Symptomatic Giant Primary Nonparasitic Splenic Cyst Treated with Laparoscopic Decapsulation: A Case Report and Literature Review

Abstract

BACKGROUND Primary nonparasitic splenic cysts (PNSC) are unusual epithelial fluid lesions of the spleen. They are considered congenital cysts and are often discovered incidentally in young people. Larger cysts can be symptomatic and are traditionally managed with splenectomy. This report is of a woman with a large symptomatic PNSC that was managed surgically by laparoscopic decapsulation. CASE REPORT A 22-year-old Lebanese woman presented with left upper-quadrant pain, left pleuritic pain, food intolerance, and significant weight loss. Investigations showed a 20×17×15 cm cystic lesion in the spleen. Secondary causes were ruled out and tumor marker and hydatid serology were unremarkable. Laparoscopic decapsulation of the cyst with spleen preservation was performed with no perioperative complications. The patient's 3-year follow-up visit revealed no clinical or radiological recurrence. CONCLUSIONS True congenital splenic cysts are rare clinical findings. Generally, they do not have malignant potential. The development of minimally invasive techniques has shifted the trend toward splenic salvaging procedures. Literature review revealed an acceptable recurrence rate with near-total rather than partial unroofing. Laparoscopic decapsulation can be a safe and adequate therapeutic option in selected cases.

Figure 1.

Ultrasound image showing a large hypoechoic fluid-filled lesion with a thin wall and no solid component.

Figure 2.

Contrast-enhanced computed tomography scan demonstrating a large homogenous hypodense cystic lesion within the spleen. There is no discernable enhancing wall and the lack of a solid component and septations are noted. These radiologic features are consistent with a simple splenic cyst.

Figure 3.

Laparoscopic exploration demonstrating a giant splenic cyst (arrow) arising within the upper pole of the spleen and occupying almost its entire surface. The stomach is seen displaced to the right lobe of the liver (arrow).

Figure 4.

Laparoscopic decapsulation of splenic cyst with splenic preservation (arrow on spleen).

Figure 5.

Gross aspect of the cyst showing a glistering inner surface with heavily trabeculated appearance (resembling endocardium).

Figure 6.

Histopathologic examination revealing nonkeratinized squamous epithelial lining (thin arrow) and Gamna-Gandy body seen in the cyst (thick arrow), both stained with hematoxylin and eosin. Features are consistent with a primary splenic cyst.