Epidermoid Splenic Cyst in Children Treated by Laparoscopic Partial Splenectomy

Abstract

Epidermoid splenic cyst is a rare benign tumour in children, accounting for 10% of all cystic lesions of the spleen and is the most common diagnosis of non-parasitic splenic cysts. Its discovery could be incidental or happen after an imaging workup for a mass or abdominal pain. Since total splenectomy exposes a patient to the occurrence of overwhelming post-splenectomy infection, laparoscopic partial splenectomy has been increasingly popular over the past two decades because it preserves the immune function of the spleen. This technique should only be performed by a well-trained team because of the high risk of bleeding. The authors report the cases of three patients who underwent laparoscopic partial splenectomy: a 7-year-old girl with no relevant history with a 4.5-cm epidermoid cyst involving the lower pole of the spleen, a 13-year-old boy, type 1 diabetic on insulin therapy, with a 7-cm epidermoid cyst of the upper pole of the spleen and a 14-year-old girl, with no previous history, with a 6-cm upper pole epidermoid splenic cyst. Operating times were 2 h 30 min, 3 h and 4 h 30 min, respectively. The intraoperative blood loss was 100 mL, 350 mL and 300 mL, respectively. The length of hospital stay was 6 days for each patient. No blood transfusion was performed perioperatively. With a mean follow-up duration of 21 months (32 months, 21 months and 10 months, respectively), no complication or recurrence occurred.

Figure 1

coronal magnetic resonance imaging of the child abdomen showing well-defined cystic mass with homogeneous fluid contents (Case 1)

Figure 2

Scan showing a hypodense cystic image within the spleen (white star)

Figure 3

Patient installed in a 3/4 right lateral decubitus position with a log under the scapula and the left buttock

Figure 4

Vascular control with Hem-o-lok

Figure 5

Opening and aspiration of the cyst

Figure 6

Application of TACHOSIL^® gauze on the section area

Figure 7

HES with low magnification. Splenic parenchyma () shifted peripherally by a cystic lesion ()

Figure 8

HES with high magnification. The lining of the cyst is a flattened cuboidal epithelium of mesothelial type

Figure 9

Immunohistochemistry. The anti-calretinin antibody highlights the epithelium confirming the mesothelial nature of the cyst