Correspondence

A Large Epithelial Splenic Cyst

N Engl J Med 2003; 349:2173-2174November 27, 2003

Article

To the Editor:

Cystic lesions of the spleen are rare findings. We describe a patient with a very large epithelial splenic cyst. A 32-year-old woman presented to our clinic with a several-month history of abdominal pain and a sensation of fullness in her left upper abdomen. Physical examination revealed a large mass occupying the left and middle portions of the abdomen. Computed tomography revealed a very large splenic cyst with compression of adjacent viscera (Figure 1AFigure 1Computed Tomographic Image of the Upper Abdomen Demonstrating a Very Large, Homogeneous Splenic Cyst (Panel A) and Intraoperative Image of the Large Spleen after Initial Mobilization (Panel B).). Laboratory tests revealed thrombocytopenia: 94,000 platelets per cubic millimeter. Serologic tests were negative for parasitic infection. At surgery, the spleen was mobilized (Figure 1B), and splenectomy was performed. The spleen measured more than 20 cm in diameter. Pathological examination revealed a 3-kg spleen consisting of an enormous solitary cyst containing serous brown fluid. Light-microscopical examination showed a single-layer interior lining of cuboidal epithelium that was consistent with the diagnosis of an epithelial cyst. Postoperative recovery was uneventful, and the platelet count returned to normal.

Splenic cysts are classified as either parasitic cysts or nonparasitic cysts, which include true cysts (primary, epithelial cysts) and false cysts (secondary, pseudocysts).1 True cysts are congenital epithelium-lined cysts. It has been suggested that they are derived from inclusions of the mesothelial lining of the splenic surface in the splenic parenchyma during development.2 Splenic cysts may reach a very large size by the time they are diagnosed. The reason for this considerable growth may be related to the proliferation of the lining cells or accelerated secretion from these cells2; further growth can be attributed to bleeding from the cystic wall, as well as to an osmotic imbalance of the cystic fluid like that which occurs with other cystic lesions.1 Treatment consists of complete or partial splenectomy. Decisions about the exact surgical procedure (i.e., open vs. laparoscopic surgery and sparing of the splenic parenchyma vs. complete splenectomy) are based on the size of the cyst, its relation to the splenic hilar vessels and parenchyma, and the amount of healthy splenic tissue remaining.3

Shmuel Avital, M.D.
Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel

Hanoch Kashtan, M.D.
Kaplan Medical Center, Rehovot 76100, Israel

3 References

1. 1

   Burrig KF. Epithelial (true) splenic cysts: pathogenesis of the mesothelial and so-called epidermoid cyst of the spleen. Am J Surg Pathol 1988;12:275-281
   CrossRef | Web of Science | Medline

2. 2

   Morgenstern L. Nonparasitic splenic cysts: pathogenesis, classification, and treatment. J Am Coll Surg 2002;19:306-314
   CrossRef | Web of Science

3. 3

   Losanoff JE, Richman BW, Jones JW. Nonparasitic splenic cysts. J Am Coll Surg 2002;195:437-438
   CrossRef | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   (2009) Simple epithelial cyst of spleen: rare entity. ANZ Journal of Surgery 79:4, 310-311
   CrossRef

2. 2

   Guang‐Yong Zhang, San‐Yuan Hu, Hai‐Feng Zhang, Ke‐Xin Wang, Lei Wang. (2007) A novel therapeutic approach to non‐parasitic splenic cysts: Laparoscopic fenestration and endothelium obliteration. Minimally Invasive Therapy & Allied Technologies 16:5, 314-316
   CrossRef