Splenic epidermoid cyst
Splenic epidermoid cysts are a type of non-parasitic primary splenic cyst.
They are thought to account for 10-25% of benign non-parasitic cysts of the spleen 3. There may be an increased female predilection.
The clinical presentation can vary ranging from being incidentally discovered on routine imaging to having nausea, vomiting, vague abdominal pain or rarely painful splenomegaly.
They are congenital in origin. As “true” cysts, they have an epithelial lining formed secondary to infolding of peritoneal mesothelium or collections of peritoneal mesothelial cells trapped within the splenic sulci 9. A genetic defect of mesothelial migration is considered the cause. While most are sporadic, rarely there is a familial occurrence 6. They typically grow slowly and are usually large (around 10 cm) at the time of discovery. They are solitary in 80%. Peripheral calcifications are uncommon (10-15%).
Usually shows an anechoic to hypoechoic well defined intrasplenic lesion. Internal echoes may be present.
Typically shows a hypoattenuating relatively well defined intrasplenic lesion. The wall is thin and has a sharp demarcation to splenic parenchyma. There is no rim or internal enhancement. Wall calcification may be present.
Complications are rare and include haemorrhage, rupture and infection 4-5.
Treatment and prognosis
Small and asymptomatic cysts do not require treatment. Symptomatic cysts are managed surgically.
A number of splenic lesions may appear cystic, depending on the modality (for a complete list see cystic lesions of the spleen article). They include:
- 1. Rabushka LS, Kawashima A, Fishman EK. Imaging of the spleen: CT with supplemental MR examination. Radiographics. 1994;14 (2): 307-32. Radiographics (abstract) - Pubmed citation
- 2. Younger KA, Hall CM. Epidermoid cyst of the spleen: a case report and review of the literature. Br J Radiol. 1990;63 (752): 652-3. Br J Radiol (citation) - doi:10.1259/0007-1285-63-752-652 - Pubmed citation
- 3. Shirkhoda A, Freeman J, Armin AR et-al. Imaging features of splenic epidermoid cyst with pathologic correlation. Abdom Imaging. 1995;20 (5): 449-51. Pubmed citation
- 4. Spencer NJ, Arthur RJ, Stringer MD. Ruptured splenic epidermoid cyst: case report and imaging appearances. Pediatr Radiol. 1997;26 (12): 871-3. Pubmed citation
- 5. Matsubayashi H, Kuraoka K, Kobayashi Y et-al. Ruptured epidermoid cyst and haematoma of spleen: a diagnostic clue of high levels of serum carcinoembryonic antigen, carbohydrate antigen 19-9 and Sialyl Lewis x. Dig Liver Dis. 2002;33 (7): 595-9. Pubmed citation
- 6. Kubo M, Yamane M, Miyatani K et-al. Familial epidermoid cysts of the spleen: report of two cases. Surg. Today. 2006;36 (9): 853-6. Surg. Today (abstract) - doi:10.1007/s00595-006-3244-3 - Pubmed citation
- 7. Vo QD, Monnard E, Hoogewoud HM. Epidermoid cyst of the spleen. BMJ Case Rep. 2013;2013 (may09 1): . BMJ Case Rep (full text) - doi:10.1136/bcr-2013-009707 - Pubmed citation
- 8. Alkofer B, Lepennec V, Chiche L. [Splenic cysts and tumors: diagnosis and management]. J Chir (Paris). 2005;142 (1): 6-13. Pubmed citation
- 9. Urrutia M, Mergo PJ, Ros LH et-al. Cystic masses of the spleen: radiologic-pathologic correlation. Radiographics. 1996;16 (1): 107-29. Radiographics (abstract) - Pubmed citation
- 10. Rana AP, Kaur M, Singh P et-al. Splenic epidermoid cyst - a rare entity. J Clin Diagn Res. 2014;8 (2): 175-6. doi:10.7860/JCDR/2014/6901.4050 - Free text at pubmed - Pubmed citation
- normal appearance of the spleen
- pseudolesion of the spleen: inhomogeneous splenic enhancement
splenic lesions and anomalies
- congenital anomalies
- mass lesions
- infiltrative processes
- incidental splenic lesion (approach)