Splenic lymphangiomas as a common indication for splenectomy: a case series with literature review

Abstract

Background: Splenic lymphangiomas (SL) are very rare benign cystic lesions found in pediatric population. Their occurrence in adults is exceptional. Splenectomy is the common management of splenic lesions for diagnostic and/or therapeutic purpose. Our aim is to report additional cases of SL diagnosed on splenectomy specimens at our Pathology laboratory with literature review.

Methods: This is a retrospective study including all cases of splenectomy recorded at our Pathology laboratory (June 2020-August 2022). We performed a comparison of clinicopathological features between patients with SL and those with other benign splenic diseases.

Results: Sixteen cases of splenectomy were included. The mean age was 30.25 years (range of 6-70 years). The final histopathological diagnoses were congestive spleens in all cases of sickle cell disease (SCD) (5/16 patients, 31.25%), splenic cystic lymphangiomas (4/16 patients, 25%), capsular splenic infiltration by gastric and colic cancers (3/16 cases, 18.75%), splenic abscess (2/16 cases, 12.5%) and splenic rupture with subcapsular hematoma (1/16 patients, 6.25%). 12/16 patients (75%) had benign splenic conditions (4/12 with SL, 5/12 with SCD, 2/12 with abscess and 1/12 with splenic trauma). Patients with SL were older than those with other benign splenic conditions (mean age of 28.27 years versus 20.87 years). Also patients with SL presented with massive splenomegaly (mean splenic weight of 1675 g versus 418.75 g, mean splenic size of 19.62 cm versus 14.63 cm). Open surgery was performed in 15/16 patients (93.75%).

Conclusion: Unlike previous studies, our series shows that SL are a common indication for splenectomy and occur in older patients with massive cystic splenomegaly. Open splenectomy is still an usual surgical practice in our country.

Keywords: Cysts; Histopathology; Lymphangioma; Spleen; Splenectomy.

Fig. 1

A Surgical specimen of distal splenopancreatectomy showing a spleen with a smooth surface (case 1). B Laparoscopic view of a spleen with a smooth surface in a patient with SCD (case 6)

Fig. 2

A Macroscopic view (after formalin fixation) of a splenic lymphangioma showing a well-encapsulated septated cyst with serous content (case 7). B Macroscopic view (after formalin fixation) of a splenic lymphangioma showing an entirely bosselated spleen (case 10). C Macroscopic view of a splenic lymphangioma cut surface showing multiple cysts occupying the entire spleen with mucoid and sero-hematic content (case 10)

Fig. 3

A Histological view of a splenic specimen in a patient with SCD showing congestive spleen with multiple dilated small vessels in the red and white pulp (hematoxylin–eosin × 40) (case 16). B At higher magnification, the splenic parenchyma is dissociated by numerous sickled, spindle-shaped red blood cells characteristic of the SCD (black arrows) (hematoxylin–eosin × 400) (case 16)

Fig. 4

A Histological view of a splenic lymphangioma showing variable-sized cystic spaces containing amorphous eosinophilic material (hematoxylin–eosin × 100) (case 10). B At higher magnification, splenic lymphangioma is made of cystic spaces lined by flattened endothelial cells without atypias (hematoxylin–eosin × 400) (case 10)

Fig. 5

Histological image of a splenic abscess consisting of necrotic cells, altered neutrophils associated with fibrin deposition (hematoxylin–eosin × 200) (case 11)