Giant splenic mesothelial cyst in a child: A case report

Abstract

Splenic mesothelial cysts are rare, accounting for a small fraction of primary non-parasitic splenic cysts. They often present as incidental findings but can become symptomatic when they reach a significant size. An 8-year-old girl presented with a 30-day history of progressive left upper quadrant abdominal pain. Physical exam revealed a firm, tender mass in the left upper quadrant. Laboratory tests including complete white count and inflammatory markers were all within normal limits. Hydatid serology was normal. Abdominal ultrasonography (US) revealed splenomegaly with a large hypoechoic cystic lesion arising from the spleen without Doppler flow. Contrast-enhanced computed tomography scan of the abdomen and pelvis confirmed the splenomegaly and a large unilocular cystic lesion measuring 15 × 10 × 14 cm, occupying nearly the entire splenic parenchyma, displacing adjacent organs. No internal enhancement, solid components, or calcifications were observed. Preoperative vaccinations were administered. Due to the size of the cyst and the persistence of pain, the patient was taken to the operating room for a laparoscopic exploration. We found minimal residual splenic tissue around the large cyst, so we proceeded with a total splenectomy after aspirating the cyst. The histopathology analysis was consistent with a mesothelial cyst. The postoperative course was uneventful. The patient was enrolled in a structured vaccination program and remains asymptomatic with no complications at two years of follow-up. For symptomatic giant splenic cysts involving the splenic hilum, laparoscopic total splenectomy remains a safe and effective option when spleen-preserving alternatives are anatomically unfeasible.