A recurrent epidermoid cyst of the spleen: report of a case and literature review

Abstract

Background: Splenic cysts are rare disease. Epidermoid cysts of the spleen belong to the primary nonparasitic splenic cysts group. They are an unusual event in surgical practice. Usually, epidermoid cysts occur in children and young female. Most often, they are asymptomatic, but they may present with abdominal discomfort.

Case presentation: We are reporting a rare case of a 23-year-old female came to our attention with history of intermittent pain and previously undergone two times to laparoscopic decapsulation of the cyst in others institutions. During hospitalization, serum and intracystic levels of tumor marker CA19-9 increased. Enhanced CT of the abdomen showed recurrent large cyst in the upper pole of the spleen with satellite nodules. Laparotomic total splenectomy was performed. Histopathological and immunoreactive examinations were executed, and they revealed stratified squamous epithelium on the inner surface of cystic wall, which was positive for EMA, CEA, and CA19-9. The diagnosis of epidermoid cyst was confirmed.

Conclusions: Recently, the surgical approach is changing towards conservative treatments in order to save the spleen in young patients for immunological reasons. Sometimes, this target is not achievable. In such circumstances, like recurrent large cyst, anomalous anatomical relationship to the surrounding tissues, total splenectomy is safe and necessary.

Keywords: Carbohydrate antigen 19-9; Epidermoid cyst; Immunohistochemistry; Laparoscopic surgery; Splenic cysts.

Fig. 1

Preoperative contrast-enhanced abdominal CT scan: a the axial projection shows the recurrent splenic mass (7.7 × 8.5 cm), disclosing absence of calcifications, no contrast uptake; b the sagittal projection shows the presence of satellite nodules, and the splenic parenchyma almost totally replace

Fig. 2

Histological examination shows a an epidermoid cyst with fibrous walls and a stratified squamous lining (top) within the spleen parenchyma (bottom) (hematoxylin and eosin, original magnification ×100); b the epithelium is immunoreactive with EMA, c CEA, and d CA19-9 (original magnification ×200)