Laparoscopic Splenectomy for a Giant Splenic Epidermoid Cyst: Report of a Case

Abstract

The use of laparoscopic splenectomy has increased in recent years, primarily for patients with idiopathic thrombocytopenic purpura (ITP). We describe herein the first known case of a laparoscopic splenectomy to be performed in Japan for a patient with a giant splenic epidermoid cyst. A 26-year-old woman presented to our hospital with the major complaint of a feeling of abdominal fullness. Prior to surgery, an ultrasound-guided splenic cyst puncture was conducted for diagnostic purposes as well as to reduce the size of the cyst. The carbohydrate antigen 19-9 (CA 19-9) level was found to be elevated in the cystic contents and in the serum. Under laparoscopic guidance, the splenic vessels were ligated using a device for extracorporeal ligation, then divided. After the resected spleen had been placed in a retrieval bag, it was delivered out of the abdominal cavity without fragmentation. Following surgery, the patient's serum CA 19-9 level returned to normal. Splenic epidermoid cysts are most often encountered in young women, and laparoscopic surgery to remove cysts of this type is both minimally invasive and excellent from a cosmetic standpoint. Thus, laparoscopic surgery should be considered as the method of choice for the majority of patients diagnosed with a splenic epidermoid cyst.

Giant True Splenic Epithelial Cyst

“…They are uncommon, comprising only about 10% of benign non-parasitic cysts. Splenic epithelial cysts occur predominantly in children and young women [3]. Small cysts are usually asymptomatic.…”

Epithelial Cyst of the Spleen-A Rare Presentation

“…The first suggests that a cyst results from invagination of the capsular surface mesothelium [10,11], and other states that it is an embryonic inclusion of epithelial cells from adjacent structure with subsequent squamous metaplasia [10,12]. Presence of tumor marker EMA and CEA on the epithelial lining of epidermoid cysts has recently been reported [13,14].…”

A Splenic Epithelial Cyst: Increased Size, Exacerbation of Symptoms, and Elevated Levels of Serum Carcinogenic Antigen 19-9 after 6-year Follow-up

“…However, this agreement is based on the facility of surgical treatment, rather than solid data. According to recent reviews, the incidence of overall complications in cases of splenic epithelial cysts was 5.2-8.5% (21,22), and ruptured cysts ranged in size from 5.5 cm to 15 cm or more (20,23,24). In an analysis of 23 splenic epithelial cysts, the average size was 14.3 cm (range: 1-25 cm), and none of the cysts were associated with complications, including rupture and infection (17).…”