Correspondence and Reprint requests : Dr Mirko Zganjer,
Children’s Hospital Zagreb, Klaiceva 16 , 10000 Zagreb, Croatia.
[Received April 02, 2009; Accepted September 6, 2009]
Huge Dermoid Cyst of the Spleen
Mirko Zganjer, Vlasta Zganjer1 and Irenej Cigit
Children’s Hospital Zagreb, Department of Pediatric Surgery, Klaiceva, 1Pfizer d.o.o. Radnicka Zagreb, Croatia
Primary splenic cysts are uncommon lesions of the spleen. Splenic cysts are classified as primary or secondary on the basis
of presence or absence of an epithelial lining. The primary cysts are further subdivided as parasitic or non-parasitic. The
congenital non-parasitic cysts are rarely met in clinical practice and it constitutes approximately 10% of all splenic cysts.
Congenital cysts are true cysts with an epithelial. Secondary cysts are in most cases posttraumatic. Patient at admission had
lower abdominal pain and splenic cyst was asymptomatic. In routine abdominal pain investigation we found cyst of the spleen
in diameter 2 cm. We made serodiagnostic tests for echinococcosis which were negative. After 3 years she came with left
upper quadrant enlargement with tangible abdominal mass, increasing abdominal girth, decrease of appetite and sometimes
vomiting. CT scan showed cyst enlargement in diameter 8x6 cm. Operative treatment was necessary and splenectomy was
done. However, splenectomy remains a relatively safe procedure, associated with few complications and avoiding any future
problems. [Indian J Pediatr 2010; 77 (4) : 454-455] E-mail: firstname.lastname@example.org
Key words : Spleen; Dermoid cyst; Children
Primary splenic cysts are uncommon lesions of the spleen
and splenic cysts are classified as primary or secondary
cysts on the basis of presence or absence of an epithelial
lining. The primary cysts are further subdivided as
parasitic or non-parasitic. The congenital non-parasitic
cysts constitutes approximately 10% of all splenic cysts.
Congenital cysts are true cysts with an epithelial lining.1
Secondary cysts are in most cases posttraumatic.2 True
cysts tumors include hemangiomas, lymphangiomas,
epidermoid and dermoid cysts. Of these, participation of
the dermoid cysts is the least.3
Congenital cysts of the spleen are usually
asymptomatic and become symptomatic because of
enlargement. In most of cases cysts were discover
accidentally when ultrasonography was made for another
reasons. Sometimes congenital cysts become symptomatic
because huge mass compresses the adjacent organs.
Preoperative diagnosis was established with
ultrasonography and computerized tomography.4 Our
patient came to us with history of vague abdominal
symptoms, dull pain, epigastric fullness, left upper
quadrant enlargement with tangible abdominal mass,
increasing abdominal girth, decrease of appetite, vomits
and constipation. Potential complications of a huge
splenic cyst include rupture with peritonitis, rupture with
massive hemorrhage, infection, abscess formation and
transdiaphragmatic perforation.5 After ultrasonography,
CT scan and laboratory tests, exploratory laparotomy was
performed and splenectomy was done.
REPORT OF CASE
An 11-yr girl came to our hospital due to pain in lower
part of abdomen. Routinely we made laboratory
examinations and ultrasound of abdomen. Laboratory
examinations showed normal results, ultrasound of
abdomen and CT scan showed cyst of the spleen in
diameter 2 cm. Abdominal pain ceased and we
recommended observation every 2 months. Before her
discharge we made serodiagnostic tests for echinococcosis
which were negative. We also made immunodiffusion
and immunoelectrophoresis which demonstrated specific
confirmation of reactivity.6,7
She did not report to the hospital for over 3 yrs. After
3 yrs, she noticed left upper quadrant enlargement with
tangible abdominal mass, increasing abdominal girth,
decrease of appetite and occasional vomiting. Physical
examination showed mild tenderness in the left upper
quadrant, with tangible abdominal mass. Roenteno-
graphy, ultrasound and CT scan were done. Laboratory
examinations showed normal results. Plain abdomen
roentenography showed that the stomach was medially
displaced; chest roentenography showed left
hemidiaphragmatic elevation. On ultrasound and CT
454Indian Journal of Pediatrics, Volume 77—April, 2010
Huge Dermoid Cyst of the Spleen
Indian Journal of Pediatrics, Volume 77—April, 2010 455
scan, we noticed a huge splenic cyst as a round
homogeneous, anechoic lesion with smooth thin wall
8x6cm in diameter. We again made serodiagnostic tests
for echinococcosis, which were negative.
