1
|
Gasparetto A, Alonso J, Temple M, Parra D, Chiramel G, Chand R, Amaral J. Safety and Effectiveness of Sclerotherapy for Nonparasitic Splenic Cysts: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2023; 34:2110-2119.e1. [PMID: 37652298 DOI: 10.1016/j.jvir.2023.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE To assess the reported safety and effectiveness of sclerotherapy for the treatment of nonparasitic splenic cysts through a systematic review and meta-analysis. MATERIALS AND METHODS A systematic search of PubMed MEDLINE, Embase, Web of Science, and the Cochrane Library through July 2023 was performed. Studies including at least 5 patients reporting percutaneous sclerotherapy of nonparasitic splenic cysts, initial and posttreatment cyst size, clinical symptoms as well as adverse events (AEs), and recurrence rates were included. A 0-8-point scale for case reports and case series was used to assess bias. Data were analyzed using random-effects meta-analysis. RESULTS Twenty-three of 833 citations were selected for full-text assessment, and 7 studies were included for a total of 99 patients. The methodological quality of the studies included scored 3-7. Composite analysis demonstrated 38% (95% CI, 23%-55%) rate of recurrence after treatment with significant heterogeneity; however, when assessed for a cyst size of <8 cm, recurrence dropped to 7% (95% CI, 2%-20%). Residual symptoms after treatment completion were present in 17% (95% CI, 7%-33%). Intraprocedural and postprocedural AE rates were 6% (95% CI, 3%-13%) and 6% (95% CI, 3%-12%) respectively. CONCLUSIONS Sclerotherapy of splenic cysts seemed to be safe, with a high rate of recurrence for cysts ≥8 cm.
Collapse
Affiliation(s)
- Alessandro Gasparetto
- Department of Interventional Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Jaime Alonso
- Department of Interventional Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael Temple
- Department of Interventional Radiology, St. Jude Hospital, University of Tennessee, Memphis, Tennessee
| | - Dimitri Parra
- Department of Interventional Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George Chiramel
- Department of Interventional Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rajat Chand
- Department of Interventional Radiology, UNC Hospitals, University of North Carolina, Chapel Hill, North Carolina
| | - Joao Amaral
- Department of Interventional Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Giurazza F, Marra P, Mosconi C, Corvino F, Corvino A, Niola R. Primary non-parasitic splenic cyst: US- and fluoroscopy-guided percutaneous management by alcohol sclerosis on six patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1360-1367. [PMID: 36053957 DOI: 10.1002/jcu.23298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/13/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This manuscript aims to report on a retrospective analysis of six patients treated with combined US- and fluoroscopic-guided percutaneous alcohol sclerosis for primary non-parasitic splenic cysts. METHODS In this retrospective analysis, three females and three males affected by primary non-parasitic splenic cysts were included. All except one were symptomatic. Preoperative cyst diameter was in mean 113 mm (range: 67-210 mm). Ethanol 96% was adopted as sclerosant agent; the amount of ethanol injected corresponded to the 20%-30% of the cystic volume. US follow-up was planned at 2/4 weeks; MR follow-up was conducted almost at 6 months after the last treatment session. Technical success was considered as cyst disappearance or reduction of the maximum diameter <50 mm; clinical success, in those symptomatic cases, was considered as symptoms resolution or marked improvement. RESULTS Eleven procedures had been performed: one in three patients, three in two patients and two in one patient. Technical success was 83.3%; clinical success was 80%. Only one patient, with a preoperative cystic diameter of 210 mm and despite three treatment sessions, had an increase in the cystic size and did not report symptoms improvement. CONCLUSIONS In this sample, US-guided percutaneous alcohol sclerosis was a safe and effective spleen preserving option to treat primary non-parasitic splenic cysts.
Collapse
Affiliation(s)
- Francesco Giurazza
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, Naples, Italy
| | - Paolo Marra
- Department of Diagnostic Radiology, Giovanni XXIII Hospital, Milano-Bicocca University, Bergamo, Italy
| | - Cristina Mosconi
- Radiology Unit, Department of Specialized, Diagnostic and Experimental Medicine, DIMES, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Fabio Corvino
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, Naples, Italy
| | - Antonio Corvino
- Motor Science and Wellness Department, University of Naples "Parthenope", Naples, Italy
| | - Raffaella Niola
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, Naples, Italy
| |
Collapse
|
3
|
Kumar SB, Richards J, Butcher K, Welbourn R. Two cases of non-parasitic splenic cysts and spleen-preserving therapy. Ann R Coll Surg Engl 2021; 103:e109-e113. [PMID: 33661055 DOI: 10.1308/rcsann.2020.7043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We review two different presentations of non-parasitic splenic cysts, both of which are post-traumatic in aetiology. The first case was of slower onset and was managed electively. The second case was of acute onset and was managed as an emergency. Non-parasitic splenic cysts are uncommon and the optimal management strategy for them is not well defined. Historically, treatment has been with open splenectomy; however, infection rates following this surgery have been high, making it an unattractive management option. Both cases were managed successfully with laparoscopic fenestration with no recurrence at subsequent follow-up.
