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Background: Splenic cysts are uncommon and very rarely malignant therefore their treatment isn't standardized. In case of symptomatic cysts different surgical approaches have been suggested. Primary malignant lymphoma of the spleen comprises less than 1% of non-Hodgkin's lymphomas. To our knowledge, only 203 cases of splenic large B-cell lymphoma (LBCL) have been reported to date and only 2 of them were fibrin-associated splenic cysts. Case presentation: 27-year-old model with a 19 × 13 cm splenic cyst without data of malignancy in the preliminary study and therefore treated with laparoscopic deroofing. After histological diagnosis of LBCL with a fibrin/EBV-associated splenic pseudocyst, the patient received 4 cycles of Rituximab and a laparoscopic splenectomy was performed due to resurgence of the pseudocyst. No evidence of malignancy has been found during follow up (EBV viral load every 3 months during the first year, PET-CT every 6 months during the first year and annual afterwards) performed after the splenectomy. Discussion and conclusions: The value of tumor markers and radiology for diagnosis of splenic cysts is put into question. Only 60 cases of Fibrin-associated LBCL (FA-LBCL) have been described in the literature therefore there are no treatment guidelines for them even though surgery together with systemic treatment has been the prevalent route with good results in most cases. [ABSTRACT FROM AUTHOR]

Abstract Background Splenic cysts are uncommon and very rarely malignant therefore their treatment isn’t standardized. In case of symptomatic cysts different surgical approaches have been suggested. Primary malignant lymphoma of the spleen comprises less than 1% of non-Hodgkin’s lymphomas. To our knowledge, only 203 cases of splenic large B-cell lymphoma (LBCL) have been reported to date and only 2 of them were fibrin-associated splenic cysts. Case presentation 27-year-old model with a 19 × 13 cm splenic cyst without data of malignancy in the preliminary study and therefore treated with laparoscopic deroofing. After histological diagnosis of LBCL with a fibrin/EBV-associated splenic pseudocyst, the patient received 4 cycles of Rituximab and a laparoscopic splenectomy was performed due to resurgence of the pseudocyst. No evidence of malignancy has been found during follow up (EBV viral load every 3 months during the first year, PET-CT every 6 months during the first year and annual afterwards) performed after the splenectomy. Discussion and conclusions The value of tumor markers and radiology for diagnosis of splenic cysts is put into question. Only 60 cases of Fibrin-associated LBCL (FA-LBCL) have been described in the literature therefore there are no treatment guidelines for them even though surgery together with systemic treatment has been the prevalent route with good results in most cases.

Wandering spleen is extremely uncommon, with a reported incidence of

Laparoscopic fenestration is the preferred treatment for symptomatic splenic cysts because it is curative and spleen‐sparing. We report a case of a 25‐year‐old female who underwent laparoscopic fenestration for a giant splenic cyst using a single‐incision plus one‐port approach. She presented to our hospital with repeated vomiting. Imaging showed a 23 × 18 cm splenic cyst with no solid components, strongly compressing the stomach to the right side. Laparoscopic fenestration was initiated through a 2.5‐cm umbilical incision, and a 5‐mm port was added in the left abdomen intraoperatively. The drain placement was deemed necessary to prevent abscess formation and post‐operative bleeding because of a thick cyst component and unexpectedly thick wall. Splenic cysts are typically benign and commonly develop in young people, hence, organ preservation and cosmetic results are crucial. Laparoscopic fenestration using single‐incision plus one‐port is considered to be an appropriate procedure for giant splenic cysts with non‐serous contents. [ABSTRACT FROM AUTHOR]

Wandering spleen is extremely uncommon, with a reported incidence of <0.5%. A cyst within the spleen is also uncommon. The majority of primary splenic cysts fall into the epithelial cyst category. The affected patients present with atypical symptoms, like feeling fullness in the left upper abdomen and a palpable mass. The treatment of a large wandering splenic cyst is an open splenectomy. This case presents a unique combination of a wandering spleen with a huge ruptured cyst, featuring an unusual right lower abdominal and pelvic location, a twisted pedicle, and a remnant of normal splenic parenchyma, collectively constituting an exceedingly rare clinical scenario. [ABSTRACT FROM AUTHOR]

