In patients with a prior primary cancer, an incidentally found splenic lesion presents a critical diagnostic challenge: distinguishing a benign tumor from splenic metastasis. Specific clinical and imaging factors determine the appropriate next steps.
The patient has a history of a primary neoplasm with a known tendency to metastasize to the spleen, and an incidentally discovered splenic lesion larger than 1 cm is present. Imaging characteristics raise concern for metastasis — including lesion heterogeneity, poorly defined or infiltrating margins, and multiplicity. In this context, the lesion should be suspected to be a metastasis until proven otherwise.
When these imaging features are present, additional diagnostic evaluation is warranted.
DOI: 10.1016/j.jacr.2013.05.020
In a patient with a history of a primary neoplasm with a tendency to metastasize to the spleen, an incidentally discovered splenic lesion >1 cm should be suspected to be a metastasis.
Although masses >1 cm may be benign, imaging characteristics that favor metastasis include heterogeneity of the lesion, poorly defined or infiltrating margins, and multiplicity.
If these imaging features are present, further evaluation with PET or biopsy may be considered.
Before any intervention of the spleen is contemplated, a surgical consult is essential for backup.
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