Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2013  |  Volume : 56  |  Issue : 2  |  Page : 181--182

An interesting case of primary epithelial cyst of spleen


Sachin B Ingle1, Chitra R Hinge2, Sopan N Jatal3,  
1 Department of Pathology, MIMSR Medical College, Latur, Maharashtra, India
2 Department of Physiology, MIMSR Medical College, Latur, Maharashtra, India
3 Department of surgery, Jatal Hospital and Research Centre, Latur, Maharashtra, India

Correspondence Address:
Sachin B Ingle
Department of Pathology, MIMSR Medical College, Latur, Maharashtra
India




How to cite this article:
Ingle SB, Hinge CR, Jatal SN. An interesting case of primary epithelial cyst of spleen.Indian J Pathol Microbiol 2013;56:181-182


How to cite this URL:
Ingle SB, Hinge CR, Jatal SN. An interesting case of primary epithelial cyst of spleen. Indian J Pathol Microbiol [serial online] 2013 [cited 2020 Aug 6 ];56:181-182
Available from: http://www.ijpmonline.org/text.asp?2013/56/2/181/118700


Full Text

Sir,

Nonparasitic cystic lesions of spleen are unusual. On the basis of the presence or absence of the epithelial lining, they are classified as primary (true epithelial) and/secondary cysts (pseudo, non-epithelial). Among these, the primary epithelial cysts are unusual and clinically present as asymptomatic masses in the left hypochondrium. [1],[2],[3] The pathogenesis of true splenic cysts is not clear and numerous hypotheses are proposed. [1],[4] In 1929, Andral first described an epidermoid splenic cyst, which was incidentally found at autopsy and Pean performed the first ever recorded splenectomy for primary splenic epithelial cyst in 1867. [5] Herein, we are reporting a similar interesting case of huge primary unilocular epithelial cyst of spleen diagnosis of which was made on histopathology and confirmed by immunohistochemistry.

A 26-year-old male admitted in YCR Hospital, Latur and presenting with a left upper abdominal mass, dragging pain and abdominal distension since 1 year. On routine hematological investigations, platelet count was found to be reduced (60,000/cumm). Ultrasonography revealed a huge cystic lesion arising from the lower pole of the spleen almost replacing the whole splenic parenchyma. There was no relevant history of trauma, any infection and exposure to hydatid disease. Emergency therapeutic splenectomy was planned and performed. The specimen was sent for histopathological evaluation to the pathology department. On gross received a huge unilocular cyst of size 15 cm 12 cm 10 cm in size and filled with yellowish fluid. The inner wall of the cyst was smooth, glistening [Figure 1]. Microscopy showed a true cyst with cuboidal to flattened epithelial lining without squamous metaplasia [Figure 2]. The lining cells showed cytoplasmic positivity for pancytokeratin [Figure 3]. Thus, the case was finally diagnosed as primary epithelial cyst of spleen and on follow-up since last 6 months is doing well until date.{Figure 1}{Figure 2}{Figure 3}

The epithelial linings of these true splenic cysts ranged from flattened, low cuboidal, low columnar to squamous type and unilayered or stratified. Ever since the first reported case of splenic cyst by Andral in 1929, the classification of these lesions has evolved into the present system. Broadly the splenic cysts are classified as parasitic and non-parasitic cysts, the non-parasitic cysts are further categorized as primary (epithelial/true) and secondary (false/pseudo) cysts based on the presence or absence of lining of the cyst. [5] Parasitic cysts are generally seen in endemic areas and are usually caused by Echinococcus granulosus infestation. The true or primary cysts may be congenital or neoplastic in origin and are lined by mesothelial, squamous or transitional epithelium.

Secondary or pseudo cysts are usually post traumatic, due to failure of organization of subcapsular or parenchymal hematomas and occasionally due to necrosis following an infarction or rarely due to an abscess. [1],[5] Clinically, primary cysts occur predominantly in children and young adolescents; often asymptomatic until they assume large sizes, they may then present with local or referred pain, abdominal distension compression of adjacent structures and rarely as thrombocytopenia. [1],[2] Surface mesothelial invagination with subsequent cyst formation, embryonic inclusion of epithelial cells from adjacent structures, epithelial cell metaplasia from adjacent structures or vascular endothelium from peritoneal inclusions are some of the proposed theories put forth to explain the genesis of these cysts. [1],[4]

To summarize, accurate pre-operative diagnosis of primary epithelial cysts is difficult, the occurrence of a unilocular cyst in the absence of previous trauma, infection or exposure to hydatid disease may help to arrive at the diagnosis.

References

1Daga G, Mittal V, Singh RJ, Sood N. Epithelial cyst of the spleen. J Indian Assoc Pediatr Surg 2011;16:18-20.
2Tsakraklides V, Hadley TW. Epidermoid cysts of the spleen. A report of five cases. Arch Pathol 1973;96:251-4.
3Williams RJ, Glazer G. Splenic cysts: Changes in diagnosis, treatment and aetiological concepts. Ann R Coll Surg Engl 1993;75:87-9.
4Cave RH, Garvin DF, Doohen DJ. Metaplastic mesodermal cyst of the spleen. Am Surg 1971;37:97-102.
5Schwarts SI. The spleen. In: Schwartz SI, Harold E, editors. Maingot's Abdominal Operations. 9 th ed., Vol. 2. Connecticut, USA: Appleton & Lange; 1990. p. 80.