Abstract
Primary splenic epidermal cysts, a type I splenic lesion, are very uncommon and usually found coincidentally. In this report, we present a primary splenic epidermal cyst that presented as a mass in the left upper quadrant associated with sharp pain, early satiety, and constipation. We review the classification of splenic cysts with a detailed look into the causes and types of type I cysts. We discuss the different treatment options, how current and past surgical options are controversial, and indications for splenectomy in spleen cysts. We explore how percutaneous drainage as a bridge to splenectomy may have been beneficial in a splenic cyst of great size. This splenic cyst was attempted laparoscopically but converted to an open splenectomy after complications. The patient recovered with no difficulties postoperatively.
Highlights
Splenic cysts are rare, and they are commonly found incidentally
We attempted removal via laparoscopic approach; due to its larger size, the decision was made to convert to an open total splenectomy
Considerations were made after the conclusion of the procedure; it was thought that percutaneous drainage prior to the operation could have prevented the conversion to open splenectomy
Summary
Splenic lesions are classified into Type I primary (true) cysts with a histological finding containing an epithelial lining of parasitic or non-parasitic origin and Type II - secondary (false) cysts without an epithelial lining [1]. Most cases are asymptomatic; as the cysts enlarge, patients generally present complaining of abdominal symptoms. We are reporting a case of a 37year-old female with a large splenic epidermoid cyst measuring 13 x 15 x 21 cm. The pathology report showed an enlarged spleen that weighed 454 grams and measured 19 x 12 x 4 cm with a thickened capsule (Figure 3). Focal cholesterol cleft formation was seen within the squamous debris These histological findings are most compatible with a splenic epithelial cyst with some serosal adhesion throughout the external aspect of the cyst wall
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