Congenital cyst in female accessory spleen: a case report

Splenic cysts are rare occurrences. In 1829, Andral was responsible for the first description of a non-parasitic spleen cyst. As early as 1978, Robbins reviewed a series of autopsies, finding 32 cases of splenic cysts. Later, isolated cases were reported and, in 1978, were confirmed cases in the world literature. Splenic cysts can be classified into: Type I – called true, which are cysts with a capsule, whose lining is squamous epithelial, and Type II – called secondary or pseudocysts [1]. In addition, congenital splenic cysts comprise approximately 25% of true cysts in the spleen, diagnosed mainly in children and young adults. Most non-parasitic cysts are pseudocysts secondary to trauma. Although the exact mechanism of its Cysts found in splenic stores, of parasitic or non-parasitic origin, are rare causes of recurrent abdominal pain, but with a significant increase in the number of diagnoses in recent years. This condition is caused by the derivation of the mesothelial cell lining of the spleen capsule, occurring in 0.5 2% of the world population. Clinically, patients tend to remain asymptomatic for years and usually have an incidental diagnosis by imaging exams or during the investigation of diffuse and recurrent abdominal pain, rarely found in females. The treatment of splenic cysts is performed through video laparoscopic splenic resection.


Introduction
Splenic cysts are rare occurrences. In 1829, Andral was responsible for the first description of a non-parasitic spleen cyst. As early as 1978, Robbins reviewed a series of autopsies, finding 32 cases of splenic cysts. Later, isolated cases were reported and, in 1978, were confirmed cases in the world literature. Splenic cysts can be classified into: Type I -called true, which are cysts with a capsule, whose lining is squamous epithelial, and Type II -called secondary or pseudocysts [1].
In addition, congenital splenic cysts comprise approximately 25% of true cysts in the spleen, diagnosed mainly in children and young adults. Most non-parasitic cysts are pseudocysts secondary to trauma. Although the exact mechanism of its Cysts found in splenic stores, of parasitic or non-parasitic origin, are rare causes of recurrent abdominal pain, but with a significant increase in the number of diagnoses in recent years. This condition is caused by the derivation of the mesothelial cell lining of the spleen capsule, occurring in 0.5 -2% of the world population. Clinically, patients tend to remain asymptomatic for years and usually have an incidental diagnosis by imaging exams or during the investigation of diffuse and recurrent abdominal pain, rarely found in females. The treatment of splenic cysts is performed through video laparoscopic splenic resection. Keywords: Epithelial Cyst; Accessory Spleen; Video laparoscopic. pathogenesis is still unknown, proposed mechanisms include: the involution of pluripotential cells from the splenic parenchyma during development with subsequent squamous metaplasia or origin from peritoneal endothelial cells or coelomic mesothelium.
Splenic cysts are often asymptomatic and found incidentally during abdominal imaging, having been increasingly recognized since the advent of ultrasound and computed tomography. If symptoms are present, the most commonly reported include: feeling of fullness and upper abdominal discomfort, pleuritic chest pain, shortness of breath, back or shoulder pain, or even renal symptoms due to compression of the left kidney, and a palpable abdominal mass may occur [2].
In many cases, the presence of symptoms is related to the size of the cysts. Smaller than eight centimeters are never symptomatic. Large splenic cysts (defined in the literature as larger than eight centimeters) can cause weight pain in the left hypochondrium by distension of the splenic capsule or by compression of adjacent structures. Epithelial cells are often positive for tumor markers CA 19-9 and CEA (carcinoembryonic antigen).
Diagnostically, on plain abdominal radiography, the presence of a mass, which may be calcified, in the upper left quadrant may be noticeable. On the other hand, on ultrasound (USG) of the total abdomen, the splenic cyst appears as a homogeneous mass, with thin walls. Calcifications are useful to differentiate cysts from other causes and splenomegaly.
On computed tomography (CT), cystic lesions are spherical, welldefined, with a thin or imperceptible capsule. Abdominal CT is more sensitive than ultrasound in identifying septa (most common in true cysts) or calcifications (most common in false cysts). Angiography can be helpful in differentiating a splenic cyst, which is normally avascular, from a solid malignant mass (lymphoma, sarcomas), usually presenting a disorganized pattern of vascularization [3].
Under microscopy, the cyst is lined internally with columnar tissue, cuboid, or epithelium scaly. Splenic cysts can be subdivided into dermoid, mesothelial, and epidermoid cysts. Laparotomy with splenectomy has been the method of choice for the treatment of many splenic cysts.
Due to the increased risk of complications, splenic cysts with a diameter greater than 4-5 centimeters should receive surgical treatment, as conservative treatment options, such as percutaneous aspiration or sclerosis, do not have good long-term control [4].

Case report
Primarily, we declare that the

Discussion and Conclusion
Despite having a clinical picture compatible with those described in the literature, this case stands out among those published, due to its rarity in females and the limited number of cases.   with the presence of postoperative liver abscess requiring drainage and even pulmonary embolism [7].
Low morbidity rate, short hospital stays and rapid return to normal activities makes video laparoscopic splenectomy the procedure of choice for elective splenectomy, especially in findings of cysts that did not adhere to several splenic regions, facilitating the investigation of its benign or neoplastic origin [8].