Preoperative diagnosis of splenic cysts in children by gray scale ultrasonography.

Ultrasonography is a useful noninvasive modality for the diagnosis of splenic cysts in children. Characteristic features plus the typical clinical and radiographic presentation should obviate the need for further more invasive and costly techniques which add little to diagnostic accuracy. Additional advantages offered by ultrasound a minimal patient discomfort, no ionizing radiation, and immediate reassurance to parents that the mass is a cyst. We report two cases of epidermoid splenic cysts preoperatively diagnosed by ultrasonography. The typical sonographic characteristics are presented and the sonographic differential diagnosis is discussed.     

Giant congenital infected splenic cyst: An interesting case report and review of the literature

Splenic cysts are rare lesions. The congenital non-parasitic cysts of the spleen are rarely met in the clinical practice. Primary cysts have a cellular lining that can be caused by congenital events or parasitic infection (Echinococcus). Secondary cysts have no cellular lining and may be of hemorrhagic, serous, inflammatory, or degenerative origin. We report a rare case of congenital cyst of spleen in a child aged 10 years treated successfully by splenectomy because of total involvement of the splenic parenchyma along with involvement of hilum by the cyst, and we review the literature.     

Laparoscopic management of a ruptured giant epidermoid splenic cyst.

BACKGROUND: Epidermoid splenic cysts are uncommon lesions of the spleen. They are known to become symptomatic as a consequence of enlargement, infection, or rupture, the latter being an exceedingly rare complication traditionally treated with open splenectomy. We herein report a unique case of a giant epidermoid splenic cyst that ruptured spontaneously and was successfully treated with the laparoscopic approach. CONCLUSION: Laparoscopic surgery may be considered an initial treatment option in cases of very large epidermoid cysts even when rupture occurs.     

Laparoscopic splenic total cystectomy in a patient with elevated CA 19-9.

True nonparasitic splenic cysts are rare. Reports of approximately 30 cases of benign true splenic cysts producing elevated CA 19-9 serum levels have been published. The traditional treatment of splenic epidermoid cysts is splenectomy. However, with all the advances in laparoscopic surgery, conservative laparoscopic approaches are accepted as the most preferred techniques for this benign disease. Laparoscopic cystectomy with its minimal invasiveness and low morbidity is the ideal technique for properly selected patients. So far, only one case report of laparoscopic cystectomy for splenic epidermoid cyst with elevated CA 19-9 levels has been published. This is the second known report of this procedure being performed to remove a splenic epidermoid cyst in a patient with elevated CA 19-9 levels.     

A diaphragmatic retroperitoneal cyst

Diaphragmatic lesions are usually congenital bronchogenic cysts. A patient with a known diaphragmatic cyst presented with new onset right upper quadrant pain. Repeat imaging showed enlargement of the cyst, the CA19–9 cancer marker was raised at 312iu/ml (normal: <27iu/ml) and positron emission tomography combined with computed tomography showed focally increased uptake in the cystic wall. In view of symptoms and risk of neoplasia, the lesion was excised. Histology showed a benign epidermoid cyst. Features falsely suggesting neoplasia have been reported previously with benign splenic cysts but not with a benign diaphragmatic epidermoid cyst.     

Total splenectomy for a recurrent giant splenic cyst

Primary splenic cysts are a rare finding. Some are large and require surgical removal. The Authors report a case of a recurrent huge splenic cyst in a 41-year-old female patient. A marsupialization was performed at another hospital 6 years before. Ultrasonography and computed tomography imaging revealed a cystic lesion in the spleen measuring approximately 20 cm in diameter. A total open splenectomy was performed. Postoperative course was uneventful. The histologic diagnosis was an epithelial cyst of the spleen with no atypical cells in the cyst wall, as previously found at the first operation. The epidermoid cysts have an epidermal lining, and prevention of recurrence is dependent on complete resection of the cyst wall preserving, whenever possible, the splenic tissue. Recurrence can be avoided with partial splenectomy in polar localization of the cyst, or complete removal of the cyst by "peeling" it off the splenic parenchyma. Marsupialization of the cyst, either via a laparoscopic or an open approach, is often ineffective.     

