Abstract
Splenic tumors are uncommon lesions that can be divided into two main categories: nonlymphoid and lymphoid. The most common nonlymphoid tumors are the vascular tumors, which include benign and malignant hemangiomas, lymphangiomas, and hemangioendotheliomas. The remaining nonlymphoid tumors, such as fibrosarcoma and lipoma, are so uncommon as to be only anecdotally reported. Of the lymphoid tumors, Hodgkin's lymphoma may rarely occur as a primary splenic tumor, but more commonly is seen as part of disseminated disease. The same is true of histiocytic lymphoma and plasmacytoma. Rare benign lymphoid lesions may simulate lymphoid tumors. Of the metastatic tumors to the spleen, melanoma, breast, and lung are the principal lesions, but metastases from many other neoplasms occur. Metastases to spleen are less common than to other parenchymatous organs for reasons yet unknown. The surgical approach to splenic tumors should conform to the principles of good tumor surgery with good access, extirpation without rupture, and correct handling of tissue for study. Partial splenectomy is an acceptable procedure for benign splenic cysts, and possibly for polar hamartomas.
Résumé
Les tumeurs spléniques sont des affections rares qui se subdivisent en deux groupes: les tumeurs lymphoïdes et les tumeurs non-lymphoïdes. Les tumeurs non-lymphoïdes les plus fréquentes sont les tumeurs vasculaires: hémangiomes bénins et malins, lymphangiomes et hémangioblastomes. Les autres tumeurs non-lymphoïdes: lipome et fibrosarcome sont rarissimes et ne sont rapportées qu'à titre anecdotique. Parmi les tumeurs lymphoïdes, la maladie de Hodgkin se traduit rarement par une tumeur splénique primitive, la splénomégalie étant en revanche le témoin de la dissémination de ce lymphome malin. Il en est de même pour le lymphome histiocytaire et le plasmocytome. Des lésions lymphoïdes bénignes rares peuvent simuler les tumeurs lymphoïdes. Les métastases spléniques des mélanomes des cancers du sein et du poumoun sont fréquentes, celles des autres néoplasmes sont moins fréquents. En fait les métastases du niveau de la rate sont plus rares qu'au niveau des autres organes ce fait restant inexpliqué.
Le traitement chirugical des tumeurs spléniques doit respecter les règles de la chirurgie carcinologique: bonne voie d'abord, exérèse sans rupture de la lésion, manipulation correcte des tissus pour permettre une étude adéquate. La splénectomie partielle s'applique seulement au traitement des kystes spléniques bénins et des harmartomes des pôles de la rate.
Resumen
Los tumores esplénicos son lesiones poco comunes que pueden ser clasificadas en dos categorías principales: no-linfoides y linfoides. Los tumores no-linfoides más comunes son los tumores vasculares, los cuales incluyen hemangiomas benignos y malignos, linfangiomas y hemangioendoteliomas. El resto de los tumores no-linfoides, tales como fibrosarcoma y lipoma, son tan poco frecuentes que apenas son informados en forma anecdótica. De los tumores linfoides, los linfomas de Hodgkin ocurren muy rara vez como tumor esplénico primario, y más bien son frecuentemente observados como parte de enfermedad diseminada. Esto también es válido para el linfoma histiocítico y para el plasmacitoma. Algunas raras lesiones linfoides benignas pueden simular tumores linfoides. De los tumores metastásicos del bazo, el melanoma y los neoplasmas del seno y del pulmón son los principales, pero las metástasis de otros neoplasmas también pueden ocurrir. Las metástasis al bazo son menos comunes que a otros órganos parenquimatosos por razones aún desconocidas. El aproche quirúrgico de los tumores esplénicos debe sujetarse a los principios de buena cirugía tumoral, con buen acceso, extirpación sin ruptura y manejo correcto de los tejidos para estudio. La esplenetomía parcial es un procedimiento aceptable para quistes esplénicos benignos y tal vez para hamartomas polares.
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Morgenstern, L., Rosenberg, J. & Geller, S.A. Tumors of the spleen. World J. Surg. 9, 468–476 (1985). https://doi.org/10.1007/BF01655283
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DOI: https://doi.org/10.1007/BF01655283