Spontaneous splenic pseudocyst: Case report of a rare entity

Abstract

Splenic cysts are classified on the basis of epithelial lining, either primary or secondary. Primary cysts are further divided as parasitic and nonparasitic. The secondary cysts are usually post traumatic or after a splenic extension of pancreatic pseudocyst. However, not all pseudocysts are associated with trauma. Mostly, they are asymptomatic (30%-60%) and usually grow in size to cause compressive symptoms. Splenic pseudocysts should be differentiated with other malignant and nonmalignant pathology, specifically hydatid cysts, in order to manage them correctly. The walls of pseudocysts may be degenerative or calcified, which may resemble hydatid cysts. Here, we present a case of a non-traumatic splenic cyst masquerading as a hydatid cyst preoperatively. The patient was taken up for surgery and intraoperatively noted to be a hemorrhagic cyst with a non-splenic cyst wall. We decided to preserve the spleen with marsupialisation of cyst and omentoplasty. On histopathology, the diagnosis of a pseudocyst of spleen was made in view of absent epithelial lining. We would like to report this case because of the diagnostic dilemma, its clinical rarity and, even more, in the absence of any history of trauma.

Keywords: pseudocyst; spleen; splenic cysts; surgery.

FIGURE 1

Plain axial CT of the cyst showing areas of relative hyperdensity and speckled calcification within.

FIGURE 2

Coronal View: in the venous phase shows the cystic lesion occupying the hilar region of the spleen, extending towards the superior pole. Note is made on splenic vein inferiorly.

FIGURE 3

Coronal View: In the venous phase shows the cystic lesion occupying the hilar region of the spleen, extending towards the superior pole. The lesion is abutting splenic vein inferiorly and cardia anteromedially with intact fat planes in between.

FIGURE 4

Intraoperative image of the cystic lesion at the upper pole of the spleen.

FIGURE 5

Image showing the hemorrhagic content of the cyst.

FIGURE 6

Image showing the marsupialisation of the cyst.

FIGURE 7

Microphotograph revealing cyst with lining epithelium and a fibrotic wall (H &E, × 20).

FIGURE 8

Microphotograph shows cyst devoid of any lining epithelial cells. Wall is fibrotic and infiltrated by chronic inflammatory cells and hemosiderin laden macrophages (H& E, × 400 times).

FIGURE 9

Gross image of cyst. Inner surface is irregular with areas of blackish discoloration.