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Splenic cysts : (report of 2 cases and review of the literature).
Cystic disease of spleen is not uncommon. Periodic review and isolated case reports have taken the number of reported nonparasitic splenic cysts and Splenic neoplasms to more than 600. Here, two cases of splenic cyst, one hydatid cyst and the other epithelial cyst are presented.
Case 1 A 25 year old female patient presented with an asymptomatic lump in the hypochondrial region for two years. On examination, there was a single, cystic, nonballotable intra-abdominal lump in the left hypochondrium that moved with respiration. The routine biochemical and hematological investigations were normal. Casoni's test and complement fixation test for hydatid disease were negative. A clinical diagnosis of cystic splenomegaly was made and the patient was subjected to the following investigations. Plain X-ray of the abdomen revealed anterior displacement of the stomach and downward displacement of the transverse colon. All the small bowel loops were pushed to the right and downwards. An upper gastro-intestinal barium series confirmed the above findings. An inferior venacavogram showed the inferior vena cave bodily shifted to the right in the thoraco-abdominal region. The excretory urogram showed slight outward shift of the upper pole of the left kidney with some flatening of the kidney anteroposteriorly. A 99mTc sulfur colloid scan revealed a normal hepatic configuration. The splenic tissue was in the form of a thin rim at the periphery and was indented by a regular rounded compression. Ultrasonography revealed a cystic lesion in relation to the spleen. The arterial phase of selective coeliac and superior mesenteric arteriogram showed displacement of aorta and its branches to the right, The splenic artery was stretched and displaced upwards. There was a stretching of omental arteries and intrasplenic vessels around a circular avascular mass [Fig. 1] on page 250B, Late parenchymatous phase demonstrated thin rim of splenic tissue around the mass opacifying finally the portal vein via the superior mesenteric vein. The splenic vein was not visualized. A splenoportogram showed abrupt cut-off of the splenic vein 1 cm beyond its formation. The diagnosis of splenic cyst was confirmed and the patient was subjected to exploratory laparotomy. On exploration, there was a large splenic cyst which had pushed the functional splenic tissue to the periphery. Splenectomy was done. Post-operative recovery was uneventful. On cut section, the cyst had a thick wall and contained two litres of brownish fluid. The interior of the cyst was trabeculated [Fig. 2] on page 250B. The microscopic examination showed a fibrous wall lined by stratified squamous epithelium with intercellular bridges, without evidence of rete pegs or skin appendages thus confirming it to be epidermoid cyst, fulfilling the criteria for primary cyst as laid down by Bostick and Lucia (1949)2 and Fowler (1953).[4] Case 2 A 30 year old male patient presented with an asymptomatic lump in the left hypochondrial region since 2 years. On examination, the patient had splenomegaly. The routine haematological and biochemical investigations were normal. Casoni's test and complement fixation test were negative. A provisional diagnosis of splenic cyst was made and the patient was investigated. An upper gastro-intestinal barium series showed stomach pushed to right. A 99mTc scan showed a normal liver with splenic shadow consisting of a thin rim of tissue of the periphery, pushed by a rounded indentation [Fig. 3] on page 250B. With a pre-operative diagnosis of splenic cyst, the patient was subjected to exploratory laparotomy. On exploration, the patient had a large splenic cyst with the functional splenic tissue pushed to the periphery. Splenectomy was done [Fig. 4] on page 250B. Post-operative recovery was uneventful. On cut section, the cyst had a thick wall. The interior of the sac contained clear fluid with scolices and brood capsules. Microscopic examination confirmed it to be a hydatid cyst.
Cystic swelling of the spleen is an uncommon disease in surgical practice. It can be either parasitic due to hydatid disease or nonparasitic which may be primary or secondary. The primary cyst, also called `Epithelial cyst' in the British literature[6], [9], [10] and `Epidermoid cyst of spleen' in American literature[3],[4],[5],[7],[8] constitute 10% of benign nonparasitic variety. The hydatid cyst forms 58% of all secondary cysts. Berthelot[1] was first to report a case of splenic cyst. Fowler,[4], [5] in 1953, compiled a series of 265 recorded cases from the literature. Qureshi et al[7] brough the total to 421 by adding their own cases.
We thank the Dean, K.E.M. Hospital, Bombay 400 012, for permitting us to report the hospital data.
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