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Stoyanov GS, Kirilova A, Naydenova K, Zlatev Z, Popov H, Georgiev R, Kirov K. A Tale of Two Cysts: A Histopathological Case Report of Epithelial and Mesothelial Splenic Cysts. Cureus 2024; 16:e75200. [PMID: 39759754 PMCID: PMC11700373 DOI: 10.7759/cureus.75200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2024] [Indexed: 01/07/2025] Open
Abstract
Splenic cysts are rare medical conditions, and their incidence is dominated by parasitic types. Non-parasitic splenic cysts, whether true cysts (with a cellular lining of the cystic wall) or pseudocysts (without a cellular lining), are significantly rarer than parasitic ones. Their etiology is not fully established, with fetal remnant development, metaplasia, and mesothelial invagination being widely accepted possible mechanisms. Splenic cysts are rarely symptomatic if small and are predominantly discovered incidentally, while larger and multiple splenic cysts mainly present with dull abdominal pain or discomfort. Herein, we report two cases of splenic cysts. The first case involves a 14-year-old female with an insignificant medical history, presenting with dull abdominal pain developing over the previous month. Computed tomography (CT) revealed a cystic lesion within the lower aspect of the spleen, measuring 150 × 130 × 115 mm, with compression of the left kidney. The patient was treated with partial splenectomy, and histopathology revealed a true epithelial cyst. The second case involves a 45-year-old male, also without significant prior medical history, presenting with subacute abdominal pain. Abdominal CT showed multiple splenic cysts, the largest measuring 50 mm, and multiple dispersed smaller ones measuring between 4 and 8 mm, with compression of the left kidney. The patient was treated with total splenectomy, and histopathology showed multiple mesothelial splenic cysts.
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Affiliation(s)
- George S Stoyanov
- Pathology, Multiprofile Hospital for Active Treatment, Shumen, BGR
- Cytopathology, Diagnostic and Consultative Center, Shumen, BGR
| | - Andreya Kirilova
- General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
| | - Kristina Naydenova
- General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
| | - Zlatko Zlatev
- Pathology, Multiprofile Hospital for Active Treatment, Shumen, BGR
| | - Hristo Popov
- General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
| | | | - Kiril Kirov
- Research Institute, Medical University of Pleven, Pleven, BGR
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2
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Sun Y, Yu XF, Yao H, Chai C. Laparoscopic partial splenectomy for a giant splenic pseudocyst with elevated CA19-9: a case report. Ann Med Surg (Lond) 2024; 86:4849-4853. [PMID: 39118735 PMCID: PMC11305767 DOI: 10.1097/ms9.0000000000002327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/02/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction and importance Currently, there is a lack of reliable evidence on the management of splenic cysts, which are rare. Exploring the efficacy of laparoscopic partial splenectomy can aid in the accumulation of treatment-related evidence. Case presentation Here, we report the case of a 31-year-old female who was diagnosed with a giant splenic cyst with elevated serum CA19-9 and subsequently underwent laparoscopic partial splenectomy. Clinical discussion The effects of most treatment options for splenic cysts, including percutaneous aspiration and drainage, fenestration, and partial splenectomy, have not been confirmed by high-level evidence. With the development of minimally invasive surgery, laparoscopic partial splenectomy has drawn increasing attention. Additionally, the relationships between tumor markers and splenic cysts need to be further elucidated. Conclusions Laparoscopic partial splenectomy might be recommended for patients with splenic cysts, especially when the cysts are not completely covered by the splenic parenchyma.
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Affiliation(s)
| | | | | | - Chen Chai
- Department of General Surgery, The People’s Hospital of Suzhou New District, Suzhou, Jiangsu, People’s Republic of China
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Gomez DM, Sivaganesh S. Large epidermoid cyst of the spleen causing massive splenomegaly: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241239530. [PMID: 38486974 PMCID: PMC10938603 DOI: 10.1177/2050313x241239530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
Splenic cysts are uncommon and are classified as primary cysts or secondary cysts based on the presence or absence of an intact epithelial lining, respectively. Epidermoid cysts have an epithelial lining of stratified squamous epithelium and have been reported in normal and intra-pancreatic accessory spleens. An 18-year-old girl presented with a symptomatic, uncomplicated splenic cyst causing massive splenomegaly and symptoms due to mass effect. Peripheral cytopaenias and lymphoproliferative neoplasm were excluded. Preoperative computed tomography was suggestive of a large splenic cyst causing massive splenomegaly and marked loco-regional pressure effects. Open splenectomy was performed and histology confirmed an epidermoid cyst with no features of malignancy. Splenic epidermoid cysts are a rare cause of massive splenomegaly. Surgical intervention is recommended due to symptoms and the risk of complications.
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Affiliation(s)
- Deshan Mario Gomez
- The University Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Sivasuriya Sivaganesh
- Division of HPB Surgery, Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Tiutiuca RC, Nastase Puscasu AI, Stoenescu N, Moscalu M, Bradea C, Eva I, Lupascu CD, Ivan L, Palaghia MM, Prisecariu DI, Târcoveanu E, Vâță A, Bejan V, Vasilescu AM. Laparoscopic Approach to Primary Splenic Cyst: Case Report and Review of the Literature. Life (Basel) 2024; 14:120. [PMID: 38255735 PMCID: PMC10817520 DOI: 10.3390/life14010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Splenic cysts are rare benign lesions of the spleen, often asymptomatic and incidentally discovered during imaging studies. While many splenic cysts remain asymptomatic and do not require intervention, surgical management becomes essential in cases of symptomatic cysts, large cysts, or when malignancy cannot be ruled out. Laparoscopic surgery has emerged as a minimally invasive and effective approach for treating splenic cysts, offering advantages such as shorter hospital stays, reduced postoperative pain, and faster recovery. In this case report, we describe our experience with laparoscopic surgery for a symptomatic splenic cyst in a young patient.
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Affiliation(s)
- Razvan Calin Tiutiuca
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | | | - Nicoleta Stoenescu
- Faculty of Psychology and Education Sciences, “Alexandru Ioan Cuza” University of Iași, 700506 Iasi, Romania
| | - Mihaela Moscalu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Costel Bradea
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Iuliana Eva
- Radiology Department, “Dr Iacob Czihac” Military Emergency Hospital of Iași, 700483 Iasi, Romania
| | - Cristian Dumitru Lupascu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Luminita Ivan
- Pathology Department, “Dr Iacob Czihac” Military Emergency Hospital of Iași, 700483 Iasi, Romania
| | - Madalina Maria Palaghia
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Denisa Ioana Prisecariu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Eugen Târcoveanu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Andrei Vâță
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Valentin Bejan
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
| | - Alin Mihai Vasilescu
- Faculty of Medicine, University of Medicine and Farmacy “Gr. T. Popa” Iasi, 700115 Iasi, Romania (A.V.); (A.M.V.)
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5
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Al Laham O, Sharaf Aldeen R, Al Kurdi MF, Alshiekh A, Bozo M. Unraveling a rare splenic pathology: a case report of a benign hemorrhagic spleen with primary congenital splenic epidermoid cysts. Ann Med Surg (Lond) 2024; 86:602-606. [PMID: 38222723 PMCID: PMC10783293 DOI: 10.1097/ms9.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/26/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance A primary congenital splenic epidermoid cyst is an immensely rare pathology with mostly unknown epidemiological parameters. Misdiagnosis can easily happen and this results in life-threatening ramifications for patients. Considering this pathology as a potential differential diagnosis allows for the required surgical intervention to be timely accomplished. In this case, the authors are documenting this pathology and presenting how it was successfully managed via proper and informed preoperative analysis and meticulous intraoperative technique. Case presentation Hereby, we portray the exceptionally rare case of a 7-year-old male who presented to our surgical clinic complaining of a sudden left hypochondriac pain with early satiety for 1 month's duration. The preoperative radiological assessment displayed numerous splenic cystic lesions throughout the splenic parenchyma. Clinical discussion Resection of the cysts was accomplished via total splenectomy. The ensuing histopathological analysis via Hematoxylin and Eosin of the resected specimens established the diagnosis of a congested hemorrhagic spleen with multiple primary congenital splenic epidermoid cysts. Conclusion Primary congenital splenic epidermoid cysts are an extremely rare type of splenic pathology. There is profound scarcity amidst the published literature regarding it. This merits in-depth study and apt documentation to raise awareness regarding this pathology as a potential differential diagnosis in cases of abdominal pain. Documentation allows us to set up proper and innovative clinical and surgical protocols for these patients. Based on our conclusive review of the published literature, the authors conclude that ours is the first ever documented case from our country of a primary congenital splenic epidermoid cyst.
