Unruptured splenic masses: Whats a veterinarian to do?

Getty ImagesHave you ever seen a patient with a non-ruptured splenic mass? What should you recommend? In patients in which the spleen has ruptured and free blood is in the abdomen, the diagnosis and treatment plan is clearer. A study found the frequency of malignancy in spleens with nonruptured masses that have been surgically removed to be as high as 241 of 500 (48%) to 59 of 100 (59%).1-4 Since splenectomy is a treatment option, clinicians want to know how to advise owners when the mass or nodule is not ruptured and may even be an incidental finding.

Exploring the mass effect

A recent study was designed to determine the frequency of malignancy and survival rates in these less clear cases. The study group included 105 client-owned dogs that had undergone splenectomy for non-ruptured splenic masses. This study was retrospective, and only patients with confirmed histologic diagnosis were included.

Seventy-four of 105 (70.5%) patients had benign splenic lesions, and 31 (29.5%) had malignant neoplasia, most commonly hemangiosarcoma (18/31 [58%]). Higher preoperative packed cell volume was associated with decreased mortality. Patients with a confirmed malignancy had the highest risk of death.

Median life expectancy of dogs with benign lesions was 436 days, which was significantly longer than the 110 days found in the group with malignant splenic tumors. More than half of the patients with benign lesions were still living at the end of the study, while only three of 31 patients with malignant neoplasia were alive at study conclusion.

Exam-room application

In this study, incidentally found splenic masses (without associated hemoperitoneum) were found to be most commonly benign. Results suggested that life expectancy for affected dogs that received prompt intervention was better than has previously been reported for other studied populations.

When advising clients whose pets have a splenic mass or nodule, knowing that many of these masses are benign and have a better prognosis when promptly treated can help you guide clients in their treatment options.

Cleveland MJ, Casale S. Incidence of malignancy and outcomes for dogs undergoing splenectomy for incidentally detected nonruptured splenic nodules or masses: 105 cases (20092013). J Am Vet Med Assoc 2016;248:1267-1273. 

Link to abstract: http://avmajournals.avma.org/doi/abs/10.2460/javma.248.11.1267

References

1. Johnson KA Powers BE Withrow SJ, et al. Splenomegaly in dogs. Predictors of neoplasia and survival after splenectomy. J Vet Intern Med 1989;3:160-166.

2. Spangler WL Kass PH. Pathologic factors affecting postsplenectomy survival in dogs. J Vet Intern Med 1997;11:166-171.

3. Spangler WL Culbertson MR. Prevalence, type, and importance of splenic diseases in dogs: 1,480 cases (19851989). J Am Vet Med Assoc 1992;200:829-834.

4. Day MJ Lucke VM Pearson H. A review of pathological diagnoses made from 87 canine splenic biopsies. J Small Anim Pract 1995;36:426-433.