Histopathological,Histogenetic, and Immunohistochemical Analysis of Epidermoid Cyst of Spleen

Splenic cysts are encountered not uncommonly, but large cysts occupying a significant portion of the spleen are extremely rare. We report a case of a young female patient presenting with a large epidermoid cyst involving the majority of the spleen. The patient was involved in a motor vehicle accident during which she sustained multiple rib fractures and traumatic internal organ injuries. She subsequently underwent exploratory laparotomy and splenectomy for grade III splenic lacerations. Incidentally, a 13.3 cm in greatest dimension splenic cyst replacing the majority of the splenic parenchyma was identified. Grossly, the inner lining of cyst was gray-white, smooth, and glistening. Histologically, the thick fibrous cyst wall was composed of stratified squamous epithelium, scattered foci of which were denuded. A panel of properly-controlled immunohistochemical stains was performed and showed the squamous epithelium to be strongly and diffusely immunoreactive with carcinoembryonic antigen (CEA), CA 19–9, and cytokeratin 5/6, focally immunoreactive with HBME-1, and negative for calretinin. The histomorphological features and immunohisto-chemical staining pattern were consistent with a diagnosis of an epidermoid cyst of the spleen.     

Cyst formation and growth in autosomal dominant polycystic kidney disease

Previous morphologic studies on kidneys from adult patients with autosomal dominant polycystic kidney disease (ADPKD) indicates that the cysts developed from nephrons and collecting ducts in association with hyperplasia of epithelial cells lining the cyst walls. In the present study, we systematically evaluated by scanning electron microscopy 387 cysts in polycystic kidneys obtained from 10 adult patients. Some cysts were lined by cells typical of collecting duct (7.2%), proximal tubule (1.8%) or glomerular visceral (2.1%) epithelium. The remaining cysts were lined by a single layer of phenotypically undefined (84.0%) or markedly hyperplastic (4.9%) epithelium. The median plane surface area of individual cells within cysts was 182 X 10(-8) cm2. Among all cysts the surface area of single epithelial cells ranged between 22 and 2530 X 10(-8) cm2, but within single cysts the range of individual cell surface areas was more narrow. Mean cell surface area did not increase in direct proportion to cyst diameter; thus, epithelial hyperplasia is a central element in the progressive enlargement of cysts. In some cysts hyperplasia was accentuated by projections into cyst lumens of polyps, small adenomas and cord-like arrangements of cells. Epithelial polyps were found in the cysts of one non-azotemic patient, excluding renal failure as a cause of this accentuated type of epithelial proliferation. Morphologic evidence that cysts compressed adjacent renal parenchyma was observed in all kidneys. In 11 cysts bisected and then both halves thoroughly examined by scanning electron microscopy, one or two tubule openings were seen in one of the hemisections in three cysts (27.3%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Laparoscopic splenectomy for a huge splenic cyst without preoperative drainage: report of a case

Laparoscopic splenectomy currently is a safe procedure and offers better cosmetic results, less pain, and a shorter hospital stay than the traditional open procedure. However, there have been only a few reports of laparoscopic removal of giant splenic cysts. An 18-year-old woman was admitted with abdominal fullness. CT scans and MRI images of the upper abdomen revealed a cystic mass having a diameter of 19 cm. Preoperative diagnosis was a large splenic cyst, and laparoscopic splenectomy with intraoperative cyst drainage (amount of drained fluid: 3,000 mL) was performed. Histologically, almost the entire cyst wall was lined with fibrous tissue, but a small portion was covered with stratified squamous epithelium. The final diagnosis was epidermoid cyst. The postoperative course was uneventful. Laparoscopic splenectomy should be tried first even in patients with a huge cyst, and intraoperative drainage under laparoscopic guidance facilitates laparoscopic splenectomy.     