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Affiliation(s)
- Omar Al Laham
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Rahaf Sharaf Aldeen
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - M Fadi Al Kurdi
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Ali Alshiekh
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al-Mouwasat University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Maher Bozo
- Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
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6
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Jeenah NR, Damodaran Prabha R, Puhalla H. Challenges in the management of a splenic pseudocyst by laparoscopic splenectomy in an adult patient: A case report. Int J Surg Case Rep 2023; 110:108718. [PMID: 37672828 PMCID: PMC10509935 DOI: 10.1016/j.ijscr.2023.108718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Splenic cysts are classified as true cysts, or pseudocysts, and larger cysts tend to be symptomatic, requiring management which has evolved to include spleen-sparing procedures to minimize the risk of overwhelming post-splenectomy sepsis (OPSS) Pitiakoudis et al. (2011), Hansen and Moller (2004), Knook et al. (2019) [1-3]. Total splenectomy remains the gold standard management, and the importance of this case is the uncommon spontaneous occurrence of a pseudocyst, and the importance to pre-operatively consent and prepare the patient for total splenectomy would intra-operative conditions not allow for spleen-preserving techniques. CASE PRESENTATION CS, a 21-year-old lady, had two presentations to the emergency department with left upper quadrant abdominal pain. The only abnormality on assessment was a large splenic cyst on CT scan, which increased in size on re-presentation. She was consented for a splenic cyst fenestration, and for total splenectomy and optimized with vaccines would intra-operative conditions not allow for spleen-sparing. During the operation, the planes between the cyst and spleen parenchyma were ill-defined, and decision was made to proceed with total splenectomy to avoid bleeding complications. She recovered well, and was discharged 5 days post-operatively, and histology confirmed a pseudocyst (Figs. 1 and 2). CLINICAL DISCUSSION The management of splenic cysts remains difficult and with no clear guidelines to uniform treatment. There are multiple spleen-preserving techniques developed to avoid OPSS (Agha RA, Franchi T, Sohrabi C, Mathew G, for the SCARE Group, 2020 [4]), however management remains individualized and case-specific. CONCLUSION Pseudocysts can occur without splenic trauma or infarct. Management is case-based, and patients with large symptomatic cysts should be consented and prepared for total splenectomy would conditions not be safe for spleen-preserving interventions.
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Affiliation(s)
| | | | - Harald Puhalla
- Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD, Australia, 4215
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Abdulla MR, Saeed YA, Abdul Aziz JM, Ahmed SA, Abdullah YA, Sabir AA, Jalal SM, Mohammed AS, Ali MD, Rasheed MK, Rashid MJ, Huy NT. Bilateral Endometriotic Cystic Ovaries and Huge Splenic Epithelial Cyst With Elevated CA-125, CA19-9: A Report of a Rare Case. Cureus 2023; 15:e44256. [PMID: 37772224 PMCID: PMC10525979 DOI: 10.7759/cureus.44256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
Histologically benign splenic cysts (SCs) resemble splenic sacs. SCs are rare. Here, we present and discuss a new case of bilateral endometriotic cystic ovaries with massive SCs. A 26-year-old single female visited the hospital with left lower quadrant discomfort and suprapubic pain for three months, accompanied by anorexia, weight loss for these three months, and persistent dysmenorrhea for two years. Splenic examination revealed a soft abdomen with left hypochondria, suprapubic tenderness, and a lump in the upper left quadrant. All laboratory results were normal, except for two cancer antigens (CA-125 and CA 19-9). Therefore, magnetic resonance imaging was used to make the definitive diagnosis, which revealed bilateral ovarian endometrioma with a left upper abdominal cystic mass of splenic origin. When CA-125 and CA-19-9 readings are high, physicians should investigate endometriotic and SCs. Imaging aids diagnosis. Histopathological results are essential. Tools and follow-up should rule out malignancy, and surgery is the best treatment option.
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Affiliation(s)
- Midya R Abdulla
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, IRQ
| | - Yadgar A Saeed
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, IRQ
| | - Jeza M Abdul Aziz
- Biomedical Science Department, Komar University of Science and Technology, Sulaymaniyah, IRQ
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, IRQ
| | - Syamand A Ahmed
- Baxshin Research Center, Baxshin Hospital, Sulaymaniyah, IRQ
| | - Yadgar A Abdullah
- Medical Laboratory Department, College of Health, Sulaimani Polytechnic University, Sulaymaniyah, IRQ
| | - Awat A Sabir
- Burn Plastic and Reconstructive Surgery Department, Sulaimani Burn Plastic Hospital, Sulaymaniyah, IRQ
| | - Sivar M Jalal
- College of Medicine, University of Sulaimani, Sulaymaniyah, IRQ
| | - Aynda S Mohammed
- Medical Laboratory Department, College of Health, Sulaimani Polytechnic University, Sulaymaniyah, IRQ
| | - Mohammad D Ali
- College of Medicine, University of Garmian, Sulaymaniyah, IRQ
| | - Mariwan K Rasheed
- Medical Laboratory of Science, College of Health Science, University of Human Development, Sulaymaniyah, IRQ
| | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, JPN
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8
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Lukman K, Sulthana BAAS, Budiman D, Nugraha P. Giant splenic cyst: A case series of rare and challenging cases from the last 22 years. Int J Surg Case Rep 2023; 106:108263. [PMID: 37116278 PMCID: PMC10163636 DOI: 10.1016/j.ijscr.2023.108263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Splenic cyst is a rare disease, with reported incidences ranging from 0.07 to 0.3 %. A splenic cyst is typically discovered inadvertently and may not cause any symptoms until it grows to a significant size. In some cases, complications such as acute abdomen may be brought on by an intracystic hemorrhage, rupture, or infection. As a rare disease, diagnosing a splenic cyst is still precarious because only a few cases have been reported. CASE PRESENTATION The first case is a 23-year-old Asian man without a significant history of illness who complains of a left upper quadrant mass that he discovered 10 years prior. Since then, the mass had been gradually growing and had been accompanied by severe pain. Walking made the pain worse; lying down made it lessen. A computed tomography (CT) scan of the abdomen showed a 20.05 × 15.95 × 26.71 cm splenic cyst. Surgery for a peri-cystic splenectomy was done. A primary splenic cyst was identified in the specimen after microscopic and macroscopic examination. After 10 days, the patient was released from the hospital without complications. The second case is that of a 28-year-old Asian man who complained of a mass in their abdomen that was getting bigger in size. Four years prior to the complaint, the patient had fallen while driving a motorcycle, and the left side of his abdomen collided with the sidewalk. In this patient, a splenectomy-the complete removal of all spleen parts-was done. The specimen's macroscopic and microscopic examination revealed a splenic pseudocyst. The patient was discharged after three days without complications. CLINICAL DISCUSSION Splenic cysts are considered rare and challenging to diagnose, as there have been only a limited number of reports. Nevertheless, proper management is still needed, as it carries the risk of rupturing and causing complications such as peritonitis and anaphylactic reactions. Considering the risk of overwhelming post-splenectomy infection (OPSI), conservative treatment can be the gold standard for splenic cysts. However, considering the risk from the size of the cyst, splenectomy or peri-cystic splenectomy is an appropriate surgery option for a splenic cyst. CONCLUSION Splenectomy, or peri-cystic splenectomy, is a surgery option for a splenic cyst with significant size and rupture risk.
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Affiliation(s)
- Kiki Lukman
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Bambang Am Am Setya Sulthana
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Deny Budiman
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Prapanca Nugraha
- Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Padjadjaran / Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
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Jang YS, Kim SS, Shin HC, Choi SY, Park CH, Lee HN, Kim SY, Park H, Kim YT. Various congenital anomalies and anatomical variations of the spleen: a multimodality pictorial review. Abdom Radiol (NY) 2023; 48:1505-1513. [PMID: 36790453 DOI: 10.1007/s00261-023-03826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/16/2023]
Abstract
There are various congenital anomalies and anatomical variations of the spleen (CAAVS). CAAVS are common and are often associated with systemic anomalies. Widespread use of computed tomography and magnetic resonance imaging in a variety of clinical situations has increased the detection of CAAVS. However, CAAVS are frequently overlooked and are occasionally misdiagnosed as pathologic disease entities. This article aimed to review the various manifestations of CAAVS with radiologic findings.
