Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13899
Revised: May 20, 2014
Accepted: June 14, 2014
Published online: October 14, 2014
Processing time: 233 Days and 18.2 Hours
Primary splenic epithelial cyst is an unusual event in everyday surgical practice with about 800 cases reported until date in the English literature. Splenic cysts may be parasitic or non-parasitic in origin. Nonparasitic cysts are either primary or secondary. Primary cysts are also called true, congenital, epidermoid or epithelial cysts. Primary splenic cysts account for 10% of all benign non-parasitic splenic cysts and are the most frequent type of splenic cysts in children. Usually, splenic cysts are asymptomatic and can be found incidentally during imaging techniques or on laprotomy. The symptoms are related to the size of cysts. When they assume large sizes, they may present with fullness in the left abdomen, local or referred pain, symptoms due to compression of adjacent structures (like nausea, vomiting, flatulence, diarrhoea) or rarely thrombocytopenia, and occasionally complications such as infection, rupture and/or haemorrhage. The preoperative diagnosis of primary splenic cysts can be ascertained by ultrasonography (USG), computed tomography or magnetic resonance imaging, although the wide use of USG today has led to an increase in the incidence of splenic cysts by 1%. However, careful histopathological evaluation along with immunostaining for presence of epithelial lining is mandatory to arrive at the diagnosis. The treatment has changed drastically from total splenectomy in the past to splenic preservation methods recently.
Core tip: Accurate preoperative diagnosis of primary epithelial cysts is difficult; the occurrence of a cystic lesion that is either unilocular or multilocular in the absence of previous trauma, infection or exposure to hydatid disease may help to arrive at the diagnosis. However, careful histopathological evaluation along with immunostaining is important to arrive at correct diagnosis. The treatment has changed drastically from total splenectomy in the past to splenic preservation methods recently. The rationale behind conservative management is to preserve the splenic function in order to avoid untoward complications related to historical treatment.