A 26-year-old female patient presented with abdominal pain mainly located in the left upper hemiabdomen for 5 months, occasionally associated with nausea, dyspnea and respiratory distress.
As part of the study an abdominal ultrasound was requested which described a cyst located to the left of the left hepatic lobe, without specifying its origin.
The study was complemented with a computed abdominal tomography (CAT) which showed a cystic lesion of 16 cm diameter of splenic origin, located in the upper pole of the spleen, as well as several smaller cystic lesions in the abdomen.
The lesion displaced neighboring structures without walls.
The serology for hydatidosis was negative and the blood tests were normal, the hemogram showed no thrombocytopenia.
With the diagnosis of splenic cyst elective surgery was performed through a left subcostal laparotomy.
A free splenic cyst was found in the abdominal cavity.
The serous liquid aspirándosc cyst was opened, the cytological analysis was negative as well as the culture.
The cystic capsule interior had a trabeculated appearance, most of this capsule was resected with some splenic parenchyma remaining only the base of implantation in the spleen.
The postoperative course was good and without complications.
At the last follow-up 1 year after surgery, the patient was asymptomatic.
The anatomopathological report described fibromuscular tissue and splenic parenchyma with white and red pulp with endothelial epithelial lining of the internal face of the cyst.
In the immunohistochemical analysis, the endothelial cells were positive for factor VIII and cystic fibrosis, which is a specific marker of lymphatic endothelium, so the definitive diagnosis is splenic lymphangioma.