Laparoscopic management of a massive splenic cyst

Splenic cysts are relatively uncommon entities in surgical practice and treatment options vary. We present a case of a young adult woman who presented with a left-sided abdominal mass. A large splenic cyst was diagnosed by abdominal ultrasound and computed tomography. Laparoscopic partial excision with marsupialisation was performed with uneventful recovery and minimal blood loss. Histopathology revealed an epidermoid cyst of the spleen. This report describes the case, and includes a short review of the literature. Laparoscopic partial excision with marsupialisation is a safe and appropriate method of treatment for large splenic cysts.     

A case of completely isolated advanced enteric duplication cyst cancer performed partial pancreatectomy

IntroductionEnteric duplication cysts are rare and, in addition, isolated enteric duplication cysts are lower morbidity prevalence rate. These cysts lack a connection to the gastrointestinal tract or the adjacent mesenteric vasculature and have only been reported in 10 case reports. In these reports, only two reports were cases with malignant transformation. Our case was a report for the advanced cancer of the isolated enteric duplication cyst.Case presentationThe patient was a 43 year-old woman with slightly abdominal pain and mass formation. The abdominal contrast-enhanced computed tomography showed 130 × 100 × 90 mm huge cystic mass existed in right upper peritoneal cavity. The cystic mass had thickened wall and many enhanced nodules. As these imaging findings suggested a tumor originated from pancreas and the preoperative diagnose was suspect of mucinous cystic neoplasm. In operative findings, the tumor originated from pancreatic head and did not attach to gastrointestinal tract. Final pathology indicated the cyst was an isolated advanced enteric duplication cyst cancer and not originated from pancreas.ConclusionWe experienced an extremely rare case of completely isolated advanced enteric duplication cyst cancer. Unique to this case, the preoperative diagnosis was suspect of mucinous cystic neoplasm arising from pancreas head and partial pancreatectomy was performed. However, in the pathological findings, this cyst diagnosed advanced enteric duplication cyst cancer.     

An atypical site of a retroperitoneal epidermoid cyst in a middle-aged woman

INTRODUCTIONRetroperitoneal cysts are rare, usually asymptomatic, abdominal lesions. Epidermoid cysts developing in this space usually occur in middle-aged women and are incidentally discovered in the presacral region during ultrasound examination. Occasionally, cysts may arise from splenic tissue or adrenal glands and develop above the presacral area.PRESENTATION OF CASEWe present the unusual location of a cyst in the retroperitoneal space in a 41-year-old woman admitted to hospital due to detection of a lesion in ultrasound imaging. A CT scan confirmed large intra-abdominal cyst. At operation, a large retroperitoneal thin-walled cyst with no evident arising point was discovered. Histologic analysis revealed epidermoid cyst.DISCUSSIONOur patient presented with giant retroperitoneal cyst extending from the subhepatic region to the uterine and bladder. To our knowledge, this unusual location in adult has not been previously reported in the literature. In our case the lesion was adjacent to inferior vena cava and mesenteric vessel which required special attention during preparation and was technically demanding.CONCLUSIONSurgery is the gold standard for the diagnosis and treatment of retroperitoneal epidermoid cysts. Successful treatment of benign retroperitoneal epidermoid cysts depends on appropriate diagnosis, careful operative technique, and adequate management of the underlying pathology.     

Splenic cysts and tumors: diagnosis and management

Cysts and tumors of the spleen are rare and are often discovered fortuitously. They are most often asymptomatic but may present with abdominal pain in the left upper quadrant. Splenic cysts are far more common than solid lesions; true cysts must be differentiated from pseudocysts of the pancreas and from cystic degeneration following splenic contusion or infarction. Cysts may be congenital (epidermoid cysts), infectious (abscess or hydatid cyst), or neoplastic (lymphangioma or angioma with tumor necrosis). Diagnosis can usually be established with the clinical context and imagery (ultrasound, CT, MRI). Surgery should be avoided for angiomas and pseudocysts. Spleen-conserving surgery is indicated for large symptomatic epidermoid cysts. Splenectomy is often required for hydatid cysts and tumors. Of the solid tumors, hemangiomas and lymphangiomas often have a characteristic fleshy appearance. For other solid tumors, whether benign or malignant, imaging may give some clues to the diagnosis, but diagnostic certitude often requires pathologic examination of the piece. Needle biopsy is contraindicated because of the risk of bleeding. Resection should be as limited as possible in order to avoid the risks of total splenectomy (overwhelming sepsis, thrombosis).     