BackgroundSplenic cysts are relatively rare benign tumors that are asymptomatic in most patients and are usually discovered incidentally by imaging. In our case, we report a splenic cyst in a child who underwent laparoscopic partial splenectomy.Case descriptionA 13-year-old boy was admitted to the hospital after an incidental finding of a splenic cyst on an abdominal ultrasound conducted 4 days prior. He was asymptomatic before admission. Upon admission, abdominal ultrasound and CT revealed a cystic lesion in the spleen, highly suspicious for a splenic cyst. Then, we used transumbilical single-site laparoscopic exploration and found a cyst measuring approximately 12 cm × 11 cm × 10 cm at the upper pole of the spleen, so we performed a partial splenectomy and diagnosed a primary epithelioid splenic cyst via postoperative pathology.ConclusionsSplenic cysts in children are very rare and can be treated conservatively in asymptomatic patients with a diameter of less than 5 cm, while surgery is required in symptomatic patients or those with a diameter greater than or equal to 5 cm. Transumbilical single-site laparoscopic partial splenectomy is a minimally invasive and effective treatment, especially for children.

Splenic hydatid cysts are caused by the Echinococcus species and rarely occur in pregnancy. This case report describes the management of a 29-year-old pregnant woman with a large (11 × 8.7 × 10.5 cm) splenic hydatid cyst. The cyst had been identified before she became pregnant by her general practitioner with imaging investigations undertaken for her persistent left upper abdominal pain. The patient also had laboratory investigations which were positive for echinococcosis species.Hydatid splenic cysts are very rare and even more so in pregnancy. Risk of splenic cyst rupture exists, and rupture has significant risk of maternal and perinatal morbidity and mortality. Among the few case reports in the literature there is no clear consensus on conservative or surgical management during pregnancy and no clear guidelines for intrapartum care or delivery. The case report reviews the literature on splenic hydatid cyst disease in pregnancy and explores the management and outcome of this patient through her fourth pregnancy, which resulted in an uncomplicated vaginal birth.

Isolated splenic lymphangiomas are rare benign lesions mostly seen in children are exceptionally rare in adults, often discovered incidentally due to their typically asymptomatic nature. This case report elaborates on the surgical excision of a rare splenic cystic lymphangioma in a 33-year-old woman, underscoring the diagnostic and therapeutic challenges these tumors pose. The patient's symptoms, abdominal pain and a palpable mass led to imaging through ultrasound and CT, which revealed a cystic splenic lesion. Total splenectomy was performed, revealing a large cystic mass, with pathological examination confirming a cystic lymphangioma. This case emphasizes the necessity of considering splenic lymphangiomas in adult patients presenting with splenic lesions. It also highlights the critical role of surgical interventions for definitive diagnosis and to prevent complications such as rupture and hemorrhage, thereby emphasizing on the complexity of managing rare splenic tumors. [ABSTRACT FROM AUTHOR]

Abstract Background Splenic cysts are quite rare and asymptomatic. They may result from infection by a parasite, especially Echinococcus granulosus (hydatid cyst), or from non-parasitic causes. Since primary splenic cysts are not common, simple cysts can be misdiagnosed with a hydatid cyst in endemic areas. Case presentation We reported a 14-year-old Iranian girl initially presented with a vague abdominal pain, which progressed to left shoulder pain, fullness, early satiety, and shortness of breath and remained undiagnosed for 7 months despite seeking medical attention. Finally, imaging revealed a massive splenic cyst measuring 220 mm × 150 mm × 160 mm raising concern for a hydatid cyst due to regional endemicity. Consequently, the patient underwent total splenectomy. However, histopathological examination surprisingly revealed a simple non-parasitic cyst. Conclusions Detecting rare simple spleen cysts requires early ultrasonography (US) and careful reassessment of diagnoses for non-responsive or worsening symptoms. Distinguishing them from splenic hydatidosis, especially in endemic areas, demands thorough paraclinical evaluations and patient history regarding potential parasitic exposure. While total splenectomy is the primary treatment for these huge cysts, the optimal surgical approach should be tailored case by case. These insights emphasize a comprehensive diagnostic approach to enhance accuracy and optimize patient care for these uncommon cysts.

