Splenic space occupying lesions are a rare clinical diagnosis.[1] The spleen cyst is seen as a part of traumatic or inflammatory infection of the
pancreas.[2] These cysts are usually pseudocysts. Out of primary lesions, hydatid cyst forms
60% of the total cases. True noninfective cysts are rare and usually congenital.[2] Splenectomy is proposed to be the definitive treatment.[3]
A 32-year-old female presented to surgical outpatient department with the complaints
of pain in the left hypochondrium for the past 2 months. With above complaints, she
was subjected to ultrasonogram of the abdomen that showed a thin-walled cyst with
floating echoes and membranes. The diagnosis was further confirmed by subjecting the
patient to hydatid serology that was negative. She underwent contrast-enhanced computerized
tomogram (CECT) abdomen that confirmed the cystic lesion involving only the spleen
and other viscera were found to be unremarkable ([Fig. 1]). After establishing the diagnosis with radiological and hematological tests, she
was put on oral albendazole 15 mg/kg therapy for three cycles. The patient was given
prophylactic pneumococcal vaccine 3 weeks prior to the surgery.
Fig. 1 Contrast-enhanced computed tomography image showing the splenic cyst.
After optimization, the patient underwent open splenectomy through a midline incision.
There was no intraoperative spillage of the cyst contents. On cutting open the specimen,
a clear fluid was aspirated. The postoperative course was uneventful. The resected
spleen was subjected to histopathology examination that revealed a 120-gram spleen
with cystic lesion 6 × 5.8 × 3 cm in the size involving the entire central splenic
parenchyma. On microscopy, the splenic capsule shows the foci of dystrophic calcification.
No ectocyst or endocyst could be identified. The patient is doing well after 7 months
of surgery.
Spleen is an important viscera that is involved in various hematopoietic, malignant
as well as benign pathologies.[4] Patients with splenic cysts present with a vague abdominal pain that is dragging
in sensation. The primary splenic cysts present as more subtle symptoms like pain
abdomen[2] and vomiting in case it is compressing upon the stomach. These patients run an indolent
course and are usually asymptomatic.
The true cysts have multiple overlap radiologically and hydatid cyst may mimic the
primary splenic cysts especially in endemic areas. The ultrasound of the splenic hydatid
may show the presence of floating membranes, hydatid sand, and multiple daughter cysts.
However, the simple cyst lacks all these signs. The simple cyst of hydatid which is
classified as a class I hydatid that typically mimicks the noninfective cysts. Calcification,
although rare in true cysts, was present in the index patient.[5] The CECT will also confirm the findings. The aspiration of the cyst fluid and subjecting
it to fluid amylase, hydatid scolices examination, and tumor markers will be helpful
to establish the definitive diagnosis.[3] The serum immunoglobulin G hydatid serology is a preoperative test that can be used
to establish the diagnosis of echinococcosis.
The splenectomy has emerged as definitive treatment in these cases.[3] Preservation of 25% of the splenic parenchyma for retained splenic function can
be tried wherever feasible.