Nonparasitic splenic cysts: pathogenesis, classification, and treatment

BACKGROUND: Nonparasitic splenic cysts (NPSCs) are uncommon lesions of the spleen, many being reported in anecdotal fashion. Early classifications of this disorder have been based on the presence or absence of an epithelial lining, indicating either a congenital or traumatic etiology. This criterion has led to confusion and mistaken reporting because the lining alone is not a reliable criterion. STUDY DESIGN: Over a 28-year period, the author has observed and studied 23 patients with NPSC. Special attention has been given to the role of trauma in the history, the nature (or absence) of a cyst lining, the gross pathology, and the preferred method of treatment. RESULTS: NPSC present as lesions with a very characteristic gross appearance and lining. The trabeculated interior can be lined with epidermoid, transitional, or mesothelial epithelium. Desquamation of the lining can lead to a spurious diagnosis, but careful search usually discloses the lining remnant. Although most NPSC in this series were treated by open partial splenectomy, the more recent approach by laparoscopic techniques offers great promise. CONCLUSIONS: A new classification of NPSC is offered, based on characteristic gross findings. NPSC are of congenital origin, with a lining derived from mesothelium. Trauma does not play a primary role in pathogenesis. Cysts that are symptomatic or over 5 cm in diameter should be removed by partial splenectomy or near-total cystectomy "decapsulation," either by the open or laparoscopic approach.     

Laparoscopic partial splenectomy for congenital splenic cyst in a pediatric patient: Case report and review of literature

Non-parasitic splenic cysts (NPSC) are a rare condition that makes difficult to know their true incidence and represent 10% of all benign splenic cysts, they can be either congenital with the presence of epithelial lining that originate from invagination of the capsular mesothelial lining or post-traumatic with absence of epithelial lining. We present our management of a splenic congenital cyst in a pediatric patient. A 10-year-old female patient presented to the clinic complaining with a 3-week abdominal pain at the left upper quadrant. An ultrasound showed an enlarged spleen with a thinned walled cystic image on the lower pole of 5 cm. An abdominal CT confirmed the presence of a splenic cyst at the lower pole of the spleen of 5 cm in diameter. Three-port laparoscopic partial splenectomy was done isolating and dividing the lower splenic artery and vein and the lower pole of the spleen with a vessel sealing device. Management of a non-parasitic splenic cyst is controversial: cystectomy, fenestration, percutaneous drainage and sclerotherapy have been previously described, most of them aiming to preserve spleen function and avoiding overwhelming post-splenectomy infection. Partial splenectomy seems the most effective one in terms of preserving spleen function and avoiding recurrence.     

Epidermoid cysts of the cerebellopontine angle with extension into the middle and anterior cranial fossae: surgical strategy and review of the literature

Summary Epidermoid cysts are tumours, which contain keratin, cellular debris and cholesterol, and lined with stratified squamous epithelium. Clinically, epidermoid cysts behave like benign, slow-growing lesions. We present a 63 year-old man with a 6-month history of right periorbital pain and hypaesthesia in the area of the first and second branch of the trigeminal nerve. MRI revealed an epidermoid cyst of the cerebellopontine angle extending into the middle and anterior cranial fossae. Radical surgical removal of epidermoid cysts should be attempted, but a less aggressive surgical strategy should be considered if there is strong adherence to the surrounding brain tissue, particularly in eloquent areas. In this case, complete tumour removal was achieved via a suboccipital retrosigmoid approach.     

