A 16-Year-Old Saudi Boy with a Symptomatic Large Splenic Epidermoid Cyst

Patient: Male, 16-year-old Final Diagnosis: Splenic epidermoid cyst Symptoms: Abdominal asymmetry • abdominal distention • decreased oral intake Medication: — Clinical Procedure: Open splenectomy Specialty: Surgery OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Splenic epidermoid cysts rarely occur and the majority of cases are discovered incidentally. However, large cysts can present with symptoms due to mass effect. Splenectomy is the treatment indicated for most splenic cysts and definitive diagnosis can only be made after histopathological examination. CASE REPORT: A 16-year-old boy was referred to the general surgery clinic from a local hospital with a history of abdominal asymmetry, distention, decreased oral intake, and early satiety. Abdominal computed tomography (CT) was performed and revealed a large splenic mass measuring 18.4×14×17.4 cm with multiple mural calcifications at the rim. The mass was displacing the stomach, jejunal loops, pancreas, left kidney, and transverse colon. Preoperative biopsy was not possible because a parasitic cyst was suspected; therefore, splenectomy was performed through midline laparotomy. The patient recovered well, with no complications except for transient reactive thrombocytosis. Histopathology was reported as benign epithelial cysts, with the most likely diagnosis being a splenic epidermoid cyst. Subsequently, the patient was followed up at the surgery clinic. During the last outpatient visit, the patient exhibited good recovery with no problems. CONCLUSIONS: Large splenic epidermoid cysts are rare, particularly in the pediatric population. Nonspecific clinical and radiological findings are hurdles to an accurate diagnosis. Preoperative diagnosis is crucial to determine the type of intervention. However, a final diagnosis can only be made after histopathological examination.