RESUMO
Giant nonparasitic splenic epidermoid cysts are relatively uncommon. These lesions can lead abdominal pain, but most of then are asymptomatic, and they are discovered incidentally. We report a 13-y old female with a giant splenic epidermoid cystic, given the special interest of diagnostic and therapeutic decision-making of this rare entity. CASE REPORT: A 13-y old female with clinical history of abdominal pain since the last two months. On physical examination a firm, tender mass was palpable in left hypochondrium. Diagnosis of a large cystic splenic mass was made based on ultrasound and abdominal computed tomography scan. Splenectomy was performed, and histopathological-immunohistochemistry studies revealed findings suggestive of primary epithelial cyst. The post-operative clinical course was satisfactory and uneventful. CONCLUSIONS: Treatment of giant nonparasitic splenic cysts is surgical. Preserve splenic parenchyma must be the aim in an individualized decision-making. The different types of surgical modalities will be according to the diagnosis and clinical situation (cyst size, age, comorbidities).
Assuntos
Cisto Epidérmico/diagnóstico , Esplenopatias/diagnóstico , Adolescente , Cisto Epidérmico/cirurgia , Feminino , Humanos , Esplenectomia , Esplenopatias/cirurgiaRESUMO
Los quistes esplénicos gigantes y no parasitarios son infrecuentes. Estas lesiones pueden manifestarse como dolor abdominal, si bien a menudo son asintomáticas y se diagnostican en forma incidental. Objetivo: Presentar el caso de un quiste esplénico epitelial gigante por su interés en la toma de decisiones diagnósticas y terapéuticas, al ser una entidad muy poco frecuente. Caso clínico: Paciente de sexo femenino de 13 años de edad que consultó por dolor abdominal de dos meses de evolución. En la exploración física se palpaba una masa de consistencia dura en hemiabdomen izquierdo. En los estudios de imágenes se visualizó una masa esplénica quística gigante. Se realizó esplenectomía obteniendo un quiste subcapsular que comprometía la mayor parte del bazo, el estudio anatomopatológico e inmunohistoquímico fueron compatible con quiste epitelial. La evolución postoperatoria y el posterior seguimiento ambulatorio fueron favorables. Conclusiones: El tratamiento de los quiste esplénicos gigantes no parasitarios es quirúrgico, intentando conservar, en lo posible, la mayor cantidad de tejido esplénico. Este procedimiento debe ser individualizado, considerando el tamaño, las posibilidades diagnósticas, el tejido esplénico residual, la edad del paciente y comorbilidades.
Giant nonparasitic splenic epidermoid cysts are relatively uncommon. These lesions can lead abdominal pain, but most of then are asymptomatic, and they are discovered incidentally. We report a 13-y old female with a giant splenic epidermoid cystic, given the special interest of diagnostic and therapeutic decision-making of this rare entity. Case report: A 13-y old female with clinical history of abdominal pain since the last two months. On physical examination a firm, tender mass was palpable in left hypochondrium. Diagnosis of a large cystic splenic mass was made based on ultrasound and abdominal computed tomography scan. Splenectomy was performed, and histopathological-immunohistochemistry studies revealed findings suggestive of primary epithelial cyst. The post-operative clinical course was satisfactory and uneventful. Conclusions: Treatment of giant nonparasitic splenic cysts is surgical. Preserve splenic parenchyma must be the aim in an individualized decision-making. The different types of surgical modalities will be according to the diagnosis and clinical situation (cyst size, age, comorbidities).