Laparoscopic Internal Marsupializaton for Large Nonparasitic Splenic Cysts: Effective Organ-Preserving Technique

Background Primary splenic cyst is a rare disease, and therefore there is no information regarding its optimal management. Most such cysts are classified as epithelial cysts. During the last few years, the laparoscopic approach has gained increasing acceptance in splenic surgery. We present our experience with the laparoscopic (organ-preserving) management of splenic cysts. Methods We managed 11 patients with large symptomatic nonparasitic splenic cysts from 1996 to 2006. All the patients had fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computed tomography. All patients were treated with either laparoscopic partial cystectomy or marsupialization. Results Seven patients had mesothelial cysts, two had epidermoid cysts, and two had pseudocysts. Nine patients did not have any problems or recurrence during an average follow-up of 29.5 months. Two patients had cyst recurrence after 14 months. Conclusion Laparoscopic organ-preserving surgery should be the goal of therapy in most cases. Total splenectomy is reserved for cases in which cyst excision cannot be done or most of the splenic tissue is replaced by the cyst. Plication of the cyst wall edges prevents the cyst walls from adhering and causing recurrence, as well as helping to control hemorrhage. Laparoscopic partial cystectomy/marsupialization is an acceptable procedure for the treatment of splenic cysts; and after short to mid-term follow-up, it seems that a reasonable rate of success is possible.     

Epithelial (epidermoid) splenic cysts in childhood: surgical management of eight cases

We report eight cases of splenic epithelial cysts in childhood to summarize our clinical experience and to discuss surgical management. Six boys and two girls, aged 8 to 14 years (mean 10.8 years) were diagnosed over a 16-year period. No patients had a history of preceding trauma or related infection. Presenting symptoms were dull (two) or acute (one) left hypochondrium pain and diffuse abdominal pain (one). In four children the cyst was an incidental finding. Ultrasound and/or CT revealed cysts of diameter 2.9 to 14 cm and radionuclide scan showed a reduced uptake in the splenic area of concern. At operation variable amounts--up to 1500 mL--of liquid were aspirated from the cysts. Splenic artery ligation was undertaken in six cases adjunctively to cystectomy. One total splenectomy was performed because the splenic parenchyma was totally replaced by the cyst. Recurrence occurred in one case, in which multiple tiny communicating cysts were detected. Histology revealed epithelial (n = 5) or stratified squamous (n = 3) lining. Five patients were seen again 0.5 to 5 years later and they were asymptomatic and with a normal ultrasound, CT, or radionuclide scan. Cyst excision was an effective treatment. Adjunctive splenic artery ligation when performed controlled hemorrhage. Other surgical methods to manage splenic cysts are discussed.     

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.     

TA-stapler resection of congenital splenic cyst. Case report

Splenic cysts are uncommon. Primary (true, epithelial) and secondary (false, non-epithelial) forms may be distinguished, the latter being more usual. Organ-preserving resection of a primary mesothelial splenic cyst, using a TA-stapler, is described and alternative techniques of splenic preservation are discussed.     

Epidermoid cysts of the spleen

The authors report three cases of epidermoid cyst of the spleen. A squamous cell lining was found in all three. One patient had a history of antecedent trauma, and in the surgical specimen the gross and histologic features were compatiible with splenic damage. No hematologic alteration was recognized on presentation. Angiography and spleen scanning were valuable aids in the diagnosis. All three patients were well 1 year after operation.     

Asymptomatic and symptomatic Rathke's cleft cysts. Histological study of 45 cases

Pituitary cysts are fairly often found incidentally in anatomical studies, but symptomatic cysts are relatively uncommon. In this study, the histological characteristics of 42 asymptomatic and three symptomatic Rathke's cleft cysts were examined and compared. The 42 cysts found incidentally at autopsy were classified as small (less than 1 mm in diameter), medium (1 to 5 mm), or large (over 5 mm). There were 23 small (55%), 13 medium (31%), and six large (14%) cysts. The mean ages of the three patient groups were 66, 60, and 53 years, respectively. Flattened epithelial cells were the most common cells in small cysts, while cuboidal to columnar epithelial cells were more prevalent in medium and large cysts. The larger cysts tended to contain cilia. The three symptomatic cysts were histologically confirmed to be Rathke's cleft cysts by their characteristic ciliated columnar epithelial lining. No essential histological differences were observed between asymptomatic and symptomatic cysts, and the mechanism of change from asymptomatic to symptomatic Rathke's cleft cyst was not clarified. Small nests of epithelium at the junction of the pars tuberalis and pituitary stalk are considered to be remnants of Rathke's pouch and are thought to give rise to craniopharyngioma. In their most typical forms, Rathke's cleft cysts and craniopharyngiomas are histologically distinguishable, craniopharyngiomas being composed of stratified squamous epithelium and simple Rathke's cleft cysts of a layer of cuboidal or columnar epithelium on a basement membrane.(ABSTRACT TRUNCATED AT 250 WORDS)     