Background: Splenic cysts are quite rare and asymptomatic. They may result from infection by a parasite, especially Echinococcus granulosus (hydatid cyst), or from non-parasitic causes. Since primary splenic cysts are not common, simple cysts can be misdiagnosed with a hydatid cyst in endemic areas. Case presentation: We reported a 14-year-old Iranian girl initially presented with a vague abdominal pain, which progressed to left shoulder pain, fullness, early satiety, and shortness of breath and remained undiagnosed for 7 months despite seeking medical attention. Finally, imaging revealed a massive splenic cyst measuring 220 mm × 150 mm × 160 mm raising concern for a hydatid cyst due to regional endemicity. Consequently, the patient underwent total splenectomy. However, histopathological examination surprisingly revealed a simple non-parasitic cyst. Conclusions: Detecting rare simple spleen cysts requires early ultrasonography (US) and careful reassessment of diagnoses for non-responsive or worsening symptoms. Distinguishing them from splenic hydatidosis, especially in endemic areas, demands thorough paraclinical evaluations and patient history regarding potential parasitic exposure. While total splenectomy is the primary treatment for these huge cysts, the optimal surgical approach should be tailored case by case. These insights emphasize a comprehensive diagnostic approach to enhance accuracy and optimize patient care for these uncommon cysts. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In this research, our goal is to carry out a retrospective assessment of patients who received surgical treatment for nonparasitic splenic cysts (NPSCs) and to propose an innovative index (Karakuz Index) for predicting the optimal surgical approach. PATIENTS AND METHODS: This study is a retrospective analysis of 48 pediatric patients who underwent surgical treatment for nonparasitic splenic cysts. The patient population was divided into two groups based on the surgical approach: open surgery (n=37) and laparoscopic surgery (n=11). RESULTS: Of the 256 patients with nonparasitic splenic cysts (NPSCs), 48 patients underwent surgical treatment (18.8%). The average age was 11.4±4.2 years, and the majority were female (52%). Surgical approaches included laparoscopic (23%) and open surgery (77%), with cystectomy, partial splenectomy, and total splenectomy performed (48%, 23%, and 29%, respectively). The Karakuz Index, a novel metric, also showed significant differences between the two groups. Histopathological findings and recurrence rates were similar between both approaches (p=0.335 and p=0.229, respectively). The Karakuz Index demonstrated a sensitivity of 60% and a specificity of 91% at a cut-off value of 16. CONCLUSIONS: The novel Karakuz Index demonstrated promising discriminatory capacity and requires further research in larger studies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Laparoscopic management of non-parasitic cysts (NSCs) of the spleen is currently the standard of care. There is a paucity of data of robotic management of NSCs. Here, we report a case of a NSC in a 13-year-old male. The patient presented to us with the chief complaints of pain in abdomen and feeling of a left upper abdomen lump for the last 3 months. The spleen being an important organ for immunity, we decided to opt for splenic preservation. Since minimal access methods offer the best outcome and we wanted to go with a safe option, we settled for near-total cystectomy of the splenic cyst. Here, we review the literature regarding the surgical management of NSCs and discuss the robotic technique for the accomplishment of the surgery.

Abstract Background Splenic cyst complicated by non-typhoid Salmonella infection is rare in healthy individuals in the era of antibiotics. Salmonella enterica subsp. enterica serovar Livingstone causing infection of giant splenic cyst has not been previously reported. Case presentation We report a case of giant splenic cyst (maximum diameter, 21 cm) complicated with Salmonella Livingstone infection, which resulted in splenic abscess, in a 16-year-old previously healthy adolescent male. The splenic abscess was successfully treated with ultrasonography-guided percutaneous drainage and antimicrobial therapy. Conclusion Infection of splenic cyst may be caused by S. Livingstone in immunocompetent individuals. This case may help clinicians to raise awareness towards splenic abscess and highlights the importance of drainage and antimicrobial agents to avoid splenectomy.

Aim. Surgical approaches for the treatment of splenic cysts (SC) in children remains controversial. There are various methods of organsaving operations on spleen with its cystic lesions in children. Aim of the stufy is to evaluate different options for surgical treatment of SC in children. Materials and methods: a retrospective study of diagnostic work-up and treatment of 265 children ages from 1 month to 18 years with splenic cyst from January 1998 to December 2019 was performed. 175 (66.04%) children underwent surgery. The other 90 (33.96%) patients were under dynamic observation. Results. 119 (68.00%) open and 56 (32.00%) laparoscopic interventions were performed in children with different localization of cysts. Among open operations, partial resection of the spleen was most often performed -- in 70 patients, partial cystectomy with unroofing -- in 36 children, partial cystectomy -- in 12 patients, and splenectomy -- in 1 child with total cystic lesion of the spleen. Recurrence of the cyst was observed in 2 (1.68%) patients, which was corrected by repeated partial cystectomy by laparotomy. Laparoscopic partial cystectomy was most commonly used in 30 children, cystectomy with unroofing -- in 21 cases, and partial splenic resection in 5 children. Cyst recurrence was observed in 3 (5.36%) patients. Recurrence was also corrected laparoscopically in 1 case and open access -- in 2 children. Minimal residual cyst cavity in the remote period was observed in 9 (7.56%) children after open and in 7 (12.50%) -- after laparoscopic correction of the SC, which healed on its own within 1-2 years. Conclusion. Partial resection of the spleen, taking into account its segmental blood supply by laparoscopic or open method, is a rational organ-preserving method of treatment of splenic cysts. Partial cystectomy should be used for small cysts that occupy only one segment of the spleen. At cysts with a diameter up to 20 mm dynamic observation is rational [ABSTRACT FROM AUTHOR]