Spinal Hydatid Cyst Mimicking Arachnoid Cyst on Magnetic Resonance Imaging

Abstract

Background: Primary spinal hydatid cysts are uncommon and account for 1% of all cases of hydatid disease. Echinococcus granulosus is most often responsible for the cyst hydatid. Intradural, extramedullary involvement is rare. When the cysts do not demonstrate typical magnetic resonance imaging findings, the differential diagnosis is more complex.

Method: Case report.

Findings: An isolated primary hydatid cyst of the spine in a 35-year-old man that appeared to be an arachnoid cyst on preoperative radiographic examination.

Conclusion: Hydatid cysts that lack the typical radiographic appearance may be mistaken for arachnoid cysts. Misdiagnosis has serious implications for surgical intervention and long-term care.     

Infected congenital splenic cyst associated with duodenal duplication cyst and malrotation--a case report

Congenital splenic cyst is a rare entity. A potential complication of this anomaly is infection. We report on an 18-month-old boy who had Salmonella enterocolitis and 2 weeks later was found to have an infected splenic cyst. At surgery, a duodenal duplication cyst and malrotation of the gut were incidentally found. Infected splenic cysts usually occur in older children or adults. To the best of our knowledge, congenital splenic cyst has not previously been reported in association with other malformations.     

Giant epithelial cyst of the accessory spleen

Splenic cysts are uncommon, and cysts derived from the accessory spleen are rare. We report a case of a huge splenic cyst derived from the accessory spleen in the omentum, concomitant with multiple epithelial cysts of the primary spleen. Both serum and cystic fluid concentrations of carbohydrate antigen (CA)19-9 were markedly elevated. A huge monolocular cyst occupied the entire abdomen. A total of 7 l of aspirated cystic fluid was turbid and yellowish-brown. The cyst wall, which consisted of CA19-9-positive squamous epithelium, contained approximately 2 × 3 × 1 cm of splenic tissue. There was a separate multicystic 16 × 8-cm spleen in the normal position. The CA19-9 serum level returned to normal postoperatively. Received: May 6, 2002 / Accepted: November 29, 2002 RID="*" ID="*" Offprint requests to: H. Takikawa     

Mature splenic teratoma: A rare case report

IntroductionTeratomas are germ cell neoplasms that can be malignant or benign. Their occurrence is more prevalent in gonads, but there are rare extragonal reports, and splenic teratomas are exceptionally uncommon.Case reportA 44-year-old woman with a report of abdominal pain on the left flank for 12 h, was evaluated with TC that visualized spleen showing an oval, intraparenchymal, hypodense image with dense areas, submitted to conventional splenectomy, what identified mature cystic teratoma.DiscussionDermoid cysts have nonspecific symptoms, usually related to extrinsic compression of other structures or rupture of the splenic capsule; the diagnosis is complex, since the alterations in imaging exams are not very specific. Thus, the confirmation is made through anatomopathological analysis.ConclusionMature splenic cystic teratomas are rare and treatment should be evaluated according to the presence or absence of symptoms and diagnostic certainty.     

Splenic cysts

The treatment of splenic cysts is a difficult challenge to surgeons and physicians. This paper reviews the literature on splenic cysts, with special attention to the pathogenesis, diagnosis, and various options of surgical treatment. Splenic cysts are classified as primary or secondary cysts, according to the presence of an epithelial lining. The primary cysts are further subdivided as parasitic or non-parasitic. Secondary cysts are in most cases posttraumatic. Symptoms are usually correlated to the size of the cyst. Prior to surgery, imaging with ultrasound and computer tomography or magnetic resonance should be performed. A cyst puncture should be conducted for diagnostic purposes (amylase and bacteria) as well as to reduce the size of the cyst. Furthermore, the titer of Echinococcus and other biomarkers can be measured. Surgeons should make every possible effort to preserve splenic tissue and spleen-saving techniques with laparoscopic techniques are recommended.     

