Presentation
Chronic abdominal pain and discomfort.Palpable left hypochondrial mass.
Patient Data
There is significant splenomegaly with a heterogeneous sonographic appearance. There is a large cystic intrasplenic mass lesion with debris and septations. There is no abnormal splenic vascularity. There is a mass effect with displaced left kidney, right of the midline.
There is significant splenomegaly (22cm) secondary to a large, simple, sharply demarcated, cystic intrasplenic mass lesion measuring 19.8 x 18.0 x 16.1 cm (craniocaudal x oblique anteroposterior x width). The cyst is thin-walled, with a few wall calcifications. There is no abnormal wall or intralesional enhancement, and no suspicious intracystic mass lesion or solid component.
There is a mass effect, with displaced stomach, small bowel, and large bowel with associated mesenteric vessels. The pancreas is compressed ,and displaced towards the right with the abdominal aorta. The left kidney is right of the midline, anteroinferior to the right kidney with an altered polarity. There is expected displaced left ureter on the delayed phase. There is no hydronephrosis or hydroureter bilaterally. The left adrenal gland is poorly identified.
There is an incidental multifiborid uterus with multiple submucosal and subserosal uterine fibroids with hyaline degeneration.
Case courtesy : Dr D.H.Jogi and Dr M.F. Suliman.
Gross specimen:
The spleen weighed 4 2776g. It measured 25 x 23 x12 cm. A large, unilocular cyst measuring 18 cm in diameter with a wall thickness of 9mm was present.
Histology confirmed intraluminal organizing hematoma, with a foreign body reaction, hemosiderin deposition,cholesterol cleft formation and dystrophic calcifications. There is no evidence of a hydatid infection. Features suggestive of a splenic pseudocyst secondary to previous trauma likely.
Images courtesy of Dr. M.F. Suliman and Dr B.Bhana.
Case Discussion
A histopathologically confirmed giant splenic pseudocyst. Splenic pseudocysts or secondary splenic cysts are usually acquired due to splenic trauma, infarction or pancreatitis (intrasplenic pancreatic pseudocyst). In this instance, it was suspected to be due to previous blunt abdominal trauma.
The patient underwent a therapeutic splenectomy with an unremarkable post-operative period.
Cystic splenic mass lesions include primary and secondary cysts, hydatid cysts, and congenital splenic lesions including hemangioma and lymphangioma. Cystic metastases although rare, must be included in the appropriate clinical setting.
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