We describe the case of a 40s woman with a carbohydrate antigen (CA)19-9-producing splenic cyst. The lesion was detected incidentally at the splenic hilum, and resected after 5 years of follow-up. Size of the lesion was enlarged from 1.6 cm to 5.3 cm, and serum CA19-9 was elevated from the normal range to 1766 U/ml. Microscopically, CA19-9-producing splenic cyst was diagnosed. It was mimicked pancreatic malignancy due to its location at the splenic hilum. Benign lesions with elevated serum CA19-9 also to be differential diagnosis.

Introduction. Posttraumatic splenic cysts are most commonly the result of blunt force trauma to the abdomen. They usually develop from subcapsular or intraparenchymal hematomas and are typically asymptomatic. Diagnostics includes clinical history and radiological imaging procedures. Surgical treatment is the only curative modality of treatment. Case outline. A 43-year-old female patient, without comorbidities, was admitted to the health institution for additional diagnostics and surgical treatment. Laboratory test results were within the reference ranges, while serological test results for hydatid disease were negative. An abdominal CT examination was subsequently performed confirming a splenic cyst positioned in the central part of the spleen. After a laparoscopic partial pericystectomy of the cyst, we identified another smaller cyst of the spleen. According to the estimation of the surgical team, the intraoperative appearance of the remaining tissue of the spleen was less than a third of the entire spleen. The decision was taken to perform a splenectomy in the best interests of the patient, bearing in mind the possibility of complications Conclusion. Accurate diagnosis of posttraumatic splenic cysts remains a challenge, despite state-of-the-art radiological imaging procedures that are applied. In addition to the well-known modalities of treatment, the laparoscopic surgical approach, i.e., minimally invasive treatment, should be the one of choice, if the situation allows it. The laparoscopic approach is a diagnostic and therapeutic method whose effect can especially be observed when the intraoperative finding differs from the preoperative radiological finding.

Introduction: Splenic cysts are quite rare. In this publication, authors focus on presenting their own observations related to the management of patients with such lesions. Aim: To evaluate the effectiveness of laparoscopic procedures in the case of patients with splenic cysts. Material and methods: The study included patients treated surgically for cystic lesions located in the spleen at the 2nd Department of General, Gastroenterological and Oncological Surgery of the Medical University of Bialystok over the years 2017-01.2020. Results: All patients were referred for elective excision of the spleen lesion (the size of the lesions ranged from 7 to 15 cm -- based on CT examination). In all cases, excision of the anterior wall of the cyst was performed with the help of advanced surgical tools. The duration of the procedure ranged between 65 and 100 minutes. No significant blood loss was observed. No postoperative complications were found. Conclusions: In conclusion, sparing laparoscopic surgery for cystic lesions of the spleen seem to be safe and rarely associated with complications or relapses. Extending the scope of the procedure to total splenectomy should also not pose a major problem. [ABSTRACT FROM AUTHOR]

Background: Splenic cysts are relatively rare benign tumors that are asymptomatic in most patients and are usually discovered incidentally by imaging. In our case, we report a splenic cyst in a child who underwent laparoscopic partial splenectomy., Case Description: A 13-year-old boy was admitted to the hospital after an incidental finding of a splenic cyst on an abdominal ultrasound conducted 4 days prior. He was asymptomatic before admission. Upon admission, abdominal ultrasound and CT revealed a cystic lesion in the spleen, highly suspicious for a splenic cyst. Then, we used transumbilical single-site laparoscopic exploration and found a cyst measuring approximately 12 cm × 11 cm × 10 cm at the upper pole of the spleen, so we performed a partial splenectomy and diagnosed a primary epithelioid splenic cyst via postoperative pathology., Conclusions: Splenic cysts in children are very rare and can be treated conservatively in asymptomatic patients with a diameter of less than 5 cm, while surgery is required in symptomatic patients or those with a diameter greater than or equal to 5 cm. Transumbilical single-site laparoscopic partial splenectomy is a minimally invasive and effective treatment, especially for children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Kong, Chen, Bai, Yan, Yi, Wang, Liu, Jia, Liu and Zhang.)

