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Verma M, Vashist M G, Dalal S, Chanchal, Singla A
Splenic cysts are not frequently encountered in everyday surgical practice. They are either parasitic (usually
hydatid cysts) or non parasitic (true cysts with epithelial lining or more commonly false cysts). We report the
case of a patient with a palpable mass and abdominal pain in the left upper quadrant. USG and CECT abdomen
revealed it to be a large splenic cyst. Histopathological examination confirmed it as an epidermoid cyst and
splenectomy was done.
splenic cyst, splenomegaly, splenectomy
Epidermoid cyst of the spleen
ABSTRACT
Keywords:
INTRODUCTION
CASE REPORT
Splenic cyst can be parasitic (hydatid) or
nonparasitic. Primary nonparasitic splenic cysts
(PNSC) are rare and account for 10% of all
nonparasitic splenic cysts, but they are the most
frequent type of splenic cysts in children. They are
classified as primary (true epithelial), lined by an
epithelial cover (epidermoid, dermoid and
mesothelial) or endothelial cover (hemangioma,
lymphangioma) and secondary (pseudocysts, non-
epithelial), which are usually of post-traumatic
1
origin. Though the cysts are asymptomatic, except
for pain due to mass effect in the abdomen. It can
get infected or rupture causing acute abdomen.
A 31-year-old man presented with history of
abdominal discomfort and fullness in his left upper
abdomen since ten months. Physical examination
revealed a large, smooth, nontender mass
occupying the left hypochondrium. The routine
hematological and biochemical tests were normal.
Serologic tests were negative for parasitic
infection. USG and CT abdomen showed a well
defined splenic cyst of size 16 x 14 cm, displacing
the stomach to the right (Fig 1).
Fig.1: CT abdomen showing hypoechoic cyst of spleen
The diagnosis of a splenic cyst was confirmed and
the exploratory laparotomy was scheduled in two
weeks. On exploration, a very large cyst of the
spleen occupying the entire left upper abdomen
was found. The large size and little splenic
parenchyma made preservation of the spleen
impossible. The splenectomy was performed and
sent for histopathological examination. The excised
organ measured 26 X 18 X 16 cm and weighed
750gms with intact surface. The cyst was unilocular
and contained about 550ml of yellowish brown
granular fluid.
The inner surface was yellowish to whitish
glistening with marked trabeculations and normal
appearing adjacent splenic parenchyma of size 8 x 3
cm. Histology revealed picture of a true cyst
composed of a wall lined by both squamous and
mesothelial cubic epithelia, consistent with the
diagnosis of an epidermoid cyst of the spleen. (Fig
2) The postoperative course was uneventful and
the patient was discharged 5 days after the
operation.
IJRRMS VOL-3 No.2 APR - JUN 2013 | | | |
IJRRMS 2013;3(2)
Case Report
47
Fig.2: Microscopic examination of splenic epidermoid
cyst.
DISCUSSION
Andral G was credited for first to report a splenic cyst
2
at autopsy. Majority of splenic cysts are parasitic
and are due to Echinococcus granulosus infestation
3
particularly in endemic areas. Martin offered a
sim plif i ed cl inica l cla ssifi cati on wh e re i n
hemangioma was the most common primary cyst
and dermoid was the rarest. Nonparasitic splenic
cysts may be completely asymptomatic or may
present with acute abdominal symptoms due to
displacement of surrounding structures by the
enlarging splenic mass. Gradual enlargement may
be due to the proliferation and the secretions of the
lining cells or to the bleeding from the cystic wall, as
4
well as to an osmotic imbalance of the cystic fluid.
USG, CT and MRI provide most of the necessary
information about the morphology of the cyst, the
composition of the cystic fluid and their location in
the spleen, the position of the cyst and its
5,6
relationship with the surrounding tissues. Earlier,
the classical approach to splenic cysts has been
open complete splenectomy but today the options
hav e c h a ng e d t o p ar t ia l s pl e ne c to m y,
marsup i a l i z a t i o n , o r cyst deca p s u l a t i o n
(unroofing), accessed either by open laparotomy
7
or lap a r o s copy. Pa r t i al splenecto m y is
recommended, if the cyst is located in the poles of
the spleen.
Present case serves to highlight that though splenic
epidermoid cyst is an infrequent entity, it should be
considered in the differential diagnosis of a splenic
cystic mass. An attempt should be made to
preserve the spleen provided there is adequate
parenchyma, otherwise splenectomy is the rule.
Assistant Professor,
E - m ail : m ani s h. v e rma 4 26 @g mai l .c om
(Corresponding Author)
Senior Professor
Professor
Junior Resident
Junior Resident
Department of General Surgery, Pt. B. D. Sharma
Postgraduate Institute of Medical Sciences,
Rohtak
AUTHOR NOTE
Manish Verma,
M. G. Vashist,
Satish Dalal,
Chanchal,
Amit Singla,
REFERENCES
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7. Till H, Schaarschmidt K. Partial laparoscopic decapsulation of congenital splenic cysts. A medium-term
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Verma M et al. Epidermoid cyst of the spleen
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