Epidermoid cyst of spleen mimicking splenic lymphangioma

Primary splenic cyst is a relatively rare entity; they comprise only about 10% of benign non-parasitic cysts. Most of these are asymptomatic and are observed incidentally during abdominal ultrasonography. The number of diagnosed splenic cyst cases seems to have risen because of the increasing use of abdominal imaging techniques. However, definite diagnosis is possible only after splenectomy when epithelial lining is confirmed histologically. We report a case of a 14-year-old child who presented with fullness of abdomen and pain in the left hypochondrium since last few months. First impression made was in favor of a splenic lymphangioma of size 8 × 8 cm which was based on a Computerized tomography scan and the sonographic findings. Splenectomy was performed and was sent for histopathological examination which in combination with immunohistochemistry revealed findings suggestive of primary epithelial cyst. A large cystic mass with a relatively thin wall localized in the spleen is likely to be a primary or secondary cyst. The diagnosis of false cyst should be favored if there is a clear history of trauma, if the patient is older than fourth decade, if there is a hematoma elsewhere in spleen, or if cyst wall is calcified. This rare entity should be considered in the differential diagnosis in a patient presenting with left hypochondrial pain.