Splenic Cystic Lesion - further evaluation with MRI

AJinNY

Hello.

I am in my mid 50's and a year ago I was diagnosed with testicular cancer. At that time a CT scan of the abdomen and pelvis was done and an incidental finding was a 5cm simple cyst in my spleen. Every few months I get a CT scan of the abdomen and pelvis to make sure that the testicular cancer has not come back. However, over the past year, the splenic cyst has continued to grow and got a little denser which the radiologist suggested could be from hemorrhage into the cyst.

My most recent CT scan showed the splenic cyst continues to grow and is now over 6 cm and the radiologist described it as "homogeneous, low in density and benign in appearance". However the radiologist recommended a pre and post contrast MRI for "further evaluation". The radiologist's report did NOT specifically say this was to evaluate for malignancy or suspicious for lymphoma. I'm scared because the oncologist did mention lymphoma as a possibility.

My oncologist gave me a physical exam and there is no splenomegaly and my blood tests - CBC and metabolic - are within normal limits. Also my LDH is normal. I am not anemic and do not have any pain, fever, night sweats, etc.. Apart from the splenic cystic lesion, everything else in my CT scan appears normal.

Is this splenic cystic lesion worrisome for lymphoma?

Thank you for reading and best wishes for good health to all.

po18guy

I do not think so. Cysts can appear, disappear, grow or shrink on their own. Doctor is covering his or her nether regions in ordering further tests. However, it might be good to either excise/drain the cyst or take a needle biopsy from several areas of it to rule malignancy out. Just my lay opinion.

AJinNY

https://csn.cancer.org/discussion/comment/1709507#Comment_1709507

Thanks for your reply, po18guy. I appreciate it.

Would you say the likelihood is that they are just making 100% sure they didn't miss anything since I previously had a malignancy?

Could a splenic cyst appear benign on a CT scan but differently on MRI?

po18guy

With your history, they are certainly being cautious. Unfortunately, this is not comforting process for the patient. Scans use differing technologies to indicate different situations or conditions. Neither CT nor MRI - or even a PET scan for that matter, are capable of diagnosing a malignancy. They simply point out unusual physical factors observed and give direction to further diagnostic work. PET scans are more cancer specific but are still not diagnostic in nature. They note only hyper-metabolic activity, which can also be associated with infection, injury, strenuous physical exertion or other factors. The only manner in which a malignancy may be properly diagnosed is via a pathological examination of an actual tissue or fluid sample.

If the cyst is asymptomatic, doctor may decide to watch and wait, treat it or excise it. I have had various cysts come and go, in my sinuses as well as my eyes. I think it best at this point to discuss with doctor the best manner of dealing with it. Lymphoma? Almost anything includes the potential for lymphoma. Our bodies generate mutated cells as we speak - and which are killed by our circulating immune cells. As to lymphoma, I have had two rare varieties five times, as well as a bone marrow cancer and lately, a low risk skin cancer. There is not much at this time that bothers me.

AJinNY

https://csn.cancer.org/discussion/comment/1709546#Comment_1709546

Maybe at some point they will do a biopsy. I hope this thing stops growing and maybe even shrinks. My recent bloodwork was normal - RBC, WBC, etc but my lymphocytes dropped and was a hair under normal. When the labs were taken I had a big flare up of allergies and was taking OTC meds. Could that have caused the drop in lymphocytes or perhaps this is just a regular fluctuation?

I'm sorry you have had to deal with so much and I wish you all the best.

Thanks again.

po18guy

https://csn.cancer.org/discussion/comment/1709582#Comment_1709582

Thank you. No worries about me. If there is any notation that your spleen is enlarged, it is probably due to it collecting lymphocytes, thus fewer are flowing in the blood, and lower readings. Why is it doing that? Well... medical degrees scratch their heads in wonder.

AJinNY

https://csn.cancer.org/discussion/comment/1709583#Comment_1709583

No splenomegaly. The oncologist also did a physical exam so from that standpoint things appear fine. Its just this cystic lesion thing 😳

po18guy

https://csn.cancer.org/discussion/comment/1709585#Comment_1709585

This site has information that aligns with your experience and what doctor has told you. Even with symptoms, "It is not cancer until a pathology report says it's cancer" - and you do not even have symptoms. I would take comfort in knowing that.

https://radiologyinplainenglish.com/splenic-cyst/

AJinNY

So I had the MRI which confirms that it is a benign appearing cyst and that the spleen is normal in size. He examined me again and pressed down on the abdomen and I confirmed there was no pain. I have to get CT scans regularly because of the testicular cancer but instead he wants me to get MRIs this way we can continue to monitor the splenic cyst and the spleen. This cyst grew more than 1 cm in a year and he said cysts are usually slow growing so he is concerned. Is he just being precautious since he is a oncologist/hematologist? Do I have to continue worrying about this?

po18guy

Aware, but not worried. Actually MRIs are better than CT scans as they do not involve radiation. So, kind of a win-win there.

AJinNY

You're absolutely right - no radiation with the MRI and I do not have to drink that barium sulfate. The only problem is that the last 5 minutes or so I was getting really anxious.

I asked if this cyst becomes problematic can we just drain it and do sclerotherapy. He said that the spleen is very vascular and we'd rather not poke around in there because it could cause bleeding. Hopefully this cyst stops growing. I do not want to lose my spleen.

po18guy

Might be a goods to shop your case around to a few abdominal surgical specialists - you have the time, thankfully.

Oh, anxiety. One in five today suffer from some form of anxiety. If an MRI gets to you, the gold standard in anxiety thertapy is drug-free and can even be done over the phone: Cognitive Behavioral Therapy. Maybe look into that, as I must admit that there is some anxiousness in your replies. Just a thought, as you deserve to live in peace.

AJinNY

Im definitely a worrier and it has been getting stressful. This cyst continues to grow but they do say it appears benign so I'm not sure why the oncologist now seems so concerned about this potentially turning into lymphoma.

po18guy

I say, deal with the stress/anxiety first! Consider: you do not have cancer, but are worried about it. Anxiety will steal your peace for years to come if not dealt with. Please look into it, as life is stressful enough as is.