What should be done with echoic splenic tumors incidentally found by ultrasound?

The incidentally found primary intrasplenic tumor is mostly benign, but leads to a well known clinical problem: B-mode sonography, as well as computed tomography and MRI are often non-specific, and it is unclear whether a histological verification is warranted or a sonographic follow-up is justified.

etween October 2003 and October 2007 40 consecutive patients showed an echoic primary tumor of the spleen incidentally found by B-mode ultrasound (US) and were included in this prospective study. All tumors were classified regarding size and echogenity. In all patients contrast-enhanced ultrasound (CEUS) was perfomed and tumor enhancement was characterized in comparison to normal splenic enhancement. Patients were followed up every 3 months during the first year, and then once a year.

Sizes of the lesions were < 3 cm in diameter in 28 (70 %), between 3 - 5 cm in 10 (25 %) and > 5 cm in 2 (5 %) patients. Lesions were classified as predominantly hypoechoic (n = 27) and hyperechoic (n = 13) on B-mode US. During the arterial phase the lesions showed a hyperechoic (n = 12), isoechoic (n = 8), hypoechoic (n = 14), and anechoic (n = 6) enhancement on CEUS. Median follow was 24.8 months (range 3 - 48 months). Lesions were constant in size (n = 34) or shrinking (n = 5). In one patient a new 5 mm lesion was seen during follow-up. This patient refused the splenectomy and follow-up was continued without further tumor growth.

Echoic splenic tumors incidentally found by ultrasound can be managed by sonographic follow-up examinations.