Histological classification of spermatic cord cysts in relation to their histogenesis

Light microscopy study of spermatic cord cysts in 26 men revealed three different histological patterns. First, cysts of probable mesothelial origin (14 cases) with an unilocular aspect: their epithelial cells showed poor cohesion and often appeared sloughed; subepithelial hyalinization or fibrin deposits were frequent. Second, cysts of probable embryonal (mesonephric) origin (8 cases): they were usually multilocular cysts and their epithelial cells showed great cohesion: zones of ciliated columnar epithelium associated with embryonal remnants displaying a similar epithelium were often found; the embryonal remnants and the cyst lumen contained spermatozoa in 2 cases. Third, cysts of doubtful origin (4 cases) showing abundant inflammatory infiltrates, which had destroyed the epithelium; the unilocular pattern observed in 3 cases suggests a mesothelial origin for these cysts, while the multilocular pattern and presence of embryonal remnants in the other case suggest an embryonal origin.     

Choroidal epithelial cyst of the cerebral hemisphere. An immunohistochemical study

A case of choroidal epithelial cyst in the left cerebral hemisphere of a 4-month-old infant is described. The cyst wall was composed of a single epithelial layer with a basement membrane and fibrous connective tissue. An immunohistochemical study revealed the presence of prealbumin in the cytoplasm of these cuboidal epithelial cells. This fact strongly suggested that the cuboidal epithelium lining the cyst wall originated from choroidal epithelial cells. The diagnostic usefulness of the immunohistochemical study in choroidal epithelial cysts is discussed.     

A case of female paraurethral cyst diagnosed as epithelial inclusion cyst

The patient was a 36-year-old woman with a chief complaint of pain of the urethral meatus. A cyst existed just below the urethral meatus. The paraurethral cyst was removed completely. Histologically, the cyst was lined by stratified squamous epithelium. According to the criteria proposed by Das, paraurethral cysts are classified into 4 groups: epithelial inclusion cysts, Müllarian cysts, G?rtner duct cysts, Skene duct cysts. In this case, the cyst seemed to be an epithelial inclusion cyst. In the Japanese literature, paraurethral cysts have been incompletely classified from an etiological perspective. Differential diagnoses based on the histological findings of the cysts may be important to determine the etiology.     

Changes in the epithelium of Rathke cleft cyst associated with inflammation

OBJECT: Rathke cleft cysts (RCCs) are composed of tall, well-differentiated, ciliated columnar epithelia. Their structures are altered by hyperplasia or squamous metaplasia, but their cause remains unknown. METHODS: The authors studied pathological findings and anterior pituitary function in 20 patients harboring RCCs. They classified RCC epithelium as either single (a single ciliated columnar cell lining or a flattened cuboidal cell lining) or stratified (a stratified ciliated columnar cell lining, basal cell hyperplasia, columnar cell hyperplasia, or squamous metaplasia). Inflammation was classified as acute, subacute, chronic, or end stage. The epithelial cell lining was observed in 13 specimens obtained during surgery (six specimens contained single and seven contained stratified epithelia). Inflammation had penetrated the cyst epithelium or subjacent stroma in 10 patients, and the stage of inflammation correlated well with the type of epithelia group: early stages of inflammation in the single epithelium group and chronic or end-stage inflammation in the stratified epithelia (p = 0.0027). The adenohypophysis was identified in 21 surgical specimens. Postoperatively, growth hormone (p = 0.019), cortisol (p = 0.027), and thyroid-stimulating hormone (p = 0.039) responses significantly worsened as the inflammation progressed. The presence of diabetes insipidus correlated well with advanced stages of neurohypophysitis (p = 0.025). CONCLUSIONS: Epithelial stratification in the RCC is caused by inflammation that may extend into the adjacent adenohypophysis or neurohypophysis and overwhelm the hypophysis, resulting in panhypopituitarism. Transsphenoidal excision may represent the best choice for treatment, at least for cases of RCC in which there is partial impairment of hypophysial function.     