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Affiliation(s)
- Young Sil Jang
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Seung Soo Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea.
| | - Hyeong Cheol Shin
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon-si, Republic of Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Shin Young Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Hyerim Park
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
| | - Young Tong Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 330-721, Republic of Korea
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10
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Haddad F, Araydah M, Al Sharie S, Haddad R, Azar S. Communicating pancreatic and splenic pseudocysts: A case report. Radiol Case Rep 2023; 18:226-231. [PMID: 36340237 PMCID: PMC9633578 DOI: 10.1016/j.radcr.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
A splenic pseudocyst is an encapsulated mature collection located within the splenic tissues. It is usually asymptomatic and is detected incidentally during either radiological workup or laparoscopy for other reasons. Our patient is a 66-year-old male presenting with a history of weight loss, early satiety, and constipation, found to have a splenic pseudocyst communicating with a preexisting pancreatic cyst. Cystic lesions of the spleen can be divided into primary and secondary types. Secondary splenic cysts (pseudocysts) are residues of either earlier infection, trauma, or infarction. Management approaches to splenic cysts are either conservative or surgical according to the symptoms and size of these cysts. Most splenic cysts are discovered incidentally either during radiological workup or laparoscopy. Such entities require the combined effort of surgeons, gastroenterologists, and radiologists to provide the maximum care for these patients.
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Affiliation(s)
| | | | | | - Rana Haddad
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shadi Azar
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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11
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Yocum BP, Hwang M, Mesa H, Collins K. Differential Diagnosis of Cystic Lesions of the Spleen: A Review of Clinical, Imaging and Pathological Findings. Int J Surg Pathol 2022:10668969221107080. [PMID: 35818747 DOI: 10.1177/10668969221107080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cystic lesions of the spleen are being noticed with increased frequency as "incidentalomas" during imaging work-up for unrelated causes. As a group, these lesions encompass pure cystic and mixed cystic and solid, benign and malignant processes that in general require a tissue sample for definitive diagnosis. In this review, we will describe the differential diagnosis of cystic lesions of the spleen, highlighting key imaging, clinical and pathologic findings.
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Affiliation(s)
| | - Michael Hwang
- Department of Pathology, 10668Indiana University, Indiana, IN, USA
| | - Hector Mesa
- Department of Pathology, 10668Indiana University, Indiana, IN, USA
| | - Katrina Collins
- Department of Pathology, 10668Indiana University, Indiana, IN, USA
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12
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Aydin Y, Vemuri B, Berg C. The Usual Presentation of an Unusual Case: Spontaneous Primary Splenic Cyst Rupture. Cureus 2022; 14:e25097. [PMID: 35733464 PMCID: PMC9204504 DOI: 10.7759/cureus.25097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/05/2022] Open
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13
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Senn AS, Bauer RC, Heigl A, Rosenberg R. 23-year old man with a long history of abdominal pain, nausea and vomiting: Case report of a splenic cyst. Int J Surg Case Rep 2022; 93:106991. [PMID: 35367949 PMCID: PMC8976122 DOI: 10.1016/j.ijscr.2022.106991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/26/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Presentation of case Discussion Conclusion
Large splenic cysts present with unspecific and upper GI-symptoms. Small splenic cysts are usually diagnosed incidentally. Large splenic cysts > 5 cm are recommended to be treated with a surgical procedure. Spleen-preserving procedures are preferred.
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Affiliation(s)
- Alina Samia Senn
- Klinik für Allgemein-, Viszeral-, Gefäss- und Thoraxchirurgie, Kantonsspital Baselland, Liestal, Switzerland.
| | - Robert Christian Bauer
- Klinik für Allgemein-, Viszeral-, Gefäss- und Thoraxchirurgie, Kantonsspital Baselland, Liestal, Switzerland
| | - Andres Heigl
- Klinik für Allgemein-, Viszeral-, Gefäss- und Thoraxchirurgie, Kantonsspital Baselland, Liestal, Switzerland
| | - Robert Rosenberg
- Klinik für Allgemein-, Viszeral-, Gefäss- und Thoraxchirurgie, Kantonsspital Baselland, Liestal, Switzerland
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14
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Franke D, Anupindi SA, Barnewolt CE, Green TG, Greer MLC, Harkanyi Z, Lorenz N, McCarville MB, Mentzel HJ, Ntoulia A, Squires JH. Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children. Pediatr Radiol 2021; 51:2229-2252. [PMID: 34431006 DOI: 10.1007/s00247-021-05131-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
Gray-scale and color/power Doppler ultrasound (US) are the first-line imaging modalities to evaluate the spleen, gallbladder and pancreas in children. The increasing use of contrast-enhanced ultrasound (CEUS) as a reliable and safe method to evaluate liver lesions in the pediatric population promises potential for imaging other internal organs. Although CEUS applications of the spleen, gallbladder and pancreas have been well described in adults, they have not been fully explored in children. In this manuscript, we present an overview of the applications of CEUS for normal variants and diseases affecting the spleen, gallbladder and pancreas. We highlight a variety of cases as examples of how CEUS can serve in the diagnosis and follow-up for such diseases in children. Our discussion includes specific examination techniques; presentation of the main imaging findings in various benign and malignant lesions of the spleen, gallbladder and pancreas in children; and acknowledgment of the limitations of CEUS for these organs.
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Affiliation(s)
- Doris Franke
- Department of Pediatric Kidney, Liver and Metabolic Diseases, MHH, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Thomas G Green
- Department of Radiology, Crouse Hospital, Syracuse, NY, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - Norbert Lorenz
- Children's Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Aikaterini Ntoulia
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Judy H Squires
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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15
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Riccipetitoni G, Pelizzo G, Ruffoli M, Cavaiuolo S, Vella C, La Pergola E, Pansini A, Del Re G, Vatta F, Avolio L, Romano PG, Raffaele A. Effectiveness of Articulating Linear Stapler for Total and Partial Laparoscopic Splenectomy in Children. J Laparoendosc Adv Surg Tech A 2021; 31:1331-1336. [PMID: 34424747 DOI: 10.1089/lap.2020.0812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: We performed a retrospective study to determine the effectiveness and feasibility of articulating linear stapler in laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS), focusing on technical laparoscopic skills that could help pediatric surgeons to avoid intra- and postoperative complications. Methods: Retrospective cohort study of children younger than 18 years who underwent laparoscopic spleen surgery between January 2008 and March 2020. Age, sex, indication for surgery, operative time (OT), intra- and postoperative complications, and postoperative length of hospital stay (LHS) were analyzed. Data from parenchymal resection and vessels sealing techniques were obtained. Results: Thirty patients, 19 LTS and 11 LPS, were included. The mean age of the patients was 10.9 years, and 16 patients were male and 14 were female. For hematologic diseases, LTS was the elective surgery, associated with cholecystectomy in 5 cases. LPS was the common procedure for splenic cysts. The stapler was used in LTS to close the hilum vessels and in LPS for parenchymal resection. No statistically significant differences in OT were observed comparing LTS and LPS. Two conversions occurred in LTS; none in LPS. The mean LHS was 6 days in both groups. No recurrence or major complications appeared in both groups at 1-12 years of follow-up. In particular for LPS, there are no relapse of cyst neither reduction in splenic function. Conclusions: This study shows the effectiveness, feasibility, and safety of mechanic stapler in splenic surgery both for hilum vessels sealing and for parenchymal resection. The use of this device can reduce risk of hemorrhagic recurrences or major surgical complications improving the safety of the operation.
