Splenic epithelial cyst mistaken with Hydatid cyst: A case report

Abstract

Introduction: Cystic lesions of the spleen are infrequent and usually diagnosed incidentally. These lesions are rare and their differential diagnosis is very wide. Splenic epithelial cysts are the most common type of primary splenic cyst (4%). Surgical treatment is indicated for cysts larger than 5 cm or symptomatic. Nowadays, spleen preserving surgery is the gold standard treatment considering the immunologic role of the spleen and the increased risk of post-splenectomy infections.

Case presentation: A 17 year old girl presented to the outpatient clinic with moderate left upper quadrant abdominal pain of 2 weeks duration with loss of appetite and denied fever, chills, sweating and jaundice. Abdominal examination showed tender splenomegaly. The abdominal imaging (Ultrasound, CT SCAN, MRI) was suggestive of hydatid cyst of the spleen, for which she received Albendazole for 1 month and then operated by laparotomy with partial resection and un-roofing of the splenic cyst. The pathology report showed a splenic epithelial cyst (SEC).

Conclusion: SEC is a rare pathology that could mimic splenic hydatid cyst. The clinical and radiological pictures may be commonly misleading and non-conclusive. Definitive diagnosis is made on histopathology. Spleen conserving surgery, when possible, is the preferred modality for treatment.

Keywords: Hydatid cyst; Spleen conserving surgery; Splenic epithelial cysts.

Fig. 1

Abdominal ultrasound showing a large splenic cyst containing homogenous internal echoes/debris.

Fig. 2

(a) Axial image of non-contrast CT abdomen shows the large splenic cyst with focal peripheral calcification in wall (White arrow), (b) contrast enhanced CT shows no peripheral enhancement, no floating membranes or enhancing solid component.

Fig. 3

Axial T1 post contrast MR image shows a non-enhancing cystic lesion (3a), Coronal T2 image shows a hyper-intense fluid signal intensity splenic lesion (3b).