Giant epidermoid cyst of the spleen in a pediatric patient: A case report

Large epidermoid cyst of the spleen causing massive splenomegaly: A case report

Splenic cysts are uncommon and are classified as primary cysts or secondary cysts based on the presence or absence of an intact epithelial lining, respectively. Epidermoid cysts have an epithelial lining of stratified squamous epithelium and have been reported in normal and intra-pancreatic accessory spleens. An 18-year-old girl presented with a symptomatic, uncomplicated splenic cyst causing massive splenomegaly and symptoms due to mass effect. Peripheral cytopaenias and lymphoproliferative neoplasm were excluded. Preoperative computed tomography was suggestive of a large splenic cyst causing massive splenomegaly and marked loco-regional pressure effects. Open splenectomy was performed and histology confirmed an epidermoid cyst with no features of malignancy. Splenic epidermoid cysts are a rare cause of massive splenomegaly. Surgical intervention is recommended due to symptoms and the risk of complications.

A Case Report of a Large Splenic Cyst in a Pediatric Patient

Splenic cysts in the pediatric population are rare but can present with a range of clinical manifestations. Acute abdominal pain, although uncommon, is a significant presentation that requires prompt evaluation and management. We present the case of an 11-year-old female who presented to the emergency department with severe left upper quadrant abdominal pain of 24 hours' duration. Physical examination revealed tenderness and guarding in the left upper quadrant with a palpable, firm mass. Elevated serum amylase and lipase levels initially raised suspicion of a pancreatic etiology, but further investigations confirmed the presence of a large cystic lesion in the spleen. The patient underwent laparoscopic splenectomy, and the resected specimen confirmed a benign splenic cyst. Postoperatively, she recovered uneventfully and was discharged with appropriate follow-up plans. This case report underscores the importance of early recognition and prompt surgical intervention in managing splenic cysts in pediatric patients. The diverse etiologies and pathophysiological mechanisms of splenic cysts necessitate a comprehensive diagnostic approach.

Large splenic epithelial cyst: A rare presentation

Introduction and importance

Splenic cysts are infrequent and most of them are related to parasitic diseases. Splenic epithelial cyst (SEC) is the most common type of primary non-parasitic splenic cysts. Its pathogenesis is not yet clear. Splenic cysts are usually asymptomatic and are detected incidentally during imaging exams or an exploratory laparotomy.

Case presentation

Our case is about a primary SEC discovered incidentally. An 18-year-old male patient without any personal and family medical history, presented with symptoms of upper urinary tract infection. Renal ultrasound was performed and found incidentally a solitary cystic lesion in the spleen. A laparoscopic partial splenectomy was made then. The specimen was sent for pathological examination and a diagnosis of primary (epidermoid) epithelial splenic cyst was given.

Clinical discussion

SEC is a rare pathology that could mimic other splenic cysts like hydatid cyst. The preoperative diagnosis of SEC can be suspected by ultrasonography, computed tomography or magnetic resonance imaging. However, histopathological examination is mandatory to confirm the diagnosis. A wide range of differential diagnoses is considered when we suspect clinically SEC because of its lower incidence.

Conclusion

Actually, spleen-preserving surgery with minimally invasive methods such as laparoscopy is the gold standard for the treatment of SEC despite the risk of recurrence encountered with these techniques. However, different surgical modalities are discussed depending on the size and the location of the cyst and the patient's age.

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Splenic cysts are infrequent and most of them are related to parasitic diseases.

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Splenic epithelial cysts are usually asymptomatic and are detected incidentally during imaging exams.

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Histopathological examination is mandatory to confirm the diagnosis.

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Spleen-preserving surgery with minimally invasive methods such as laparoscopy is the gold standard for the treatment of splenic epithelial cyst.