Splenic benign tumors

　　According to the different origins of the tissues, the etiology of splenic benign tumors is mainly divided into three major types:

　　1. Splenic hamartoma is extremely rare, with an incidence rate of about 3 in 200,000 during splenectomy, and less than 10 cases have been reported in China. Its constituent components are consistent with those of normal spleen, also known as accessory spleen within the spleen, nodular proliferation of the spleen, and also referred to as splenic defect tumor in some literature. The etiology is the early developmental abnormality of the spleen blastocyst, which causes disordered combination ratio of normal spleen constituent components. The tumor is mainly composed of dysregulated splenic sinuses, and spleen corpuscles are rarely seen, while splenic trabeculae are absent or occasionally visible. Macroscopically, the tumor section appears round or elliptical, with clear boundaries, no capsule, and is grayish white and light red.

　　2. Splenic hemangioma is composed of spongy dilated blood vessels, also known as cavernous hemangioma, splenic cavernous hamartoma, splenic peripheral vascular dilatation hemangioma, and splenic hemangioma disease. Its occurrence is based on the fetal developmental abnormality of splenic vascular tissue, and it is also rare.

　　3. Splenic lymphangioma is common among the three benign tumors, accounting for 2/3. Splenic lymphangioma is composed of cystically dilated lymphatic vessels and is also known as cavernous lymphangioma or cystic lymphangioma of the spleen. Its occurrence is based on congenital local developmental abnormalities, with blocked lymphatic vessels continuously expanding.

　　In some cases, especially in splenic hemangiomas, spontaneous splenic rupture can occur due to the relationship between the artery and vein. Postoperative complications of benign spleen tumors can also include the following:

　　I. Abdominal complications

　　1. Bleeding: Delayed postoperative abdominal bleeding often occurs in patients with splenic dysfunction and poor liver function. Measures should be taken before and after surgery to improve coagulation function to prevent and treat bleeding.

　　2. Subdiaphragmatic infection or abscess: Often secondary to subdiaphragmatic hematomas. If the body temperature rises again 3 to 4 days after surgery, high vigilance should be maintained and a detailed examination should be conducted in a timely manner. If an abscess has formed, it should be drained promptly.

　　3. Postoperative acute pancreatitis: Although rare, it is a very serious condition, often caused by injury during surgery. For patients with severe upper abdominal or left upper abdominal pain, pancreatic amylase should be measured in a timely manner to make an accurate diagnosis and handle the situation promptly.

　　II. Pulmonary complications

　　Pulmonary atresia and pneumonia are the most common, especially in the elderly. If there is reactive pleural effusion on the left side of the chest, it should be suspected as subdiaphragmatic infection, but it can also be caused by pulmonary complications. Thoracentesis should be performed in time to aspirate the fluid for further diagnosis and treatment.

　　III. Other complications

　　1. Splenic vein inflammation: After the splenic vein is ligated during surgery, the proximal end becomes a blind end, making it prone to thrombosis. If complications such as infection occur, symptoms such as high fever, abdominal pain, and sepsis often occur. Prevention and treatment should be noted. Splenic vein inflammation is often the main cause of persistent fever after splenectomy, but it is also necessary to exclude the possibility of infection due to decreased immunity in patients after splenectomy.

　　2. Postoperative jaundice and hepatic coma: More common in patients with liver cirrhosis, with generally poor prognosis. Increased vigilance and timely prevention and treatment should be ensured.

　　Benign spleen tumors are often solitary, with varying sizes and shapes. Due to their hidden symptoms, clinical diagnosis is relatively difficult, and they are often found accidentally during post-mortem examination or laparotomy. In a few cases, symptoms such as left upper abdominal mass, pain, postprandial fullness, shortness of breath, and palpitations are caused by massive splenomegaly, or anemia and bleeding tendency caused by splenic dysfunction are found when seeking medical attention. Some cases are also found due to the cystic transformation and calcification of the mass.

　　To prevent benign spleen tumors, attention should be paid to the following:
　　Develop good living habits, maintain a balanced diet and nutrition, quit smoking and limit alcohol consumption. The principle of early prevention and early treatment should be adhered to for this disease. The patient's diet should be light and easy to digest, with an emphasis on eating more vegetables and fruits, reasonably matching the diet, and ensuring adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods.

　　The examination and laboratory tests for benign spleen tumors are briefly as follows:

　　Abdominal X-ray examination can detect an enlarged spleen shadow and local compression signs, but it is not specific. After barium meal, there are pressure marks on the fundus and greater curvature of the stomach, the transverse colon splenic flexure can be seen to be pushed to the right after barium enema, the left kidney can be seen to be pushed downward under venous angiography, B-ultrasound examination can be used as the first choice for the diagnosis of spleen tumors, which can show the size of the spleen, distinguish the cystic and solid nature of the tumor, understand the capsule condition of the tumor, and has high value for the diagnosis of spleen tumors. Color Doppler ultrasound can understand the blood supply inside the tumor, which is helpful to judge the nature of the tumor. CT is currently the most valuable imaging examination for diagnosing spleen tumors, which can provide a relatively accurate size, shape, and relationship with surrounding organs, and can detect small tumors of about 1cm. It can also compare and understand whether there are other lesions in surrounding organs. MRI has a similar diagnostic value for spleen tumors as CT, but its clinical application is not numerous. Selective abdominal aortic angiography can understand the distribution of spleen vascular branches, and can judge its nature according to the number of tumor vessels, compression, interruption, and new vessels, which is of important value for the diagnosis and differential diagnosis of spleen tumors. However, fine needle aspiration biopsy of the spleen under the guidance of B-ultrasound or CT is more difficult to locate due to the influence of the patient's breathing, and can also cause massive intra-abdominal hemorrhage or splenic pseudo-aneurysm, which has a high risk and should be used with caution.

　　Laparoscopic examination can observe the surface lesions of the spleen, and angiography and puncture biopsy can be performed under its guidance, which is of certain value for the diagnosis or understanding of the etiology of spleen diseases.

　　Patients with benign spleen tumors should avoid eating greasy, cold, and difficult-to-digest foods. Their diet should be light and easy to digest, with an emphasis on eating more vegetables and fruits, a reasonable diet, and ensuring adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, cold foods.

　　Due to the difficulty in distinguishing between benign and malignant tumors of the spleen in clinical practice, it is currently advocated that once discovered, a total splenectomy should be performed. For those confirmed to be benign tumors, segmental splenectomy or autologous splenoplastic transplantation after total splenectomy can also be considered to preserve the function of the spleen as much as possible. Some people believe that no treatment should be given for benign spleen tumors, but close follow-up and regular复查 should be conducted.