Epidermoid Splenic Cyst: Report of Two Cases

A splenic cyst is the formation of a cavity filled with fluid in the spleen. It constitutes a rare pathological entity [1]. We distinguish primary cysts and secondary cysts. Among the primary cysts, parasitic cysts and non-parasitic or congenital or epidermoid cysts are described [1]. The diagnosis of this affection is often made on imaging, but the diagnosis certainty is provided by histology. The aim of this work is to report two rare cases of epidermoid cysts treated at Kara University Hospital and then to provide a literature review.


Introduction
A splenic cyst is the formation of a cavity filled with fluid in the spleen. It constitutes a rare pathological entity [1]. We distinguish primary cysts and secondary cysts. Among the primary cysts, parasitic cysts and non-parasitic or congenital or epidermoid cysts are described [1]. The diagnosis of this affection is often made on imaging, but the diagnosis certainty is provided by histology. The aim of this work is to report two rare cases of epidermoid cysts treated at Kara University Hospital and then to provide a literature review.

Observation 1
46-year-old patient with no pathological history, admitted for left hypochondria pain associated with bloating of the abdomen that has been evolving for years, treated traditionally without success. The examination made notes: a good general state; an apyrexia; a good hemodynamic state; an enlarged abdomen with non-sensitive type V splenomegaly. We have evoked the hypothesis of a tumor of the spleen. A biological examination performed was normal. An abdominal CT scan showed a large splenic cyst (Figures 1 and 2). The indication of a total splenectomy was retained.

Discussion
Splenic cysts are rare lesions, often discovered by chance [2]. Martin in 1958 proposed a classification of splenic cysts into two classes: primary cysts grouping congenital or epidermoid cysts and parasitic cysts (echinococcosis), on the one hand, and secondary cysts or pseudo cysts, on other the hand [3]. Secondary cysts recognize several causes: infections, abdominal trauma and tumors [1,2]. Studies have shown that parasitic cysts caused by echinococcus granulos are frequently encountered, for instance, in central Europe and North America [1,4]. The clinical manifestations of splenic cysts depend on the size of the cyst. Thus, small splenic cysts are most often asymptomatic, unlike bulky cysts, which can give vague localized abdominal pain in the left hypochondrium and signs of compression of neighboring organs, as in one case in our series.
The diagnosis of these cysts is often made incidentally by imaging represented primarily by ultrasonography, CT and MRI with superiority of the last two exams, which provide much more descriptive precision [7,8]. However, the diagnosis is certainly provided by histology, which is characterized by the presence of a squamous-type pluristratified epithelium in the cystic wall.
The spontaneous evolution of these splenic cysts is fraught with complications among which one can note: a spontaneous rupture, an infection and an intracystic hemorrhage [1]. Our second patient in whom the cyst was infected concretely denotes an example of complication. Spontaneous regression of the cyst has also been described in some cases [9]. Their support involves several therapeutic means, total splenectomy, partial splenectomy, percutaneous drainage, marsupialization and fenestration. Indeed: a) Abstention is recommended for small asymptomatic splenic cysts, as they may regress spontaneously. But monitoring is required because of the complications that may occur [9]. b) Total splenectomy is indicated in cases of polycystic spleen, large splenic cyst, hilar or intraparenchymal location of the splenic cyst. However, it causes immunosuppression and exposes the body to infections [1,6].

c)
Partial splenectomy consists of resection of the part of the spleen containing the cyst with a decrease in the risk of recurrence and allows the body to maintain its immunity [1,6]. d) Echo or scan-guided percutaneous drainage is an elegant, slightly aggressive method for treating splenic cyst.
We could associate with this an intracystic injection of alcohol.
Nevertheless, cases of recurrence have been noted [10].
e) The fenestration is an opening of the cyst in the peritoneal cavity by resection of a part of the wall of the cyst. Its only disadvantage is the high risk of recidivism [1].
f) Marsupialization is a technique that consists of a separation of the splenic parenchyma cyst. It is indicated for non-parasitic superficial cysts [1].

Conclusion
The epidermoid splenic cyst is a rare pathological entity among the disorders of the spleen. It must be sought before any