Introduction: In recent years, dome resection, which preserves the splenic immunological function, has been the primary technique used to treat splenic cysts. We herein report a surgical technique using a needle grasper and indocyanine green (ICG) fluorescence to perform dome resection of a huge nonparasitic splenic cyst in a pediatric patient. Patient and Surgical Technique: A 13‐year‐old girl was incidentally diagnosed with a splenic cyst during follow‐up for scoliosis. Abdominal enhanced computed tomography (CT) showed a 17 × 14 × 14 cm unifocal cyst. Laparoscopic dome resection was planned. The intraoperative findings showed that the spleen was distended, but there was no apparent prominence of the thin cyst wall on the surface of the spleen. An ICG fluorescence camera overlay revealed poor coloration in the thinning area. We punctured the area and aspirated the cyst contents. We grasped the cyst wall with a percutaneous needle grasper and dissected the cyst wall with a vessel sealing system. We placed anti‐adhesion agent at the dissection line to prevent recurrence. Discussion: ICG fluorescence was useful for identifying the thinning area of a splenic cyst. The use of a percutaneous needle grasper facilitated the performance of dome resection of a huge splenic cyst in a pediatric patient with minimal invasiveness and an improved cosmetic outcome. [ABSTRACT FROM AUTHOR]

Background: Splenic cyst complicated by non-typhoid Salmonella infection is rare in healthy individuals in the era of antibiotics. Salmonella enterica subsp. enterica serovar Livingstone causing infection of giant splenic cyst has not been previously reported.Case Presentation: We report a case of giant splenic cyst (maximum diameter, 21 cm) complicated with Salmonella Livingstone infection, which resulted in splenic abscess, in a 16-year-old previously healthy adolescent male. The splenic abscess was successfully treated with ultrasonography-guided percutaneous drainage and antimicrobial therapy.Conclusion: Infection of splenic cyst may be caused by S. Livingstone in immunocompetent individuals. This case may help clinicians to raise awareness towards splenic abscess and highlights the importance of drainage and antimicrobial agents to avoid splenectomy. [ABSTRACT FROM AUTHOR]

Nonparasitic splenic cysts often cause nonspecific symptoms such as pain or early satiety. As it is relatively rarer than hepatic cysts, no established treatment exists for splenic cysts. A 24-year-old woman with a complaint of abdominal discomfort was referred to our hospital. Computed tomography revealed an 11-cm diameter splenic cyst, thought to be the cause of her symptom. Sclerotherapy was performed using polidocanol foam, administered at a volume of 40 mL through a catheter, under local anesthesia. After 2 sessions, the cyst measured 5 cm in diameter, 3 months after the first treatment. Sclerotherapy using polidocanol foam can treat large splenic cysts. It can be performed using local anesthesia and a single puncture, reducing sclerosant use.

An 89-year-old female presented to the emergency department (ED) with hypotension and altered mental status. The patient had no external signs of trauma or hemorrhage and no abdominal tenderness on examination. The patient remained hypotensive after initial fluid resuscitation, and laboratory testing revealed a significant anemia. Point-of-care ultrasound (POCUS) was used to perform a rapid ultrasound in shock (RUSH) exam in an attempt to uncover the etiology of undifferentiated hypotension. The exam displayed free fluid in the right upper quadrant and the left upper quadrant exam demonstrated a large splenic lesion with mixed echogenicity. Subsequent computed tomography (CT) of the abdomen and pelvis with intravenous contrast suggested a ruptured hemorrhagic splenic cyst, and the patient underwent an emergent splenectomy for hemorrhage control. Operative pathologic examination revealed the cystic lesion to be a splenic hemangioma. This case report highlights the utility of the Rapid Ultrasound for Shock and Hypotension (RUSH) protocol when evaluating patients with undifferentiated nontraumatic shock, and a rare cause of spontaneous intra-abdominal hemorrhage., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities., (Copyright © 2024, Glusman et al.)

