Giant Primary Epithelial Splenic Cyst in an Adolescent Girl

A 13-year old girl presented with abdominal pain and upper abdominal fullness for 4 months. On examination, there was a large, smooth, and firm lump palpable involving the left hypochondrium, epigastrium, left lumbar region, and reaching almost up to the umbilicus. It was moving with respiration and the upper limit was not reachable. Rest of the examination was normal. All routine hematological and biochemical investigations were within normal range. Hematological tests for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) viz. ELISA for HIV, anti-HCV and HBsAg were negative. X-ray chest revealed slight elevation of left diaphragm. Abdominal ultrasonography revealed a giant unilocular cystic lesion in the spleen. Casoni’s skin test and complement fixation test for Echinococcus granulosus were negative. Stool examination done over 3 consecutive days was found to be normal. Computed tomography confirmed the splenic large cyst with dimensions of 22x17x15cm with thin, compressed rim of normal parenchyma posterolaterally (Fig.1). At laparotomy, a huge splenic cyst of more than 20 cm of maximum diameter was found with almost total displacement and compression of remaining splenic parenchyma. However due to cyst size and location, preservation of spleen was considered impossible and total splenectomy was carried out after decompression of the cyst by aspiration of about 2000 ml of turbid serous fluid (Fig.2). The postoperative period was uneventful and patient was discharged in fair health on 5th postoperative day.