Adjacent epidermoid cyst and primary central nervous system lymphoma: case report

BACKGROUND: Except for cases with radiotherapy or phacomatosis, multiple primary brain tumors of different histologic types are rare. The authors report the association of an epidermoid cyst and a primary CNS lymphoma. CASE DESCRIPTION: A 66-year-old man with a 20-year history of gait disturbance was admitted because of recently worsening symptoms. Magnetic resonance imaging showed an abnormal mass in the posterior fossa. The mass lesion had the appearance of a cystic tumor with a large mural nodule. Gross total removal of the tumor was performed. Histologic examination disclosed the cystic portion to be an epidermoid, whereas the nodular portion exhibited the histologic and immunohistochemical features of a malignant lymphoma. The lymphoma cells were shown to harbor EBV by in situ hybridization. CONCLUSIONS: To our knowledge, this is the first report of the coexistence of an epidermoid cyst and primary CNS lymphoma. When the lesions are adjacent, a definite preoperative diagnosis can be difficult. Epstein-Barr virus-associated CNS lymphoma is rare among the immunologically normal population. The possible pathogenesis for the coexistence of these 2 tumors is discussed.     

Familial Epidermoid Cysts of the Spleen: Report of Two Cases

The familial occurrence of epidermoid cysts of the spleen is rare, with only six cases having ever been reported, to our knowledge. We recently diagnosed epidermoid cysts of the spleen in a mother and son. First, a 15-year-old boy was admitted to our hospital for management of blunt abdominal trauma. Computed tomography (CT) showed a ruptured large splenic cyst with an intraabdominal hematoma. We performed a splenectomy, and histopathological examination confirmed the existence of an epidermoid cyst of the spleen. About 2 years and 6 months later, the family physician found that the patient's 41-year-old mother had a large splenic cyst, and she was referred to our hospital for further investigation. CT showed a 10 × 8 cm cyst occupying most of the spleen. The patient underwent splenectomy, and a pathological diagnosis of an epidermoid cyst of the spleen was confirmed. Although the etiology of epidermoid cysts of the spleen is unclear, this familial occurrence may support the hypothesis of congenital malformation as a result of genetic change.     

Retrorectal epidermoid cyst in an elderly woman: Report of a case

An epidermoid cyst is a common occurrence in the skin. Such a cyst occurring in the retrorectal space, however, is extremely rare. We herein present a case of retrorectal epidermal cyst in a 67-year-old Japanese woman. She reported no symptoms and a perirectal mass behind the lower rectum was accidentally detected by computed tomography (CT). Contrast CT and magnetic resonance imaging revealed a cystic mass (76 x 70 x 63 mm) with a slightly enhanced thin wall which was attached to the lower rectum. The patient underwent surgery via a posterior approach. The mass was exposed after an excision of subcutaneous fat and was firmly adhered to the anal sphincter muscle. The cystic mass was completely removed without a proctectomy. Histologically, the cyst was diagnosed to be an epidermoid cyst. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. A diagnosis of retrorectal cystic tumor is difficult, and a complete resection is necessary for the treatment of such tumors.     

Case report of successful partial splenectomy for a splenic abscess in a paediatric patient

IntroductionSplenic abscess (SA) is a rare potentially fatal condition in the paediatric population. It is difficult to diagnose given its non-specific presentation. There are no current guidelines for management of SA in this population but splenic preservation is advantageous given the vital role the spleen plays in immunity.Presentation of caseWe present a case of a 15-year-old boy with a large splenic abscess. He underwent successful partial splenectomy with resolution of his symptoms thereafter.DiscussionStandard surgical treatment for splenic abscess is antibiotics and drainage. Spleen-preserving options include percutaneous drainage, partial splenectomy, subtotal splenectomy and splenic auto-transplantation. Spleen-preserving techniques should be used where possible to achieve best outcome in clearing infection and to ensure the immunologic role of the spleen is not compromised.ConclusionSplenic abscess is rare conditions seen in paediatric practice with high mortality and partial splenectomy can be a useful spleen-preserving technique in treating this condition.     

Conservative laparoscopic treatment of a posttraumatic splenic cyst

Laparoscopy has recently been demonstrated to be a useful alternative to open surgery for the surgical treatment of spleen disorders, and it can also facilitate a conservative approach for treatment of selected spleen lesions. We present the laparoscopic spleen-preserving treatment of a post-traumatic spleen cyst. A 28-year-old female presented a mass in the left hypochondrium immediately after an uneventful pregnancy. CT revealed a splenic cyst of 10×8 cm. Laparoscopic exploration showed a cyst located in the lower pole of the spleen. All the cyst wall not covered by spleen tissue (70%) was excised, and the fragment of cyst wall was recovered through a bag. The patient recovered uneventfully and was discharged 72 hours later. The laparoscopic approach should be considered for evaluation and treatment of selected benign cystic lesions of liver, retroperitoneum or spleen origin.