Splenic Epidermoid Cyst - A Rare Entity

Abstract

C Splenic epidermoid cysts are relatively uncommon. Most often, they are asymptomatic, but they may present with abdominal discomfort, predominantly at young ages. We are reporting a rare case of 12-years-old female child with history of dull intermittent pain, tender palpable mass in left hypochondrium on physical examination. Ultrasonography (USG) of abdomen showed large cyst in upper pole of spleen, and an X ray of chest revealed slightly raised left hemidiaphragm. Axial sections taken on computerized tomography of abdomen showed a large well defined cystic mass near upper pole of spleen, with a thin septum in it. On laparotomy, open total splenectomy was performed. Sections from cystic wall were processed and histopathological examination revealed fibrous tissue covered by stratified squamous epithelium. Although, now-a-days emphasis is being laid on minimal invasive operative procedures which preserve spleen. This case report favours total splenectomy, considering postoperative outcome. The final diagnosis always depends upon histopathological examination.

Huge splenic epidermoid cyst with elevation of serum CA19-9 level

“…Of these three types of cysts, epithelial cysts comprise epidermoid and dermoid cysts (8). In the present case, the diagnosis of the epidermoid cyst was made by histological examination of the excised spleen because the inner surface of the cyst was lined by squamous epithelial cells without skin appendages such as hair roots or sweat glands.…”

“…The size of most splenic epidermoid cysts is less than 15 cm, and only a few splenic epidermoid cysts larger than 20 cm have been reported (2). The origin of epidermoid cells is still unclear, however, they are considered to develop from mesonephric tissue in the developing spleen in early embryonic life (8). In general, small epidermoid cysts are asymptomatic, but left upper abdominal quadrant pain and tenderness are the most common clinical findings.…”

“…Total splenectomy is the treatment of choice for larger cysts more than 5 cm in diameter in order to prevent serious complications such as rupture, hemorrhage, or infection of the cysts (8,9). In particular, cysts sized larger than 10 cm have a high risk of rupture (10), and therefore splenectomy should be performed.…”

Partial splenectomy for a giant epidermoid cyst of the spleen

“…The size of most splenic epidermoid cysts is <15 cm, and only a few splenic epidermoid cysts larger than 20 cm have been reported. The origin of epidermoid cells is still unclear; however, they are considered to develop from mesonephric tissue in the developing spleen in early embryonic life 4. In general, small epidermoid cysts are asymptomatic, but left upper abdominal quadrant pain and tenderness are the most common clinical findings.…”

Cisto esplênico com aumento de CA 19-9: relato de caso

“…Um cisto grande pode causar dor e desconforto devido a compressões extrínsecas dos órgãos adjacentes e alterações laboratoriais como a trombocitopenia 9 . Os principais exames de imagem utilizados para diagnóstico são: radiografia simples de abdome, USG, tomografia computadorizada (TC), ressonância nuclear magnética (RNM) e angiografia 8,9 . Além disso, esses exames são úteis para diagnóstico diferencial preferencialmente com infecções parasitárias, traumas, malformações congênitas, neoplasias e metástases.…”