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Affiliation(s)
- Giovanna Riccipetitoni
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gloria Pelizzo
- Department of Biomedical and Clinical Science "L.Sacco," University of Milano, Milano, Italy.,Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Maria Ruffoli
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Cavaiuolo
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Vella
- Department of Pediatric Surgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Enrico La Pergola
- Department of Biomedical and Clinical Science "L.Sacco," University of Milano, Milano, Italy
| | - Andrea Pansini
- Department of Biomedical and Clinical Science "L.Sacco," University of Milano, Milano, Italy
| | - Giulia Del Re
- Department of Biomedical and Clinical Science "L.Sacco," University of Milano, Milano, Italy
| | - Fabrizio Vatta
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigi Avolio
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Giovanni Romano
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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16
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Alhaddad B, Hussain AA, Al-Rawi H, Al Saady RM. Large expanding splenic pseudocyst: A case report and review of literature. Int J Surg Case Rep 2021; 86:106317. [PMID: 34418805 PMCID: PMC8379287 DOI: 10.1016/j.ijscr.2021.106317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Splenic pseudocysts are extremely uncommon. Most of these cysts are asymptomatic and may result from previous blunt abdominal trauma. We report an interesting uncommon case of large splenic pseudocyst without history of previous abdominal trauma. Case presentation A 56 year old male patient, presented with symptoms of pain in the left side of middle back and discomfort in the left hypochondrium for few months. His physical examination was unremarkable. The abdominal Ultrasound and contrast-enhanced Computed tomography showed a large splenic cyst occupying most of the splenic parenchyma. Echinococcus multilocularis antibody test was negative. The differential diagnosis of this case included non-parasitic splenic cysts. The patient underwent elective exploratory laparoscopy which was converted to laparotomy with total splenectomy. Histopathological examination of the specimen revealed a splenic pseudocyst. Clinical discussion The splenic cyst in this case was symptomatic due to its large size. It was hard to elicit an etiology as there was no history of abdominal trauma, infection, or degenerative disease. The main factors in selecting either conservative or radical surgical approach for such cases are the cyst location, cyst size, and the residual splenic parenchyma. Conclusion The goal of splenic pseudocysts treatment is to relieve symptoms and avoid complications. Partial splenectomy is the recommended procedure when the size and location of the cyst allow preservation of at least 25% of splenic parenchyma. Otherwise, Total splenectomy is unavoidable.
Splenic pseudocysts are extremely uncommon lesions of benign nature. Splenic pseudocysts are often secondary to the resorption of a hematomas due to previous blunt abdominal traumas. Sometimes it is hard to elicit a clear etiology of these cystic lesions. Cyst location, cyst size, and residual splenic parenchyma determine the therapeutic surgical approach. Partial splenectomy is the recommended procedure if at least 25% of splenic parenchyma is achievable.
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17
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Dapri G, Arts S. Technique for Reduced Trocar Decapsulation of a Giant Nonparasitic Splenic Cyst. Surg Laparosc Endosc Percutan Tech 2021; 31:804-807. [PMID: 34075010 DOI: 10.1097/sle.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minimally invasive surgery is adopted for patients presenting benign splenic cysts. Reduced port laparoscopy is an evolution of conventional laparoscopy, which can be applied for splenic cysts as well. In this video, a 3-trocar laparoscopic decapsulation of a giant nonparasitic splenic cyst is reported. CASE REPORT A 16-year-old man, without history of trauma or abdominal surgery, suddenly presented abdominal pain in the left hypochondrium, associated to fever and hyperleukocytosis. A thoracoabdominal computed tomography scan showed a giant cyst of the upper pole of the spleen; serum tumor markers carcinoembryonic antigen and carbohydrate antigen 19-9 were negatives. Any preoperative vaccine was prescribed. RESULTS Operative time was 130 minutes, and operative bleeding 10 mL. No additional trocar or conversion to laparotomy was necessary. Postoperatively, 4 g of paracetamol were used for 2 days, when the patient was discharged. Pathology confirmed the nonparasitic epidermoid splenic cyst. At 18 months, the patient is fine, without symptoms and without disease's recurrence. CONCLUSIONS Decapsulation of a giant nonparasitic splenic cyst is feasible to be performed by 3-trocar laparoscopy. This technique allows to improve the patient's comfort and the cosmetic results, to reduce the postoperative pain and to finally avoid a preoperative vaccine.
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Affiliation(s)
- Giovanni Dapri
- International School Reduced Scar Laparoscopy, Brussels, Belgium
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18
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Krichen I, Maazoun K, Kitar M, Kamal NM, Khan U, Khalif MY, A R, Assiri H, Bokari KA. Huge Non-parasitic Mesothelial Splenic Cyst in a Child: A Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2021; 15:11795565211021597. [PMID: 34158804 PMCID: PMC8182210 DOI: 10.1177/11795565211021597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
Background: Splenic cysts are one of the relatively rare conditions in pediatric surgery
practice. Primary non-parasitic splenic cysts are even more scarce. Case presentation: A 13-years-old female patient presented with chronic left hypochondrial pain
of 2 months duration. Abdominal ultrasonography and computed tomography
revealed huge 18 cm × 14 cm × 10 cm splenic cyst. Deroofing of the cyst was
done which was complicated by secondary infection. Subsequently, the patient
was re-operated on and partial splenectomy done with good outcome at
6 months follow up. Conclusion: Partial splenectomy is the best management strategy for huge non-parasitic
splenic cysts in children. There is also less recurrence rate of splenic
cysts with preservation of splenic functions.
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Affiliation(s)
- Imed Krichen
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Kais Maazoun
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Murad Kitar
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Naglaa M Kamal
- Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ubaidullah Khan
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mostafa Yl Khalif
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Rasha A
- Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Haifa Assiri
- Alhada Armed Forces Hospital, Taif, Saudi Arabia
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19
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Abstract
Cystic lesions of the spleen are rare lesions and can be parasitic or nonparasitic. Nonparasitic cysts are of two types: primary cysts and secondary pseudocysts. Primary cysts of the spleen are very rare and are also called true, congenital, epidermoid, or epithelial cysts. Splenic cysts are usually asymptomatic and often found incidentally during imaging studies. We are presenting a case of a 19-year-old female with a large splenic cyst which was surgically treated by open splenectomy.
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Affiliation(s)
| | - Sudhir Khichy
- Surgery, Baba Farid University of Health Sciences, Faridkot, Faridkot, IND
| | - Harkanwalpreet Kaur
- Surgery, Guru Gobind Singh Medical College, Baba Farid University of Health Sciences, Faridkot, Faridkot, IND
| | - Harinder Singh
- Surgery, Guru Gobind Singh Medical College, Baba Farid University of Health Sciences, Faridkot, Faridkot, IND
| | - Parampreet Singh Sandhu
- Surgery, Guru Gobind Singh Medical College, Baba Farid University of Health Sciences, Faridkot, Faridkot, IND
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20
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Kumar SB, Richards J, Butcher K, Welbourn R. Two cases of non-parasitic splenic cysts and spleen-preserving therapy. Ann R Coll Surg Engl 2021; 103:e109-e113. [PMID: 33661055 DOI: 10.1308/rcsann.2020.7043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We review two different presentations of non-parasitic splenic cysts, both of which are post-traumatic in aetiology. The first case was of slower onset and was managed electively. The second case was of acute onset and was managed as an emergency. Non-parasitic splenic cysts are uncommon and the optimal management strategy for them is not well defined. Historically, treatment has been with open splenectomy; however, infection rates following this surgery have been high, making it an unattractive management option. Both cases were managed successfully with laparoscopic fenestration with no recurrence at subsequent follow-up.
