Sclerotherapy of Symptomatic Nonparasitic Splenic Cysts: Excellent Long-Term Treatment Response'

Abstract

Background Splenic cysts are rare and occur in 0.5 to 2% of the population. They are usually asymptomatic and do not require therapy. In case of symptomatic nonparasitic splenic cysts, potential therapy includes partial splenectomy or laparoscopic cyst de-roofing as well as ultrasound-guided sclerotherapy with 1% polidocanol or 10% sodium chloride (NaCl) as an interventional alternative. So far, single-session sclerotherapy of symptomatic nonparasitic cysts is recommended only if clear-transparent cyst fluid is aspirated.

Materials and Methods We report a case series of 17 patients with symptomatic macroscopically turbid nonparasitic splenic cyst fluid who underwent ultrasound-guided fine needle sclerotherapy with either polidocanol ± 10% NaCl (n = 12) or 10% NaCl alone (n = 5) and a follow-up of a maximum of 12 years after first intervention. Clinical, sonographic, and laboratory chemistry data were recorded at baseline and during the follow-up.

Results The mean follow-up time was 43.65 ± 40.18 months. At the end of the follow-up, a 79% reduction of cyst size was achieved. The maximum size reduction in the polidocanol group was 76 ± 18% and 84 ± 21% in the sodium chloride group (p >0.05). At the end of follow-up, 15 out of the 17 patients did not have any further symptoms. Despite the cystic fluid being turbid, it was hardly possible to detect a microbiological superinfection.

Conclusion Sclerotherapy of splenic cysts leads to a significant size regression in all patients, independent of the sclerotherapy agent used with fewer systemic toxic side effects of polidocanol treatment. It was shown that in a tertiary care center with significant experience, sclerotherapy of splenic cysts is also safe and successful and can lead to a drastic regression of cyst size and symptoms. This shows that interventional therapy is a good alternative to surgical procedures.

Keywords

splenic cyst - sclerotherapy - polidocanol - interventional ultrasound - de-roofing

Authors' Contribution

M.D.: Acquisition of data, or analysis and interpretation of data; drafting the article.

H.W.: Critical revision for important intellectual content; final approval of the version to be published.

M.G.: Critical revision for important intellectual content; final approval of the version to be published.

A.P.: Conception and design, interpretation of data; critical revision for important intellectual content; final approval of the version to be published.

S.Z.: Conception and design, interpretation of data, drafting and critical revision of the article for important intellectual content; final approval of the version to be published.

Publication History

Received: 04 May 2021

Accepted: 10 December 2021

Article published online:
14 January 2022

• References

• 1 Higaki K, Jimi A, Watanabe J, Kusaba A, Kojiro M. Epidermoid cyst of the spleen with CA19-9 or carcinoembryonic antigen productions: report of three cases. Am J Surg Pathol 1998; 22 (06) 704-708
• 2 Ignee A, Cui X, Hirche T. et al. Percutaneous biopsies of splenic lesions – a clinical and contrast enhanced ultrasound based algorithm. Clin Hemorheol Microcirc 2014; 58 (04) 529-541
• 3 Martin JW. Congenital splenic cysts. Am J Surg 1958; 96 (02) 302-308
• 4 Rasheed K, Zargar SA, Telwani AA. Hydatid cyst of spleen: a diagnostic challenge. N Am J Med Sci 2013; 5 (01) 10-20
• 5 Macheras A, Misiakos EP, Liakakos T, Mpistarakis D, Fotiadis C, Karatzas G. Non-parasitic splenic cysts: a report of three cases. World J Gastroenterol 2005; 11 (43) 6884-6887
• 6 Ingle SB, Hinge Ingle CR, Patrike S. Epithelial cysts of the spleen: a minireview. World J Gastroenterol 2014; 20 (38) 13899-13903
• 7 Palanivelu C, Rangarajan M, Madankumar MV, John SJ. Laparoscopic internal marsupializaton for large nonparasitic splenic cysts: effective organ-preserving technique. World J Surg 2008; 32 (01) 20-25
• 8 Gianom D, Wildisen A, Hotz T, Goti F, Decurtins M. Open and laparoscopic treatment of nonparasitic splenic cysts. Dig Surg 2003; 20 (01) 74-78
• 9 Goktay AY, Secil M, Ozcan MA, Dicle O. Percutaneous treatment of congenital splenic cysts: drainage and sclerotherapy with polidocanol. Cardiovasc Intervent Radiol 2006; 29 (03) 469-472
• 10 Rifai K, Berger D, Potthoff A, Manns MP, Gebel MJ. Fine needle sclerotherapy as a new effective therapeutic approach for nonparasitic splenic cysts: a case series. Dig Liver Dis 2013; 45 (07) 595-599
• 11 Dietrich CF, Chiorean L, Potthoff A, Ignee A, Cui X, Sparchez Z. Percutaneous sclerotherapy of liver and renal cysts, comments on the EFSUMB guidelines. Z Gastroenterol 2016; 54 (02) 155-166
• 12 Brunetti E, Kern P, Vuitton DA. Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114 (01) 1-16
• 13 Ito A, Craig PS. Immunodiagnostic and molecular approaches for the detection of taeniid cestode infections. Trends Parasitol 2003; 19 (09) 377-381
• 14 Sylvoz N, Villier C, Blaise S, Seinturier C, Mallaret M. [Polidocanol induced cardiotoxicity: a case report and review of the literature]. J Mal Vasc 2008; 33 (4-5): 234-238
• 15 Doolas A, Nolte M, McDonald OG, Economou SG. Splenic cysts. J Surg Oncol 1978; 10 (05) 369-387
• 16 Robbins FG, Yellin AE, Lingua RW, Craig JR, Turrill FL, Mikkelsen WP. Splenic epidermoid cysts. Ann Surg 1978; 187 (03) 231-235
• 17 Sinha CK, Agrawal M. Nonparasitic splenic cysts in children: current status. Surgeon 2011; 9 (01) 49-53
• 18 Yang X, Yu J, Liang P. et al. Ultrasound-guided percutaneous ethanol ablation for primary non-parasitic splenic cysts in 15 patients. Abdom Radiol (NY) 2016; 41 (03) 538-544