Splenic cysts are extremely rare entities that typically result from prior abdominal trauma, infections, and degenerative diseases. They are divided into two categories: true cysts with epithelial lining, and false pseudocysts without epithelial lining, which is more common than true cysts. We describe here a case of a non-traumatic splenic pseudocyst in a healthy 29-year-old male patient, who presented with left upper quadrant abdominal pain. Physical examination revealed scaphoid abdomen and left hypochondrium fullness. The spleen was uniformly enlarged, smooth, and firm, with mild tenderness. Laboratory testing was normal. An abdominal CT scan showed a huge unilocular non-enhancing cyst occupying the upper part of the spleen, measuring around 16 × 18.5 × 20 cm. The patient was managed with cyst aspiration and partial cystectomy. The histopathological examination findings are consistent with splenic pseudocyst. A one-year follow-up period revealed no complications or recurrence. Spleen cysts are rare in clinical practice, posing challenges in diagnosis and treatment. Surgical options include partial or total splenectomy, cyst aspiration, percutaneous drainage, partial cystectomy, and marsupialization. The choice depends on the cyst's size, splenic coverage, and relation to the hilum. Recently, spleen-preserving approaches have been favored to avoid life-threatening sepsis. Non-traumatic splenic pseudocysts present significant diagnostic dilemmas, requiring histopathological examination for definitive diagnosis. Spleen-preserving management is highly recommended to reduce the risk of life-threatening sepsis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Abu Sabha et al.)

Primary (isolated) splenic hydatid cyst is rare and accounts for less than 2 % of hydatid patients, even in endemic regions. Diagnosis of splenic hydatid cyst can be challenging due to the rarity of the condition and its nonspecific symptoms. Surgery is the mainstay of treatment. This case report discusses management options for such a rare condition. We present a 33-year-old female patient with abdominal pain for six months and splenomegaly. Ultrasonography and CT scan showed a giant splenic cyst with clear walls and multi-vesicular contents suggestive of a hydatid cyst. There was no involvement of the liver or other organs. Indirect hemagglutination was positive for Echinococcus. Through a left subcostal incision total splenectomy was performed. The patient was discharged from hospital on the sixth postoperative day. No local recurrence was detected during postoperative follow up. Primary splenic hydatid disease is rare. It may be detected incidentally or present with nonspecific complaints. If untreated, a splenic hydatid cyst can lead to various potentially severe complications, including cyst rupture and secondary infection. Standard treatment is open total or partial splenectomy: preservation surgery should always be considered, to avoid post splenectomy infection, especially in young patients. Primary splenic hydatid cyst is rare even in endemic areas. Symptoms may be non-specific. Standard treatment is open total or partial splenectomy. • The spleen is the third most common site of hydatid disease, after the liver and lungs • Splenic hydatid cyst can be either primary (isolated to the spleen only) or secondary (accompanied by hydatid cysts in other organs) • Primary splenic hydatid cyst is rare even in endemic regions • Diagnosing hydatid cyst disease of the spleen can be challenging due to the rarity of the condition and often nonspecific symptoms • Surgery is the usual management of hydatid cyst of the spleen [ABSTRACT FROM AUTHOR]

Abstract Background Non-parasitic splenic cysts are associated with elevated serum carbohydrate antigen (CA) 19–9 levels. We report a case in which a 23-year-old female exhibited a large ruptured splenic cyst and an elevated serum CA19–9 level. Case presentation The patient, who experienced postprandial abdominal pain and vomiting, was transferred to our hospital and was found to have a large splenic cyst during an abdominal computed tomography (CT) scan. On physical examination, her vital signs were stable, and she demonstrated rebound tenderness in the epigastric region. An abdominal CT scan revealed abdominal fluid and a low-density region (12 × 12 × 8 cm) with enhanced margins in the spleen. The patient’s serum levels of CA19–9 and CA125 were elevated to 17,580 U/mL and 909 U/mL, respectively. A cytological examination of the ascitic fluid resulted in it being categorized as class II. Finally, we made a diagnosis of a ruptured splenic epidermoid cyst and performed laparoscopic splenic fenestration. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 5. The cystic lesion was histopathologically diagnosed as a true cyst, and the epithelial cells were positive for CA19–9. Follow-up laboratory tests performed at 4 postoperative months showed normal CA19–9 (24.6 U/L) and CA125 (26.8 U/L) levels. No recurrence of the splenic cyst was detected during the 6 months after surgery. Conclusion Laparoscopic fenestration of a ruptured splenic cyst was performed to preserve the spleen, after the results of abdominal fluid cytology and MRI were negative for malignancy.

