symptom(cysts are usually symptomatic when reach 10cm); description "complex" may sound bit worrying,but most epithelial are described as complex ones so I dont think this is suggestive of some malignant potential. Spleen biopsy is rarely indicated,since the most valuable test for us is the dynamic of cyst growth. This is why the follow up was recommended. If there is rapid growth,then it can indicate complicated cyst and treatment may be necessary. If there is no rapid growth,no treatment is necessary. MRI wont show anything new. Probably,you had this cyst for many years,maybe even this is congenital so some significant growth in these 3-6 months is not expected; however,follow up is always recommended just to be sure about the diagnosis; I suggest to do CT scan at next follow up,it will visualize the cyst better,but now I dont see a reason for biopsy or MRI. you should just check WBC to rule out hematologic disorders which can be related to spleen tumors. Even if this is or become complicated or enlarged cyst,tumor or heamngioma,treatment is very successful. In most cases spleen is preserved and sometimes splenectomy is necessary,but there are no serious consequances after it. But as I explained, surgery is not something that you should think of when there is just 1cm large cyst. Wish you good health. If you have any questions I ll be glad to help. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (2 hours later)

Thank you very much. Your answer is detailed and thorough. The "complex" bit unerved me. Does "complex" generally mean more risk of turning into something bad or at that small size does it not mean much. Thx so much again for you time and answer. Very much approciated!r

Answered by Dr. Dr. Ivan Romich (12 hours later)

Brief Answer: Hi Detailed Answer: I am glad I can help and give you some advice from my clinical experience. I dont think that your radiologist can determine is it "complex" or "simple" when there is such small lesion.Complex means that this is not clear fluid in oval lesion,but there are also some "structures" inside this cyst. But as I said,in 1cm cyst these structures cant be clearly seen on US so dont be so sure in his finding. Maybe he can see it if he is really experienced sonographer,but ultrasound is operator dependent test so I would recommend CT at next follow up. Nothing serious can happen in 6months and even 1 year follow up would be enough in your case...

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (44 minutes later)

Thanks again. Could I ask you aonther question that came up on my ultrasound?

Answered by Dr. Dr. Ivan Romich (4 hours later)

Brief Answer: hi Detailed Answer: Yes,of course. You can ask anything you want

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (57 minutes later)

Thank you... The ultrasound test also came back with the Liver details below. My Dr didn't even mention it. I do have high cholesterol and take 10 mg of Lipitor which does the job perfectly (my levels are perfect). I also just had my routine blood test for liver function too which were also fine. I do drink in moderation and could prob exercise more. Could you give me any more insight to the below or should I worry? I do have some belly fat that I could lose a few lbs, but do enjoy a beer or wine (moderately) “The liver is unremarkable in size and is mildly and diffusely heterogenous in echogenicity. There is no focal mass or intrahepatic bile duct dilatation. The common duct is unremarkable and measures 0.3 cm.” Conclusion - "Heterogenous liver echotexture c/w mild fatty infiltration." Thanks again for your help!

Answered by Dr. Dr. Ivan Romich (1 hour later)

Brief Answer: Hi Detailed Answer: Well,this is US suggestive of fatty liver changes and this is common finding on routine US check ups. The most important thing is that there is no focal lesion ,tumor or sign of cirrhosis and biliary duct obstruction. Everything else is not serious and is reversible. You should not have some liver related symptoms considering this findings,especially if LFTs and bilirubin levels are fine, but certain lifestyle and dietary changes should be done. There is definitely no need for hepatoprotective medicines,but you should regulate your blood lipids and sugar since these are main causes of fatty liver. Also,obesity,alcohol and certain food and drugs have bad effect on liver too. There is no need for some drastic changes,but try to lose few kg, dont drink more than 4-5 beer per week,do some exercise and eat more vegetables and fruit,avoid fatty and spicy food. Liver condition should improve on these measures. You can check it again in 6 months, as well as LFTs and bilirubin levels.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (2 hours later)

Again, thank you very much. You time and effort has exceeded my expectations. This is a great resource for clarification and is much appreciated. Wish you were local to have as a main doctor! :-)

Answered by Dr. Dr. Ivan Romich (5 hours later)

Brief Answer: hi Detailed Answer: You re welcome. But I wish that you wont need surgeon in you life:)

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar