Saudi Journal of Gastroenterology

CASE REPORT
Year
: 2003  |  Volume : 9  |  Issue : 1  |  Page : 20--22

Splenic epithelial (epidermoid) cyst


Hedayat Riazi1, Mohammed Reza Kohsari1, Saba Hoda2,  
1 Department of General Surgery, Razi Hospital, Rasht, Iran
2 Department of Pathology, Razi Hospital, Rasht, Iran

Correspondence Address:
Hedayat Riazi
Dept of Surgery, Razi Hospital, P.O. Box 41448, Rasht
Iran




How to cite this article:
Riazi H, Kohsari MR, Hoda S. Splenic epithelial (epidermoid) cyst.Saudi J Gastroenterol 2003;9:20-22


How to cite this URL:
Riazi H, Kohsari MR, Hoda S. Splenic epithelial (epidermoid) cyst. Saudi J Gastroenterol [serial online] 2003 [cited 2021 Apr 11 ];9:20-22
Available from: https://www.saudijgastro.com/text.asp?2003/9/1/20/33363


Full Text

Splenic cysts are rare, but must be considered in the differential diagnosis of left upper quadrant masses [1],[2] Fewer than 1000 cases have been reported in the literature [2] . Cystic lesion of the spleen comprises parasitic and non-parasitic cysts. Non-parasitic cysts are classified as primary (true) cysts and secondary (false) cysts (or pseudocysts) [1],[3] . Splenic cysts may be asymptomatic, but when symptoms occur, they are vague and are caused primarily by mass effects, compression of adjacent viscera and diaphragmatic irritation [1],[3],[4] . In children, it has been shown that symptoms are unusual until the cysts become greater than 8cm in size [5] . Potential complications include hemorrhage, perforation and infection [4].

Although selected nonparasitc cysts may be effectively managed by aspiration, splenectomy should be performed for all large cysts, those with uncertain diagnosis, and when the cystic masses are inflammatory, infected or involve the hilum [1],[3],[4] . Because of postsplenectomy sepsis, the management has shifted to splenic preservation when feasible. In some patients, splenic cyst may be suitably located for excision by partial splenectomy [1],[3],[4] . Other attractive alternatives for management of splenic cysts include splenic decapsulation and resective treatment [6],[7],[8] .

 Case Report



A 22-year old female patient was admitted to surgical ward in Razi Hospital in Rasht, Iran on 31 Jan 2000, with a two-month history of left upper quadrant pain radiating to the left shoulder. Her pain was dull, vague and constant. She had no history of any other accompanying symptoms. Physical examination was unremarkable except for mild tenderness in the left upper quadrant. Her vital signs were normal. Laboratory investigations revealed no abnormalities. Her abdominal ultrasonography showed a 7x8cm splenic cyst in the upper pole of the spleen [Figure 1]. Computerized tomography scan of the abdomen demonstrated a large cyst in the upper pole of the spleen [Figure 2]. At celiotomy, an 8x8cm splenic cyst was found, which was located in the upper pole of the spleen. The spleen was exposed and excision of the cyst was performed without any complications.

Histological examination confirmed a primary nonparasitic epidermoid splenic cyst [Figure 3],[Figure 4]. During a 20-month follow-up after surgery, the patient was free of any symptoms.

 Discussion



Cysts of the spleen are rare entities [1],[4] . In 1929, Andral first described a splenic cyst; this as a dermoid cyst found at autopsy. Pean performed the first recorded splenectomy for cyst in 1867 [3] . Splenic cysts can be divided into parasitic and nonparasitic cysts. Parasitic cysts are due almost exclusively to echinococcal disease and account for 60-70% of splenic cysts in countries where hydatid disease is endemic [1],[3],[4]. Nonparasitic cysts are classified as primary cysts, which have an epithelial lining and secondary cysts, which are much more common and are usually of a post traumatic etiology [1],[3],[4] . Primary cysts of the spleen are very rare and include epidermoid and dermoid cysts, cystic hemangiomas, and cystic lymphangioms [1] .

The origin of the epithelial (epidermoid) cysts of the spleen is unclear. They have been attributed to developmental misplacement of epithelial tissue and to metaplasia. A combination of immunohistochemical and morphological investigations, including electron microscopy has provided evidence that probably most epithelial cysts are derived from metaplasia of mesothelium: the original cause is probably traumatic damage to the capsule of the spleen, with a resultant ingrowth of mesothelium and subsequent cyst formation and metaplasia [9] .