Splenic cysts are not so common in incidence. Only 800–850 cases have been reported till now in the literature. Splenic cysts can be further classified into parasitic and non-parasitic cysts. Non-parasitic cyst is further subdivided into true and false or pseudocyst. Pseudocysts are those who are lacking any epithelial lining. Splenic pseudocysts are usually a result of trauma, infection or infarction. We present a case of splenic pseudocyst that was diagnosed incidentally on routine check-up, and we managed this case with minimally invasive approach with complete preservation of spleen and only removal of pseudocyst. We used indocyanine green dye that helped us in complete delineation of splenic parenchyma and vascular structure adjacent to it. In our view, as in this study also, adopting a new technique that can be helpful in better treatment of the patient and if it can change the surgical outcome of the disease in favour of the patient, it should be encouraged.

A 22-year-old primigravida was diagnosed with an 18-cm splenic cyst during routine third-trimester routine ultrasound examination. She was referred to a tertiary obstetric hospital and after multidisciplinary consultation, expectant management was decided on. Induction of labour was performed at term and she delivered vaginally with vacuum extractor application without complications. Percutaneous aspiration and sclerotherapy of the cyst was performed one week after delivery. She was hemodynamically stable throughout.

Primary splenic cysts (PSC) are rare lesions in surgical pathology; those symptomatic, or greater than 5 cm, should be treated surgically to avoid the risk of complications. A histopathological examination should be performed to confirm the splenic cyst subtype and rule out a possible malignant transformation of the pluripotential epithelial lining. The aim of this manuscript was to report a case of PSC who had undergone surgery and to review the existing evidence regarding its morphological, therapeutic and prognostic characteristics. An 18-year-old woman (MAC), consulted for progressive abdominal distention of several months of evolution. Abdominal tomography revealed the existence of a large heterogeneous mass, 21 cm in diameter, in relation to the transverse colon and the greater gastric curve. Intraoperative examination revealed a solid cystic mass arising from the transverse mesocolon. Surgery consisted of splenectomy and in-block excision of the tumor. The patient evolved satisfactorily and was discharged on the fifth postoperative day. Diagnosis of epithelial splenic cyst was established based on the pathological examination of the surgical specimen. At six months postoperative the patient had evolved satisfactorily without complications. Following abdominal tomography control a functioning supernumerary spleen was confirmed. [ABSTRACT FROM AUTHOR]

Musculoskeletal pain in the thoracic spine is a common complaint and often seen in the osteopathic clinic. An underlying cause may be pain originating from an internal organ referring to the segmental related somatic structures, i.e. a viscerosomatic reflex. A splenic cyst causing a viscerosomatic reflex in the thoracic spine is a rare but serious differential diagnosis for thoracic musculoskeletal pain that may be identified during routine osteopathic assessment and treatment. A 36-year-old women was referred for osteopathy with pain in the thoracic spine as the main complaint. The pain was aggravated by twisting motions, prolonged standing and sitting. The physical examination identified hyperalgesia, hypertonic paraspinal muscles with trophic changes at T6-10 and hypomobility at T6-8. On palpation the diaphragm muscle was hypertonic. In the abdomen, a palpable mass was found in the left upper quadrant, which was suspected to be an enlarged spleen. A normal size spleen is not palpable; therefore, the patient was referred for further investigations. An X-ray and CT scan identified a splenic cyst of approximately 10 cm which was removed with a splenectomy as advised, leading to resolution of the thoracic pain. A splenic cyst mimicking mechanical pain in the thoracic spine is rare; however, this case report highlights the importance of comprehensive history taking and screening of red flags, combined with careful physical examination of both musculoskeletal and visceral structures. • Thorough assessment of the visceral system may help to identify a serious pathology. • A palpable spleen should be referred for further examination. • A splenic cyst may cause a viscerosomatic reflex in the thoracic spin. [ABSTRACT FROM AUTHOR]

Splenic abscess is a rare disease that generally occurs in immunocompromised patients. It is difficult to distinguish between splenic abscesses and cysts using imaging studies, especially if they are asymptomatic. A 50-year-old asymptomatic man who had received steroid therapy for underlying rheumatoid arthritis was referred to a university hospital due to presence of several splenic cysts, with the largest being 3.5 cm in diameter. Percutaneous aspiration was performed, and fluid analysis showed cysts infected by extended-spectrum, beta-lactamase-producing Escherichia coli. The patient was treated with ertapenem for four weeks, and the lesion disappeared on follow-up imaging studies. Splenic abscess should be included as a differential diagnosis of splenic cystic lesions in immunocompromised patients.

