Recurrent splenic epidermoid cyst in a young adult: A case report and literature review

Abstract

Splenic epidermoid cysts are rare congenital lesions, accounting for approximately 10 % of non-parasitic splenic cysts. While often asymptomatic and discovered incidentally, large cysts may cause symptoms or complications, including rupture, infection, or recurrence, particularly after spleen-preserving surgery. We report the case of a 19-year-old woman with no significant medical history who presented with progressive left upper quadrant pain. Imaging revealed a giant unilocular cystic lesion of the spleen measuring 155 × 114 × 150 mm. A partial splenectomy was performed due to the cyst's size and compressive effects. Histopathological analysis confirmed the diagnosis of an epidermoid cyst. Eight months later, follow-up imaging revealed recurrence of the lesion. A total splenectomy was then performed, and the patient recovered uneventfully. Splenic epidermoid cysts are rare entities that require a combination of imaging and histopathological analysis for accurate diagnosis. While partial splenectomy offers the benefit of preserving immune function, recurrence remains a potential complication, especially in cases of incomplete excision. We reviewed the literature and summarized previously reported cases of recurrent splenic epidermoid cysts. Our findings suggest that recurrence is most frequently associated with spleen-preserving strategies and may necessitate secondary total splenectomy for definitive treatment. This case highlights the diagnostic and therapeutic challenges posed by splenic epidermoid cysts and emphasizes the importance of long-term follow-up. Individualized surgical planning remains essential, balancing the risks of recurrence against the benefits of splenic preservation. • Splenic epidermoid cysts are rare congenital lesions, typically diagnosed in children and young adults. • Recurrent splenic epidermoid cysts are exceptionally rare and underreported in the literature. • Imaging alone is insufficient to reliably differentiate epidermoid cysts from parasitic or pseudocystic lesions. • Partial splenectomy is a spleen-preserving option but may carry a risk of recurrence. • Total splenectomy remains the definitive treatment in recurrent or complicated cases.