Transumbilical single-site laparoscopic treatment of primary splenic cyst in child: a rare case report and review of literature

Abstract

Background: Splenic cysts are relatively rare benign tumors that are asymptomatic in most patients and are usually discovered incidentally by imaging. In our case, we report a splenic cyst in a child who underwent laparoscopic partial splenectomy.

Case description: A 13-year-old boy was admitted to the hospital after an incidental finding of a splenic cyst on an abdominal ultrasound conducted 4 days prior. He was asymptomatic before admission. Upon admission, abdominal ultrasound and CT revealed a cystic lesion in the spleen, highly suspicious for a splenic cyst. Then, we used transumbilical single-site laparoscopic exploration and found a cyst measuring approximately 12 cm × 11 cm × 10 cm at the upper pole of the spleen, so we performed a partial splenectomy and diagnosed a primary epithelioid splenic cyst via postoperative pathology.

Conclusions: Splenic cysts in children are very rare and can be treated conservatively in asymptomatic patients with a diameter of less than 5 cm, while surgery is required in symptomatic patients or those with a diameter greater than or equal to 5 cm. Transumbilical single-site laparoscopic partial splenectomy is a minimally invasive and effective treatment, especially for children.

Keywords: children; laparoscopy; partial splenectomy; single site; splenic cyst.

Figure 1

Ultrasound and CT imaging findings of splenic cyst. (A) Abdominal ultrasound findings showed a cystic echogenic area measuring approximately 11.4 cm × 11.0 cm × 10.0 cm explored at the upper pole of the spleen, with clear borders and poor internal translucency (Transverse section of the spleen). (B) Abdominal ultrasound showed the longitudinal section of the spleen. (C) Abdominal CT results showed an enlarged spleen with a cystic hypodense shadow measuring approximately 10.8 cm × 10.0 cm × 9.1 cm, with clear borders, and no obvious abnormal enhancement on enhancement scan. This figure shows a cross section of the spleen. (D) CT showed the coronal surface of the spleen.

Figure 2

Method and procedure of transumbilical single site laparoscopic splenic cyst resection. (A) Trocar position in the umbilicus. (B) Exposure of the superior pole of the splenic vessels. (C) Puncture needle to aspirate fluid from the splenic cyst. (D) Ligasure resection of the upper pole of the spleen. (E) Removal of the splenic cyst from the umbilical incision. (F) Postoperative umbilical appearance.

Figure 3

Gross appearance and histopathological findings of resected splenic cyst specimen. (A) The gross examination of the resected splenic cyst reveals a grayish-red surface that is smooth and uniform. Certain areas of the specimen exhibit a wall-like appearance typical of cystic structures. (B) HE staining showed primary epithelioid cyst lined with a single layer of cuboidal or flattened epithelium; ×100. (C) Fibrous tissue hyperplasia with focal calcification was seen in the splenic cyst; ×100. (D) Immunohistochemistry showed that the splenic cyst was lined with epithelial cells that were positive for CK; ×100.

Figure 4

Complete timeline, including diagnosis, surgery, postoperative recovery, and follow-up.