Laparoscopic splenectomy is gaining popularity due to less morbidity and minimal operative complications. Nowadays, laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. Splenic pseudocyst due to non-traumatic cause has been very rarely reported in literature. We report an interesting case of a rare large splenic pseudocyst without a history of previous abdominal trauma, treated successfully by laparoscopic technique and discuss literature for the same.

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.

A female patient, 20 years old, with a history of a progressive increase in abdominal volume on the left side, starting 3 years ago, with no associated symptoms and no history of trauma. Ultrasonography and a computed tomography scan of the abdomen were performed, which revealed a large splenomegaly, and a partial minilaparoscopic splenectomy was indicated. We opted for unroofing of the cyst, and the procedure was uneventful, with a total surgical time of 47 min. The patient progressed clinically well, without abdominal pain, being discharged on the 2nd post-operative day.

• Primary splenic hydatidosis is an uncommon entity. • Total splenectomy is considered the standard treatment, but carries multiple risks. • Partial splenectomy offers comparable outcomes with reduced morbidity. • Partial splenectomy is recommended for simple, single, small, and peripherally located cysts. • Laparoscopic cyst unroofing is feasible in treating primary splenic hydatid cysts. Primary splenic hydatidosis is an uncommon etiology. Total splenectomy has been the treatment of choice, however, spleen preserving surgery has been gaining popularity. We present a case of a 52-year-old man who was evaluated for a splenic cyst, found incidentally on CT scan done at another institution. MRI was repeated in our institution along with an indirect hemagglutination test to confirm the diagnosis. Since our patient had a single non-complicated cyst confined to the spleen's lower pole, we decided to opt for laparoscopic cyst unroofing and omentoplasty, a spleen preserving technique. Due to the rarity of splenic hydatidosis, no strict management guidelines are available, and the decision is usually left for the surgeon. Total splenectomy has been considered the standard of care, however, spleen preserving surgical techniques and percutaneous interventions have been suggested as better alternatives. Spleen preserving techniques lead to surgical outcomes comparable to total splenectomy, with the added benefit of preserving the immunological protection provided by the spleen and protecting patients from dramatic complications that might follow total splenectomy, such as overwhelming post-splenectomy infections, which are associated with very high mortality. Laparoscopic cyst unroofing and omentoplasty is a feasible surgical technique to treat primary splenic hydatidosis while preserving the spleen's immunologic function. [ABSTRACT FROM AUTHOR]

Splenic cysts are not so common in incidence. Only 800-850 cases have been reported till now in the literature. Splenic cysts can be further classified into parasitic and non-parasitic cysts. Non-parasitic cyst is further subdivided into true and false or pseudocyst. Pseudocysts are those who are lacking any epithelial lining. Splenic pseudocysts are usually a result of trauma, infection or infarction. We present a case of splenic pseudocyst that was diagnosed incidentally on routine check-up, and we managed this case with minimally invasive approach with complete preservation of spleen and only removal of pseudocyst. We used indocyanine green dye that helped us in complete delineation of splenic parenchyma and vascular structure adjacent to it. In our view, as in this study also, adopting a new technique that can be helpful in better treatment of the patient and if it can change the surgical outcome of the disease in favour of the patient, it should be encouraged. [ABSTRACT FROM AUTHOR]

Abstract We describe the extraordinary finding of a hepatic epidermoid cyst in a 5-year-old patient, treated successfully with laparoscopic deroofing and mucosal stripping. The pathologic examination revealed a cyst with the same features of a true epithelial splenic cyst whose origin is still controversial, even though a coelomic derivation is the most accredited hypothesis. A cyst in this anatomic district with such characteristics has never been described in existent literature. Highlights • A hepatic epidermoid cyst, with the same features of a true epithelial splenic cyst, is described for the first time. • Laparoscopic deroofing and mucosal stripping of the cyst can be an option for successful treatment of hepatic cysts. • Splenic cysts, and this case a hepatic cyst, are likely to have a coelomic origin. [ABSTRACT FROM AUTHOR]

The spleen is the most commonly injured solid organ in blunt abdominal trauma and contributes to mortality and morbidity. Epidermoid splenic cysts are an example of primary congenital cysts that contain an epithelial lining unlike secondary cysts that are collection of fibrous tissue. An 18-year-old male presented with acute left upper abdominal pain, feeling of fullness and dyspepsia since 10 days ago. His past medical history was positive for renal transplantation from deceased donor five years prior to presentation. Physical examination revealed normal findings except a palpable soft mass measuring 15x20 cm in the left upper quadrant (LUQ). [ABSTRACT FROM AUTHOR]