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Affiliation(s)
- S B Kumar
- Musgrove Park Hospital, Taunton, Devon, UK
| | - J Richards
- Musgrove Park Hospital, Taunton, Devon, UK
| | - K Butcher
- Musgrove Park Hospital, Taunton, Devon, UK
| | - R Welbourn
- Musgrove Park Hospital, Taunton, Devon, UK
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21
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A splenic cyst causing a viscerosomatic reflex in the thoracic spine. A case report. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Termos S, Othman F, Aljewaied A, Alkhalil AM, Alhunaidi M, Parayil SM, Alabdulghani F. Symptomatic Giant Primary Nonparasitic Splenic Cyst Treated with Laparoscopic Decapsulation: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927893. [PMID: 33211675 PMCID: PMC7684427 DOI: 10.12659/ajcr.927893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patient: Female, 22-year-old Final Diagnosis: Primary nonparasitic splenic cyst Symptoms: Abdominal pain • mass in abdomen Medication: — Clinical Procedure: Laparoscopic decapsulation of giant splenic cyst. Specialty: Surgery
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Affiliation(s)
- Salah Termos
- Department of Surgery, Al-Amiri Hospital, Kuwait, Kuwait
| | - Feras Othman
- Department of Surgery, Al-Amiri Hospital, Kuwait, Kuwait
| | - Ali Aljewaied
- Department of Surgery, Al-Amiri Hospital, Kuwait, Kuwait
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23
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Komoike Y, Nomura-Komoike K, Matsuoka M. Intake of acrylamide at the dietary relevant concentration causes splenic toxicity in adult zebrafish. ENVIRONMENTAL RESEARCH 2020; 189:109977. [PMID: 32980030 DOI: 10.1016/j.envres.2020.109977] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
Acrylamide (AA) has recently been recognized as an immediate hazardous chemical compound owing to its various toxicities and unavoidable contamination of certain daily foods prepared at a high temperature. AA in foods is thus a worldwide concern; however, its toxicity at the dietary relevant concentration has yet to be experimentally elucidated. To determine whether dietary AA intake causes adverse health effects, adult zebrafish were fed a diet containing AA at a relevant dose for one month. Although AA-fed zebrafish showed no superficial abnormalities, their spleen was severely swollen. Therefore, their spleen was analyzed histologically and pathologically and the changes in cytokine expression in their spleen were also examined. Based on our findings, the intake of AA-containing food caused splenic damages, including cyst formation, hemorrhage, and inflammation, which were accompanied by immune responses as indicated by the appearance of a melanomacrophage center, activation of macrophages, and upregulation of major inflammatory cytokines in the spleen. Collectively, for the first time, we provided experimental evidence of the splenic toxicity caused by dietary AA intake.
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Affiliation(s)
- Yuta Komoike
- Department of Hygiene and Public Health, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Kaori Nomura-Komoike
- Department of Anatomy, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Masato Matsuoka
- Department of Hygiene and Public Health, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan.
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24
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Chung P, Swinson B, O'Rourke N, Schmidt B. Massive splenic cyst in pregnancy: case report. BMC Pregnancy Childbirth 2020; 20:273. [PMID: 32375702 PMCID: PMC7201964 DOI: 10.1186/s12884-020-02968-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary splenic cysts are very rarely diagnosed in pregnancy, with only thirteen cases described in the literature. We examine the approach towards diagnosing and managing uniquely large abdominal masses that significantly complicate obstetric care. CASE PRESENTATION A 37-year-old primigravida woman presented with abdominal distension and discomfort, yet otherwise asymptomatic. On ultrasound, an incidental pregnancy at 25 weeks of gestation and a large pelvic lesion were discovered. MRI defined a 28 × 29 cm lobulated, complex cystic mass in the upper abdomen. The patient underwent two ascitic drainages throughout her pregnancy. At 34 weeks of gestation, she had a classical caesarean section. Then at five-weeks postpartum, she underwent a laparotomy and total splenectomy with 16 L of fluid drained. Histopathological analysis revealed an epithelial cyst of the spleen. Her recovery was complicated by complete portal vein thrombosis. CONCLUSION This case describes the largest splenic cyst ever reported in pregnancy and explores the diagnostic dilemmas and treatment challenges associated. We introduce the utility of serial ascitic drainages in prolonging the pregnancy and emphasise the reliance on imaging for surveillance of splenic size and fetal wellbeing.
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Affiliation(s)
- Philip Chung
- Department of Obstetrics and Gynaecology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.
| | - Ben Swinson
- Department of General Surgery, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Nicholas O'Rourke
- Department of General Surgery, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Bart Schmidt
- Department of Obstetrics and Gynaecology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
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25
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Kala PS, Azad S, Sharma T, Acharya S. Primary epithelial splenic cyst: A rare encounter. INDIAN J PATHOL MICR 2020; 62:605-607. [PMID: 31611451 DOI: 10.4103/ijpm.ijpm_335_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Splenic cysts are rare with an overall incidence of 0.07% in a large autopsy series and 0.5% among all the splenectomies done. The parasitic splenic cysts, usually caused by Echinococcus granulosus, account for 60% of all primary splenic cysts. The primary epithelial cysts account for 10% of all splenic cysts. We report a case of 30-year-old female presenting with left upper abdominal pain and heaviness. Computed tomography revealed a multiloculated cyst in spleen. Hydatid serology was negative. Total splenectomy was done. Histopathological evaluation was done and a diagnosis of primary epithelial splenic cyst was given.
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Affiliation(s)
- Pooja Sharma Kala
- Department of Pathology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Sheenam Azad
- Department of Pathology, Sri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Trisha Sharma
- Department of Pathology, Sri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Seema Acharya
- Department of Pathology, Sri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
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26
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Res LC, Knook MTT, Hazelbag HM, Guicherit OR. Spontaneous rupture of a non-parasitic splenic cyst. BMJ Case Rep 2019; 12:e231473. [PMID: 31666253 PMCID: PMC6827751 DOI: 10.1136/bcr-2019-231473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 11/03/2022] Open
Abstract
Rupture of a non-parasitic splenic cyst is a rare but possibly dangerous complication with 21 cases described so far. We present a 46-year-old woman who presented with acute abdominal pain and was diagnosed with a spontaneous ruptured splenic cyst that was successfully treated by laparoscopic splenectomy. Histological examination showed characteristics corresponding with a non-parasitic congenital cyst that had lost its epithelial lining. Several treatment options can be considered for splenic cysts, depending on size and location. In case of rupture, the clinical condition of the patient should be taken into account.
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Affiliation(s)
- Lodewijk Cs Res
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Mireille T T Knook
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Hans M Hazelbag
- Department of Pathology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Onno R Guicherit
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
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27
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Tbouda M, Toufga Z, Jahid A, Bourhoum N, Zouaidia F, Bernoussi Z. Une tendinite "splénique"? Presse Med 2019; 48:91-94. [DOI: 10.1016/j.lpm.2018.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 09/23/2018] [Accepted: 11/07/2018] [Indexed: 11/29/2022] Open
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28
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Manciu S, Tudor S, Vasilescu C. Splenic Cysts: A Strong Indication for a Minimally Invasive Partial Splenectomy. Could the Splenic Hilar Vasculature Type Hold a Defining Role? World J Surg 2018; 42:3543-3550. [PMID: 29717347 DOI: 10.1007/s00268-018-4650-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of the study is to assess the impact of the splenic hilar vasculature configuration on the amount of remnant splenic parenchyma volume after partial splenectomy for splenic cysts. METHODS The data of all patients receiving a splenectomy for a splenic cyst from 2002 to 2016 at the Center of General Surgery and Liver Transplantation of Fundeni Clinical Institute were retrospectively reviewed. The size and location in the splenic parenchyma of the cyst and the splenic hilar vasculature type were assessed for each patient with a splenectomy. RESULTS Thirty-one patients with non-parasitic and 32 patients with hydatid cysts were recorded. In cases of centrally located cysts, a total splenectomy was performed for the majority of cases, while in peripheral cysts a spleen-preserving surgery was feasible for most of the patients (p = 0.001). The size of the cyst was significantly higher in the group of patients with a total splenectomy, compared with the group with a partial splenectomy (p = 0.003). In the subgroup with a distributed arterial pattern, preservation of more than 50% of the initial parenchyma was achieved in a significantly higher proportion of patients, compared with the subgroup of patients with a magistral pattern (p = 0.012). CONCLUSION Besides cyst size or peripheral location in the splenic parenchyma, the vascular pattern is also considered another decisive factor that associates with successful conservative or minimally invasive approach.
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Affiliation(s)
- Simona Manciu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Stefan Tudor
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania
| | - Catalin Vasilescu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, 258 Fundeni Street, Bucharest, Romania.
