Giant Splenic Cyst with Spectacular Gross Morphology: A Case Report

Splenic cysts are rare lesions with a documented prevalence of 0.07% to 2%. Primary splenic cysts have an epithelial lining. A 32-year-old female presented with a complaint of abdominal pain and a dragging sensation on the left side. On examination, a soft lump was palpable 20 cm below the left costal margin. A Computed Tomography (CT) scan of the abdomen revealed splenomegaly and a large, smooth-walled cyst. The diagnostic work-up for splenic cysts typically involves a combination of clinical assessment, imaging studies, and laboratory tests. The imaging modalities can provide information about the size, location, and nature of the cyst. Ultrasound can confirm the cystic nature of the lesion, while CT and Magnetic Resonance Imaging (MRI) offer more detailed visualisation of the cyst’s internal structure, septations, and wall characteristics. Radiological examination may not be sufficient to differentiate between various types of splenic cysts. In endemic regions, it is difficult to distinguish from non-parasitic cysts based on imaging alone and additional diagnostic measures are necessary. Cyst fluid examination, such as fluid amylase, titre of echinococcus and other biomarkers, may aid in differentiating between cysts in the pancreatic tail, parasitic cysts and malignancy. Image-guided biopsy or partial or complete splenectomy, and histopathological examination are necessary for definitive diagnosis. In this case, the cyst on histopathological examination showed features of a primary splenic mesothelial cyst. Primary splenic mesothelial cysts are extremely rare lesions with a documented prevalence of 0.07% to 2%. There is limited available literature, which merits the documentation of this case report. The various classifications of splenic cysts, clinico-radiological and morphological findings of mesothelial cysts are discussed in this case report.