Operative treatment included splenectomy.
Splenectomy was method of choice because the cyst was
large, with hilum pressure and only tiny island of splenic
tissue.8 After splenectomy, postoperative period was
without complications and girl was discharged from
hospital after 5 days. To avoid the risk of infection
following splenectomy, polyvalent pneumococcus
vaccine and antibiotic prophylaxis were advised.9
Histopathologically, dermoid cyst was composed of a
loosely fibrous wall which was covered with flattened,
epidermoid and low cuboidal epithelium on the inner
surface. Inner cyst surface was glossy with striking
trabeculation and contained serous fluid in the lumen. We
also noticed in the lumen, some appendage of smooth
muscle and connective tissue without skin appendages
Complete removal of the cysts is needed because
recurrence of the dermoid cysts has been reported.
Laparoscopic treatment of large true cysts of the spleen is
ineffective, because excision of the cysts lining is essential
and recurrence after laparoscopic excision is great. The
safe method of choice for huge cysts is splenectomy. We
prefer total splenectomy because this operative surgical
procedure is safer than other surgical procedure.
Splenectomy remains a relatively safe procedure,
associated with few complications and avoiding any
future problems. Laparoscopic marsupialization of giant
nonparasitic splenic cysts is not method of choice because
it is very difficult to make excision of the cysts lining.
After splenectomy, to avoid the risk of infection,
polyvalent pneumococcus vaccine and antibiotic
prophylaxis were given.9
The present patient recovered uneventfully and
without any complications. In postoperative period
routine hematological data, blood clotting factors, and
immunoglobulins were normal.
Contributions: Mirko Zganjer performed research and wrote the
paper; Vlasta Zganjer analyzed data; Irenej Cigit designed research
Conflict of Interest : When writing this paper no conflict of interest
was included in any aspects.
Role of Funding Source : No one had influence on the scientific
program and no one had any role in the writing of this report or in
the decision to submit it for publication
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6. Lequin R. “Enzyme immunoassay (EIA)/enzyme-linked
immunosorbent assay (ELISA)”. Clin Chem 2005; 51: 2415–
7. Yang YR, Craig PS, Ito A et al. A correlative study of
ultrasound with serology in an area in China co-endemic for
human alveolar and cystic echinococcosis. Trop Med Int Health
2007; 12: 637-646.
8. Ganti AL, Sardi A, Gordon J. Laparoscopic treatment of large
true cysts of the liver and spleen is ineffective. Am Surg 2002;
9. Mourtzoukou EG, Pappas G, Peppas G et al. Vaccination of
asplenic or hyposplenic adults. Br J Surg 2008; 95: 273-280.
Fig. 1. Spleen cyst after splenectomy.
Congenital cysts of the spleen are rare and are usually
discovered incidentally in childhood or adolescence.
Nonoperative treatment is recommended for small cysts
upto 5 cm in diameter, if the cysts are asymptomatic.
Imaging characteristics with serodiagnostic tests for
echinococcosis are typical of nonparasitic splenic cysts.
For cysts over 5 cm in diameter with clinical signs,
operative treatment is necessary. Potential complications
of huge splenic cysts include infection, abscess formation,
transdiaphragmatic rupture with empyema.
with peritonitis and