Epidermoid cysts of the spleen occur in children and in young adults in 75% of cases. About two thirds of the patients have been female. The clinical manifestation is dependent upon the size of the cyst. The most frequent complaint is left upper quadrant pain radiating to the left shoulder or chest. Symptoms related to pressure on the stomach occur less frequently [3] . A type of squamous-lined cyst in the pancreas is the epidermoid cyst arising in intrapancreatic spleen [10] .

At time of presentation, two-thirds of patients with splenic cysts are less than 40 years of age and 60% are females. The cyst are usually singular, although multiple cysts have been reported and are usually of a familial types [11] . Most cyst are located in the lower pole and 65% are subcapsula [3] . Ultrasonography of the spleen shows the cystic areas and their relationship to surrounding structures [8],[12] . Computerized tomography scan accurately diagnoses splenic cysts and can further exclude exrasplenic involvement [3] .

Treatment of splenic cysts has been splenectomy, but because of postsplenectomy sepsis, splenic preservation surgery if feasible, is an attractive alternative [4] . Golinsky et al described a vertical partial splenectomy for epidermoid splenic cyst [13]. External drainage and narsupialization have an unacceptable incidence of infection, bleeding and cyst re-accumulation and are inappropriate techniques for management of splenic cyst [1]. Touloukian et al reformed splenic decapsulation for six patients with splenic cysts and concluded that splenic decapsulation is an effective treatment for splenic epithelial cysts, which both preserve splenic function and prevents recurrence [6] . Baglaj and Czenik have reported an epidermoid cyst in a wandering spleen, which successful surgical management of the cyst had been cystectomy and splenectomy [7] . In a case report, Pouche et al concluded that hilar localization of splenic cyst does not always exclude the possibility of resective treatment and not all hilar cysts must be considered an absolute indication to splenectomy. An accurate and extensive exposure of splenic artery and vein can demonstrate vascular anatomical variations permitting resection also for large hilar cysts [8].

References

1Beauchamp RD, Holzman MD, Fabian TC. The spleen In: Beauchamp RD, Everf, Matton; textbook of surgery; sixteenth edition, Philadelphia: W.B. Saunders 2001: 1151-2.
2Alexander D, Minerva N, Ovens G. Splenic cysts. J Surg Oncol 1978; 10: 369-87.
3Schwatz SI. The spleen In: Zinner MJ, Schwatz SI, Ellis H. Maingots abdominal operations; tenth edition, Appleton and Lange, 1997: 2039-41.
4Daves LG, Malangoni MA. Cystic masses of the spleen. Am Surg 1986; 52: 33-6.
5Tsakayamis DE, Mitchell K, Kozakewich HPW, Shamberger RC. Splenic preservation in the management of splenic epidermoid cysts in children. J Pediatric Surg 1995; 30: 1468-70.
6Touloukian RJ, Maharaja A, Ghousoob R, Reyes M. partial decapsulation of splenic epithelial cysts. J Pediatric Surg 1997; 32: 273-4.
7Baglaj M, Czenik J. Epidermoid cyst in a wandering spleen. Pediatr Surg Int 1998; 14:113-5.
8Pouche A, Lanzi S, Pukini G, Lancini G, Ottaviani GM, Guilini SM. Hilar localization of splenic cysts does not always exclude the possibility of excessive treatment. G-Chir 1999; 20: 25-30.
9Lan Lauder. The spleen In: Symers, William St Clair II. Henry, K (Krisin); Thymus, lymph nodes, spleen and lymphatic. Longman Group UK Limited. Systematic pathology 1992; 3: 596.
10Adsay NV, Hasteh F, Cheng JD, Klimstra DS. Squamous-lined cysts of the pancreas. Semin Diagn Pathol 2000; 17: 56-65.
11Ivanaka T, Nakanishi H, Tsuchida Y, et al. Familial multiple mesothelial cysts of the spleen. J Pediatr Surg 1995;30: 1743-5.
12Kaufman RA, Silver TM, Wesley JR. Preoperative diagnosis of splenic cysts in children by gray scales ultrasonography. J Pediatr Surg 1979; 14:450-4.
13Glonisky D, Freud E, Seinberg R, Zer M. Vertical partial splenectomy for epithelial cyst. J Pediatr Surg 1995; 30: 1704-5.