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     

Epidermoid cyst of the spleen,a case report

IntroductionSplenic tumors are rare and are either primary or secondary, benign or malignant. Most have none to minimal symptomatology and are found incidentally. Splenic cysts can be infectious, congenital, or traumatic. Epidermoid cysts and parasitic cysts are examples of primary cysts and usually have a classic presentation on imaging. Despite advanced imaging modalities and patient's clinical presentation, it can be difficult to diagnose an epidermoid cyst without histological examination. The purpose of this paper is to discuss typical findings of primary splenic cysts on imaging, but how they may differ in appearance.Presentation of case51 year old female who presented with vague abdominal discomfort and was found to have a large splenic mass with cystic components on imaging which did not demonstrate a typical primary splenic cyst appearance. Patient underwent an uneventful hand-assisted laparoscopic total splenectomy and had an uneventful recovery with histopathology revealing an epidermoid splenic cyst.ConclusionPrimary splenic cysts are difficult to diagnose and differentiate with imaging alone. They have a variable presentation and can present like as a cystic mass. It is important to include them in the differential diagnosis of splenic masses since histopathology is the final determinant of the diagnosis.     

Laparoscopic splenectomy for epithelial cyst of the spleen

Splenic cysts of all types are a relatively rare entity. The origin of epithelial cysts of the spleen is controversial, most probably congenital in origin. Generally, epithelial cysts of the spleen are asymptomatic and discovered incidentally. We present the case of a 40-year-old woman with a 3.5 cm splenic cyst diagnosed four years before. The cyst raised progressively in dimension, the actual size being of 6.5 cm. Computed tomography scan and magnetic resonance showed a central splenic cyst in close relations with main splenic vessels. An initial indication of partial splenectomy was established, eventually a total splenectomy being performed by laparoscopy due to close relations of the cyst with the main hilar splenic vessels. The hemostasis was assured with the aid of Ligasure Atlas 10 mm instrument. The pathology examination revealed a multilocular splenic cyst with a cuboidal epithelial lining. Central localization of splenic cysts represents an indication for total splenectomy. Laparoscopy provides a minimal access method of obtaining pathological confirmation of diagnosis, reduction of cyst complications, and a short hospital stay. This article discusses different aspects of epithelial cysts related to pathology, diagnostic and indications for operative treatment, a review of the literature being also presented.     

Lumbar synovial cysts: experience with nine cases

Nine patients treated surgically for lumbar spinal synovial cyst were reviewed. Four patients had synovial, two had ganglion, one had posterior longitudinal ligament, and two had ligamentum flavum cyst. Synovial cysts had a single layer of epithelial cells in the inner layer of the cyst with continuity with the facet joint. Ganglion cyst had no continuity with the facet joint and epithelial lining was present in one and absent in one case. Posterior longitudinal ligament and ligamentum flavum cysts had no continuity with the facet joint and no epithelial lining. Magnetic resonance imaging showed the cysts better than computed tomography. All patients treated for nerve root compression or lumbar spinal canal narrowing. One patient suffered recurrence 1 year later and was reoperated. Operative results were excellent in six and good in three patients. Lumbar spinal synovial cysts should be considered in differential diagnosis of lumbar radiculopathy/neurogenic claudication and is surgically treatable.