Collapse
Affiliation(s)
- S B Kumar
- Musgrove Park Hospital, Taunton, Devon, UK
| | - J Richards
- Musgrove Park Hospital, Taunton, Devon, UK
| | - K Butcher
- Musgrove Park Hospital, Taunton, Devon, UK
| | - R Welbourn
- Musgrove Park Hospital, Taunton, Devon, UK
| |
Collapse
|
4
|
Chung P, Swinson B, O'Rourke N, Schmidt B. Massive splenic cyst in pregnancy: case report. BMC Pregnancy Childbirth 2020; 20:273. [PMID: 32375702 PMCID: PMC7201964 DOI: 10.1186/s12884-020-02968-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary splenic cysts are very rarely diagnosed in pregnancy, with only thirteen cases described in the literature. We examine the approach towards diagnosing and managing uniquely large abdominal masses that significantly complicate obstetric care. CASE PRESENTATION A 37-year-old primigravida woman presented with abdominal distension and discomfort, yet otherwise asymptomatic. On ultrasound, an incidental pregnancy at 25 weeks of gestation and a large pelvic lesion were discovered. MRI defined a 28 × 29 cm lobulated, complex cystic mass in the upper abdomen. The patient underwent two ascitic drainages throughout her pregnancy. At 34 weeks of gestation, she had a classical caesarean section. Then at five-weeks postpartum, she underwent a laparotomy and total splenectomy with 16 L of fluid drained. Histopathological analysis revealed an epithelial cyst of the spleen. Her recovery was complicated by complete portal vein thrombosis. CONCLUSION This case describes the largest splenic cyst ever reported in pregnancy and explores the diagnostic dilemmas and treatment challenges associated. We introduce the utility of serial ascitic drainages in prolonging the pregnancy and emphasise the reliance on imaging for surveillance of splenic size and fetal wellbeing.
Collapse
Affiliation(s)
- Philip Chung
- Department of Obstetrics and Gynaecology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.
| | - Ben Swinson
- Department of General Surgery, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Nicholas O'Rourke
- Department of General Surgery, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Bart Schmidt
- Department of Obstetrics and Gynaecology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
5
|
Imoto Y, Einama T, Fukumura M, Kouzu K, Nagata H, Matsunaga A, Hoshikawa M, Nishikawa M, Kimura A, Noro T, Aosasa S, Shimazaki H, Ueno H, Yamamoto J. Laparoscopic fenestration for a large ruptured splenic cyst combined with an elevated serum carbohydrate antigen 19-9 level: a case report. BMC Surg 2019; 19:58. [PMID: 31146770 PMCID: PMC6543565 DOI: 10.1186/s12893-019-0517-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 05/14/2019] [Indexed: 12/19/2022] Open
Abstract
Background Non-parasitic splenic cysts are associated with elevated serum carbohydrate antigen (CA) 19–9 levels. We report a case in which a 23-year-old female exhibited a large ruptured splenic cyst and an elevated serum CA19–9 level. Case presentation The patient, who experienced postprandial abdominal pain and vomiting, was transferred to our hospital and was found to have a large splenic cyst during an abdominal computed tomography (CT) scan. On physical examination, her vital signs were stable, and she demonstrated rebound tenderness in the epigastric region. An abdominal CT scan revealed abdominal fluid and a low-density region (12 × 12 × 8 cm) with enhanced margins in the spleen. The patient’s serum levels of CA19–9 and CA125 were elevated to 17,580 U/mL and 909 U/mL, respectively. A cytological examination of the ascitic fluid resulted in it being categorized as class II. Finally, we made a diagnosis of a ruptured splenic epidermoid cyst and performed laparoscopic splenic fenestration. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 5. The cystic lesion was histopathologically diagnosed as a true cyst, and the epithelial cells were positive for CA19–9. Follow-up laboratory tests performed at 4 postoperative months showed normal CA19–9 (24.6 U/L) and CA125 (26.8 U/L) levels. No recurrence of the splenic cyst was detected during the 6 months after surgery. Conclusion Laparoscopic fenestration of a ruptured splenic cyst was performed to preserve the spleen, after the results of abdominal fluid cytology and MRI were negative for malignancy.
Collapse
Affiliation(s)
- Yoshitaka Imoto
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takahiro Einama
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Makiko Fukumura
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Keita Kouzu
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiromi Nagata
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ayano Matsunaga
- Laboratory Department, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Mayumi Hoshikawa
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Makoto Nishikawa
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Akifumi Kimura
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takuji Noro
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Suefumi Aosasa
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hideyuki Shimazaki
- Laboratory Department, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Hideki Ueno
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Junji Yamamoto
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| |
Collapse
|