Tiffany Hennedige;
National Cancer Centre Singapore
Background
Identify imaging characteristics that may assist in determining if a focal splenic lesion is benign or malignant.
Educational Goals / Teaching Points
Recognize imaging characteristics that are more commonly encountered in benign and malignant focal splenic lesions.
Be able to make a more informed decision on whether a focal splenic lesion may be benign or malignant.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
All focal lesions were pathologically proven from splenectomy specimens obtained from our institution from January 2005 - October 2018. Imaging characteristics including number and size, margin (well or ill-defined), nature (mainly solid or mainly cystic), enhancement pattern (none, homogeneous or heterogeneous) and presence of calcification were used to determine if a focal splenic lesion was more likely to be benign or malignant. Imaging appearance of benign splenic lesions on CT, MRI and PET including cysts, hemangiomas, hamartomas, inflammatory pseudotumour, sclerosing angiomatoid nodular transformation (SANT) and extramedullary hematopoiesis are illustrated. Imaging appearance of malignant splenic lesions on CT, MRI and PET including metastases, diffuse large B-cell lymphoma and inflammatory pseudotumour-like follicular dendritic cell tumour are illustrated.
Conclusion
Majority of malignant splenic lesions are ill-defined, heterogeneously enhancing, mainly solid and often associated with an underlying malignancy. Few splenic lesions have associated calcification but those which did were more than likely to be benign. Both benign and malignant splenic lesions may be solitary or multiple and had no size predilection.
