Rj. Touloukian et al., PARTIAL DECAPSULATION OF SPLENIC EPITHELIAL CYSTS - STUDIES ON ETIOLOGY AND OUTCOME, Journal of pediatric surgery, 32(2), 1997, pp. 272-274
Purpose: The presence of squamous epithelium in the cyst wall of child
ren with large splenic cysts has generally been thought to require com
plete resection of the cyst lining to prevent recurrence. The risks of
major bleeding or possible total splenectomy necessitates a simplifie
d procedure to preserve splenic function without cyst recurrence. Meth
ods: Six patients treated for splenic cyst over a 10-year period under
went partial splenic decapsulation retaining the hilar portion of the
spleen. The patient group, including five girls, ranged in age from 6
to 18 years (mean, 13 years). Presenting findings were splenomegaly (n
= 4), progressive cyst enlargement (n = 4), left upper quadrant pain
(n = 2), ultrasound for unrelated condition (n = 2), and prior history
of trauma (n = 1). Cyst location varied from peripheral to deep corti
cal and ranged in size from 5 to 20 cm containing from 200 to 1,700 mL
of sterile straw-colored to dark brown-colored liquid. Results: Palpa
ble splenomegaly resolved in all patients with progressive decrease in
size of the splenic remnant, and return of vascularity to normal was
confirmed by Doppler ultrasound. Each patient remains asymptomatic wit
hout recurrence of the splenic cyst from 1 to 10 years after surgery S
quamous epithelial lining cells found in sheets and clusters were seen
within the cyst lining of all patients. Immunohistochemistry of the p
araffin-embedded tissue showed that these cells expressed keratin, epi
thelial membrane antigen (EMA), carcino-embryonic antigen (CEA), but w
ere negative for BerEP4 (conventionally positive in cells of epithelia
l origin). Conclusion: The authors conclude that splenic decapsulation
is an effective treatment for splenic epithelial cysts, which both pr
eserves splenic function and prevents recurrence despite retention of
hilar cyst lining. Epithelial metaplasia of the mesothelial-mesodermal
undifferentiated cells from exposure to an unidentified irritant may
explain the histological presence of squamous epithelium within the cy
st wall. Copyright (C) 1997 by W.B. Saunders Company.