A Sleiman Youssef, Bohlok Ali, El-Khoury Melody, Demetter Pieter, Zalcman Marc, El Nakadi Issam
Service de Chirurgie, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Belgium.
Service de Chirurgie, Université Libanaise, Beirut, Lebanon.
Int J Surg Case Rep. 2018;53:21-24. doi: 10.1016/j.ijscr.2018.10.011. Epub 2018 Oct 12.
Cystic lesions of the spleen are infrequent and usually diagnosed incidentally. These lesions are rare and their differential diagnosis is very wide. Splenic epithelial cysts are the most common type of primary splenic cyst (4%). Surgical treatment is indicated for cysts larger than 5 cm or symptomatic. Nowadays, spleen preserving surgery is the gold standard treatment considering the immunologic role of the spleen and the increased risk of post-splenectomy infections.
A 17 year old girl presented to the outpatient clinic with moderate left upper quadrant abdominal pain of 2 weeks duration with loss of appetite and denied fever, chills, sweating and jaundice. Abdominal examination showed tender splenomegaly. The abdominal imaging (Ultrasound, CT SCAN, MRI) was suggestive of hydatid cyst of the spleen, for which she received Albendazole for 1 month and then operated by laparotomy with partial resection and un-roofing of the splenic cyst. The pathology report showed a splenic epithelial cyst (SEC).
SEC is a rare pathology that could mimic splenic hydatid cyst. The clinical and radiological pictures may be commonly misleading and non-conclusive. Definitive diagnosis is made on histopathology. Spleen conserving surgery, when possible, is the preferred modality for treatment.
脾脏囊性病变并不常见，通常是偶然诊断出来的。这些病变很罕见，其鉴别诊断范围很广。脾上皮样囊肿是原发性脾囊肿最常见的类型（4%）。对于大于5厘米或有症状的囊肿，建议进行手术治疗。如今，考虑到脾脏的免疫作用以及脾切除术后感染风险增加，保留脾脏手术是金标准治疗方法。
一名17岁女孩因持续2周的左上腹中度腹痛就诊于门诊，伴有食欲不振，否认发热、寒战、出汗和黄疸。腹部检查显示脾脏肿大且有压痛。腹部影像学检查（超声、CT扫描、MRI）提示脾脏包虫囊肿，为此她接受了1个月的阿苯达唑治疗，然后通过剖腹手术进行了脾囊肿部分切除和去顶术。病理报告显示为脾上皮样囊肿（SEC）。
SEC是一种罕见的病理情况，可能会模仿脾脏包虫囊肿。临床和放射学表现通常可能具有误导性且无定论。最终诊断依靠组织病理学。在可能的情况下，保留脾脏手术是首选的治疗方式。