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
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29
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A Sleiman Y, Bohlok A, El-Khoury M, Demetter P, Zalcman M, El Nakadi I. Splenic epithelial cyst mistaken with Hydatid cyst: A case report. Int J Surg Case Rep 2018; 53:21-24. [PMID: 30366172 PMCID: PMC6203242 DOI: 10.1016/j.ijscr.2018.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/25/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Cystic lesions of the spleen are infrequent and usually diagnosed incidentally. These lesions are rare and their differential diagnosis is very wide. Splenic epithelial cysts are the most common type of primary splenic cyst (4%). Surgical treatment is indicated for cysts larger than 5 cm or symptomatic. Nowadays, spleen preserving surgery is the gold standard treatment considering the immunologic role of the spleen and the increased risk of post-splenectomy infections. CASE PRESENTATION A 17 year old girl presented to the outpatient clinic with moderate left upper quadrant abdominal pain of 2 weeks duration with loss of appetite and denied fever, chills, sweating and jaundice. Abdominal examination showed tender splenomegaly. The abdominal imaging (Ultrasound, CT SCAN, MRI) was suggestive of hydatid cyst of the spleen, for which she received Albendazole for 1 month and then operated by laparotomy with partial resection and un-roofing of the splenic cyst. The pathology report showed a splenic epithelial cyst (SEC). CONCLUSION SEC is a rare pathology that could mimic splenic hydatid cyst. The clinical and radiological pictures may be commonly misleading and non-conclusive. Definitive diagnosis is made on histopathology. Spleen conserving surgery, when possible, is the preferred modality for treatment.
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Affiliation(s)
- Youssef A Sleiman
- Service de Chirurgie, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Belgium
| | - Ali Bohlok
- Service de Chirurgie, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Belgium
| | | | - Pieter Demetter
- Service d'Anatomie Pathologique, Erasme, Université Libre de Bruxelles (ULB), Belgium
| | - Marc Zalcman
- Service de radiologie, Erasme, Université Libre de Bruxelles (ULB), Belgium
| | - Issam El Nakadi
- Service de Chirurgie, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Belgium.
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Pratt JJ, Connell TG, Bekhit E, Crawford NW. Splenic cyst and its management in a 21-month-old boy: a rare complication of invasive meningococcal disease. BMJ Case Rep 2018; 2018:bcr-2018-224613. [PMID: 29728436 DOI: 10.1136/bcr-2018-224613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Splenic complications of invasive meningococcal disease (IMD) are well recognised, though cyst formation is rare, particularly in paediatric populations. The best approach to their management is not yet established. This case outlines the management of a splenic cyst in a 21-month-old boy following severe IMD. The case took place in the context of an acute emergence of serogroup W prompting significant media attention and subsequent change in vaccination practice at a jurisdictional level in Australia. The patient was critically unwell early in the illness, then later a collection in the left upper quadrant was detected, shown on ultrasound to be a 11.6×7.7 cm splenic cyst. In this case, the cyst was managed by ultrasound-guided drainage tube insertion. The residual collection was small and stable on subsequent imaging.
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Affiliation(s)
- Jeremy John Pratt
- Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia
| | - Tom G Connell
- Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Elhamy Bekhit
- Department of Radiology, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia
| | - Nigel W Crawford
- Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Surveillance of Adverse Events Following Vaccination In theCommunity (SAEFVIC), Murdoch Children's Research Institute (MCRI), Melbourne, Victoria, Australia
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Hassoun J, Ortega G, Burkhalter LS, Josephs S, Qureshi FG. Management of nonparasitic splenic cysts in children. J Surg Res 2018; 223:142-148. [DOI: 10.1016/j.jss.2017.09.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/18/2017] [Accepted: 09/28/2017] [Indexed: 11/27/2022]
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Al Khafaji B, Younis MU. Laparoscopic splenic cyst fenestration-a viable spleen preserving option. J Surg Case Rep 2017; 2017:rjx154. [PMID: 28852463 PMCID: PMC5570058 DOI: 10.1093/jscr/rjx154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/07/2017] [Accepted: 07/10/2017] [Indexed: 11/12/2022] Open
Abstract
Cystic lesions of the spleen are a rare encounter in surgical practice and are broadly split into two categories: true and false, depending upon the presence of a defined epithelial lining. True cysts can further be broken down into parasitic and non-parasitic origins while false or pseudocysts tend to develop commonly after a traumatic event. We present here a 23-year-old female who came to the clinic with symptoms of abdominal fullness, early satiety and left flank pain which was diagnosed as a large splenic cyst after radiology confirmation. The patient was prepared and underwent laparoscopic splenic cyst fenestration successfully without any complications. Laparoscopic fenestration for benign uncomplicated splenic cysts is a viable alternative to splenectomy with low rates of recurrence and less patient morbidity along with the advantage of preservation of splenic function.
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Affiliation(s)
- Basim Al Khafaji
- Department of General Surgery, Canadian Specialist Hospital, Dubai, UAE
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Silver DS, Pointer DT, Slakey DP. Solid Tumors of the Spleen: Evaluation and Management. J Am Coll Surg 2017; 224:1104-1111. [DOI: 10.1016/j.jamcollsurg.2016.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 12/31/2022]
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Akhan O, Dagoglu-Kartal MG, Ciftci T, Ozer C, Erbahceci A, Akinci D. Percutaneous Treatment of Non-parasitic Splenic Cysts: Long-Term Results for Single- Versus Multiple-Session Treatment. Cardiovasc Intervent Radiol 2017; 40:1421-1430. [PMID: 28462445 DOI: 10.1007/s00270-017-1650-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to investigate the efficacy and safety of percutaneous sclerotherapy for non-parasitic splenic cysts (NPSCs). The secondary aims were to introduce puncture-aspiration-injection-reaspiration (PAIR) technique in the treatment of NPSCs and to compare multiple- and single-session techniques. MATERIALS AND METHODS This retrospective study included 24 (17 females, 7 males) patients, treated between the years 1997 and 2015. Three techniques were used. Group A (n = 8), Group B (n = 6) and Group C (n = 10) were treated by PAIR, single-session catheterization and multiple-session catheterization, respectively. Since both PAIR and single-session catheterization techniques are carried out in a single session, Group A and Group B were evaluated in one group (Group A + B). Group A + B was compared with Group C in terms of patient demographics, the initial volume of the cysts, follow-up periods, complication and hospitalization rates and follow-up results. Recurrence and reduction rates were evaluated for two groups. RESULTS Technical success rate was 100%. The mean follow-up period was 68.9 months. Recurrence detected in 7 (29.1%) patients. Final reduction rate was between 40.7 and 100% (median 96.4%) with a significant difference in cyst volume (p < 0.05). There was no significant difference regarding recurrence rates (p = 1) and the final reduction rates (p = 0.51) between the two groups. CONCLUSION Percutaneous sclerotherapy is a minimally invasive technique, preserving maximum tissue while effectively treating NPSCs. Single-session sclerotherapy which reduces hospitalization days and increases patient comfort is as effective as multi-session sclerotherapy as the initial procedure. This study supports that single-session sclerotherapy should be a valid treatment option.
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Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, 6100, Sihhiye, Ankara, Turkey.
| | | | - Turkmen Ciftci
- Department of Radiology, Hacettepe University School of Medicine, 6100, Sihhiye, Ankara, Turkey
| | - Cigdem Ozer
- Numune Training and Research Hospital Radiology Clinic, Ülkü Mahallesi Talatpaşa Bulvari No: 5, Altindag, 6080, Ankara, Turkey
| | - Aysun Erbahceci
- Sadi Konuk Training and Research Hospital Radiology Clinic, Tevfik Saglam Caddesi No: 11, Zuhuratbaba, 34147, Istanbul, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, 6100, Sihhiye, Ankara, Turkey
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temiz A, Albayrak Y, Er S, Albayrak A, Aslan OB. Primary splenic hydatidosis: Case series. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2017. [DOI: 10.25000/acem.302081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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de Azevedo OS, do Nascimento Santos B, de Souza Liboni N, da Costa JF, de Campos OD. Splenic Angiosarcoma: A Diagnostic Splenectomy Finding. Case Rep Oncol 2016; 9:733-737. [PMID: 27920710 PMCID: PMC5126591 DOI: 10.1159/000452619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 12/29/2022] Open
Abstract
Splenic tumors are not frequent. Blood vessel neoplasms are a rare category of tumors and have an extremely low incidence in the spleen. This case report aims to describe a 57-year-old woman in whom a routine imaging examination had shown splenic cysts. During her follow-up, the cysts became larger and increased in number. A diagnostic splenectomy was performed and its analysis showed a rare splenic angiosarcoma.
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37
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Grover S, Garg B, Sood N, Singh S. Splenic Epidermoid Cyst in a Five-Year-Old Child. J Clin Diagn Res 2016; 10:ED07-9. [PMID: 27630857 DOI: 10.7860/jcdr/2016/19064.8085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/14/2016] [Indexed: 01/03/2023]
Abstract
Splenic epidermoid cysts are rare non-parasitic true cysts affecting the spleen. We report a five-year-old child who presented with an abdominal lump associated with pain of 15 days. Ultrasonography of the abdomen showed a huge cystic lesion of obscure origin. At laprotomy a huge unilocular cyst involving upper part of spleen containing pultaceous fluid was seen and its removal necessitated splenectomy. Histopathological findings were consistent with splenic epidermoid cyst. Thus histopathology helped in elucidating the aetiology and diagnosis.
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Affiliation(s)
- Sumit Grover
- Assistant Professor, Department of Pathology, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
| | - Bhavna Garg
- Professor, Department of Pathology, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
| | - Neena Sood
- Professor and Head, Department of Pathology, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
| | - Satpal Singh
- Professor, Department of G.E. Surgery, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
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Accinni A, Bertocchini A, Madafferi S, Natali G, Inserra A. Ultrasound-guided percutaneous sclerosis of congenital splenic cysts using ethyl alcohol 96% and minocycline hydrochloride 10%: A pediatric series. J Pediatr Surg 2016; 51:1480-4. [PMID: 27320839 DOI: 10.1016/j.jpedsurg.2016.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The management of congenital splenic cysts continues to evolve. In the past the standard treatment was splenectomy, but increased knowledge about the spleen's immunologic function has led most pediatric surgeons to preserve splenic tissue. A great number of studies using sclerosing substances have been published, but to date reports in children have been limited. Our study concerns a group of 15 children with congenital splenic cysts treated with percutaneous drainage and sclerosis with alcohol. We performed the procedure under general anesthesia and checked radiologically for possible leakage. METHODS In 2000 our group started managing pediatric patients with splenic cysts. During the first eight years surgery was the treatment of choice. From April 2008 to December 2014, a prospective study was conducted on 15 consecutive patients treated with percutaneous sclerotherapy. The outcomes regarding cystic dimensional variations before and after treatment were analyzed. RESULTS In 20% of patients complete disappearance of the cystic lesion was achieved. In 67% of the patients the maximum diameter of the cyst was reduced to below 50mm. CONCLUSION Our results should encourage the use of this treatment because it is a valid and safe option in childhood. The high success rate achieved with percutaneous drainage and sclerotherapy of cystic lesions supports our results.
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Affiliation(s)
- Antonella Accinni
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
| | - Arianna Bertocchini
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome.
| | - Silvia Madafferi
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
| | - Gianluigi Natali
- Interventional Radiology Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
| | - Alessandro Inserra
- General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome
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Abstract
Splenic cysts are rare in the United States but more common in regions of the world where Echinococcus is endemic. Cysts are typically classified as true cysts or pseudocysts. True cysts can be parasitic or nonparasitic in origin, whereas most pseudocysts are a result of previous trauma. Recent recognition of features shared by true cysts and pseudocysts suggests the classification system may need to be revised. The prevalence of splenic cysts has increased secondary to the widespread use of abdominal imaging and successful nonoperative management of traumatic splenic injuries. Treatment previously consisted primarily of total splenectomy. However, recognition of the importance of the spleen throughout a patient's life has led to changes in the management of splenic disease. Advances in the testing and preoperative localization of splenic lesions have also led to increased efforts in splenic conservation. [Pediatr Ann. 2016;45(7):e251-e256.].
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40
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Craig DH, Campbell DC, Powell MS. Laparoscopic Splenectomy for Giant Splenic Cyst. Am Surg 2015. [DOI: 10.1177/000313481508101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David H. Craig
- Department of General Surgery Wake Forest Baptist Medical Center Winston-Salem, North Carolina
| | - Douglas C. Campbell
- Department of General Surgery Wake Forest Baptist Medical Center Winston-Salem, North Carolina
| | - Myron S. Powell
- Department of General Surgery Wake Forest Baptist Medical Center Winston-Salem, North Carolina
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41
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Gezer HÖ, Oğuzkurt P, Temiz A, İnce E, Ezer SS, Koçer NE, Demir Ş, Hiçsönmez A. Spleen Salvaging Treatment Approaches in Non-parasitic Splenic Cysts in Childhood. Indian J Surg 2015; 78:293-8. [PMID: 27574347 DOI: 10.1007/s12262-015-1373-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022] Open
Abstract
The aim of this study was to evaluate our experience with primary non-parasitic splenic cysts (NPSC) which are relatively rare in children and consist almost exclusively of single case reports or small case series in the literature. The medical records of all patients who presented to our clinic with NPSC between 2005 and 2015 were evaluated retrospectively. There were 22 children whose ages ranged from 2 months to 14 years (mean 9.2 ± 4.7 years). The size of the cysts was in the range of 5 to 200 mm (mean 55.4 ± 48.2 mm). Ten patients underwent surgery for splenic cysts. Partial splenectomy (n = 2), total cyst excision (either open n = 4 or laparoscopically n = 1), and total splenectomy (n = 3) were performed. The non-operated patients were asymptomatic and followed with ultrasound (US). The follow-up period in non-operated patients ranged from 6 months to 5 years (mean 2.27 ± 1.29 years). Complete regression was observed in four (33 %) non-operated patients. The regressed cyst measurements were 10, 16, 30, and 40 mm, respectively. Approximately half of the NPSC is diagnosed incidentally. Small (<5 cm) asymptomatic cysts should be under regular follow-up with US/physical examination for regression. If surgery is required, we prefer open cyst excision as it gives excellent results and preserves splenic immune function.
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Affiliation(s)
- Hasan Özkan Gezer
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Dadaloğlu Mah 39 sokak, No: 6, Yüreğir, Adana, 01210 Turkey
| | - Pelin Oğuzkurt
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Dadaloğlu Mah 39 sokak, No: 6, Yüreğir, Adana, 01210 Turkey
| | - Abdulkerim Temiz
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Dadaloğlu Mah 39 sokak, No: 6, Yüreğir, Adana, 01210 Turkey
| | - Emine İnce
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Dadaloğlu Mah 39 sokak, No: 6, Yüreğir, Adana, 01210 Turkey
| | - Semire Serin Ezer
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Dadaloğlu Mah 39 sokak, No: 6, Yüreğir, Adana, 01210 Turkey
| | - Nazım Emrah Koçer
- Department of Pathology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Şenay Demir
- Department of Radiology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Akgün Hiçsönmez
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Dadaloğlu Mah 39 sokak, No: 6, Yüreğir, Adana, 01210 Turkey
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Abstract
Patient's first pregnancy was complicated by mild thrombocytopenia caused by a 13-cm splenic cyst, who delivered vaginally without complication. Risks and management of maternal splenic cysts in pregnancy and delivery are reviewed here.
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Affiliation(s)
| | - Markus Schäfer
- b Department of Visceral Surgery , University Hospital of Lausanne (CHUV) , Lausanne , Switzerland
| | | | - David Baud
- a Department of Obstetrics and Gynecology and
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Management of non-parasitic splenic cysts: does size really matter? J Gastrointest Surg 2014; 18:1658-63. [PMID: 24871081 DOI: 10.1007/s11605-014-2545-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/13/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Splenic cysts are relatively rare clinical entities and are often diagnosed incidentally upon imaging conducted for a variety of clinical complaints. They can be categorized as primary or secondary based on the presence or absence of an epithelial lining. Primary cysts are further subdivided into those that are and are not secondary to parasitic infection. The treatment of non-parasitic splenic cysts (NPSC) has historically been dictated by two primary factors: the presence of symptoms attributable to the cyst and cyst size greater or less than 5 cm. While it is appropriate to resect a symptomatic lesion, the premise of recommending operative intervention based on size is not firmly supported by the literature. METHODS In the current study, we identified 115 patients with splenic cysts and retrospectively reviewed their management that included aspiration, resection, or observation. RESULTS Our data reveal a negative overall growth rate of asymptomatic cysts, a high recurrence rate after percutaneous drainage, as well as demonstrate the safety of observing asymptomatic lesions over time. CONCLUSION We conclude that observation of asymptomatic splenic cysts is safe regardless of size and that aspiration should be reserved for those who are not surgical candidates or in cases of diagnostic uncertainty.
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Rana SS, Sharma R, Sharma V, Bhasin DK. An unusual cause of gastric submucosal bulge on endoscopy. Endosc Ultrasound 2014; 3:198-199. [PMID: 25184128 PMCID: PMC4145482 DOI: 10.4103/2303-9027.138798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 01/07/2014] [Indexed: 02/02/2023] Open
Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Shanthi V, Reddy VC, Rao NM, Grandhi B, Kona S. Epithelial cyst of the spleen with squamous metaplasia: a rare entity. J Clin Diagn Res 2014; 8:FD05-6. [PMID: 24959455 DOI: 10.7860/jcdr/2014/7795.4225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/02/2014] [Indexed: 11/24/2022]
Abstract
Epithelial splenic cysts are uncommon lesions which occur the spleen. The aetiopathogenesis of these cysts is not clear. We are reporting a case of an epithelial cyst which occurred in the spleen in a 40-year-old female, which was multi loculated and which had flattened lining epithelium. Some foci showed squamous metaplasia.
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Affiliation(s)
- Vissa Shanthi
- Associate Professor, Department of Pathology, Dr. NTR University of Health Sciences Vijayawada, Andhra Pradesh, India
| | - Vengala Chidananda Reddy
- Assistant Professor, Department of Pathology, Dr. NTR University of Health Sciences Vijayawada, Andhra Pradesh, India
| | - Nandam Mohan Rao
- Associate Professor, Department of Pathology, Dr. NTR University of Health Sciences Vijayawada, Andhra Pradesh, India
| | - Bhavana Grandhi
- Assistant Professor, Department of Pathology, Dr. NTR University of Health Sciences Vijayawada, Andhra Pradesh, India
| | - Suneetha Kona
- Assitant Professor, Department of Pathology, Dr. NTR University of Health Sciences , Vijayawada, Andhra Pradesh, India
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46
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Varban O. Splenic cyst during pregnancy. Int J Surg Case Rep 2014; 5:315-8. [PMID: 24794024 PMCID: PMC4066563 DOI: 10.1016/j.ijscr.2014.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 03/21/2014] [Accepted: 03/26/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Splenic cyst during pregnancy is rare and may result in spontaneous rupture during the third trimester, which increases perinatal morality. PRESENTATION OF CASE We present a 27-year-old healthy Caucasian female who presented at 18 weeks gestation with left flank pain, early satiety and weight loss. Imaging studies demonstrated a large complex multiloculated splenic cyst. The patient underwent a successful laparoscopic splenectomy and delivered a healthy child at term without complication. DISCUSSION Spontaneous rupture of a splenic cyst during the third trimester incurs a perinatal mortality rate as high as 70%. Surgical management includes open or laparoscopic splenectomy or fenestration and preservation of the spleen. CONCLUSION Laparoscopic splenectomy during the second trimester appears to be safe and offers definitive management of a large symptomatic splenic cyst during pregnancy.
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Affiliation(s)
- Oliver Varban
- University of Michigan Health Systems, 2210 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI 48109-5343, United States.
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47
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Rana APS, Kaur M, Singh P, Malhotra S, Kuka AS. Splenic epidermoid cyst - a rare entity. J Clin Diagn Res 2014; 8:175-6. [PMID: 24701525 DOI: 10.7860/jcdr/2014/6901.4050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 12/19/2013] [Indexed: 11/24/2022]
Abstract
C Splenic epidermoid cysts are relatively uncommon. Most often, they are asymptomatic, but they may present with abdominal discomfort, predominantly at young ages. We are reporting a rare case of 12-years-old female child with history of dull intermittent pain, tender palpable mass in left hypochondrium on physical examination. Ultrasonography (USG) of abdomen showed large cyst in upper pole of spleen, and an X ray of chest revealed slightly raised left hemidiaphragm. Axial sections taken on computerized tomography of abdomen showed a large well defined cystic mass near upper pole of spleen, with a thin septum in it. On laparotomy, open total splenectomy was performed. Sections from cystic wall were processed and histopathological examination revealed fibrous tissue covered by stratified squamous epithelium. Although, now-a-days emphasis is being laid on minimal invasive operative procedures which preserve spleen. This case report favours total splenectomy, considering postoperative outcome. The final diagnosis always depends upon histopathological examination.
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Affiliation(s)
- Amrit Pal Singh Rana
- Assistant Professor, Department of Surgery, Guru Gobind Singh Medical College , Faridkot, India
| | - Manjit Kaur
- Assistant Professor, Department of Pathology, Guru Gobind Singh Medical College , Faridkot, India
| | - Parvinder Singh
- Assistant Professor, Department of Surgery, Guru Gobind Singh Medical College , Faridkot, India
| | - Satish Malhotra
- Assistant Professor, Department of Surgery, Guru Gobind Singh Medical College , Faridkot, India
| | - Amarjit Singh Kuka
- Assistant Professor, Department of Surgery, Guru Gobind Singh Medical College , Faridkot, India
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Zvizdić Z, Karavdić K. Spleen-preserving surgery in treatment of large mesothelial splenic cyst in children--a case report and review of the literature. Bosn J Basic Med Sci 2014; 13:126-8. [PMID: 23725510 DOI: 10.17305/bjbms.2013.2395] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The nonparasitic primary splenic cysts are very rare clinical entity. In the past, splenectomy was the treatment of choice but with the recognition of the spleen's important immunological function, spleen-preserving surgery is the preferred treatment modality. We hereby present a case of a large splenic mesothelial cyst and its treatment with preservation of the remaining splenic parenchyma. Our case shows that spleen-preserving surgery in treatment of the large splenic cysts is possible and safe procedure with maintenance of the splenic function.
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Affiliation(s)
- Zlatan Zvizdić
- Clinic of Pediatric Surgery, Clinical Centre of Sarajevo University, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina.
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Oversized pseudocysts of the spleen: Report of two cases: Optimal management of oversized pseudocysts of the spleen. Int J Surg Case Rep 2014; 5:104-7. [PMID: 24463562 PMCID: PMC3921642 DOI: 10.1016/j.ijscr.2013.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/18/2013] [Accepted: 11/09/2013] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pseudocysts of the spleen are usually asymptomatic and associated with a history of trauma, infection or infarction. In this report, we present two uncommon cases of solitary, oversized pseudocysts of the spleen. PRESENTATION OF CASE Two patients (cases A and B), with symptoms of abdominal pain, were investigated. The laboratory and ultrasound examination confirmed the diagnosis of a large, non-parasitic splenic cyst in both cases. Computed tomography described an oversized pseudocyst occupying almost the entire splenic parenchyma in both cases and in patient A, the cyst was located in the splenic hilum. The medical history revealed a previous abdominal injury only in case A. The two patients underwent an open total splenectomy. The pathology examination verified the diagnosis of a non-parasitic splenic pseudocyst. DISCUSSION Both patients presented with symptoms, in contrast to the majority of patients with splenic cysts. The medical history of patients with splenic pseudocysts does not always reveal the cause of the pseudocyst formation. Any type of spleen-sparing procedure is not easy to perform in cases of surgical and anatomical difficulty, because of recurrence and the risk of intractable bleeding from the spleen. CONCLUSION Partial splenectomy is the recommended method for parenchymal preservation, but total splenectomy is preferred when the splenic cyst is oversized or cannot be excised with safety.
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Aparício DJS, Leichsenring C, Rodrigues ÂR, Alves AC. Laparoscopic upper pole splenectomy of the simple splenic cyst. BMJ Case Rep 2013; 2013:bcr2013200438. [PMID: 24287475 PMCID: PMC3847514 DOI: 10.1136/bcr-2013-200438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Splenic cysts are rare clinic entities. Non-parasitic cysts are the most frequent cystic lesions of the spleen. In the last decade acknowledgment of the importance of the spleen function, along with development of imaging methods and surgery technics, allowed a conservative approach to be increasingly considered as the best approach in splenic cysts treatment. We present the case of a 34-year-old woman with an asymptomatic simple splenic cyst in the upper pole incidentally diagnosed in a thoracic CT. A laparoscopic upper pole splenectomy was performed on the patient, with no complications. Despite the rareness of this procedure and the fact that it was used in a simple splenic cyst, this article emphasises the idea that this approach is safe, reproducible and advantageous for the patient.
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