Non parasitic true cyst of spleen

Splenic cysts are rare a occurrence in children. They were first classified by Martin into true cysts (primary) and false cysts (pseudocysts). True cysts are far less frequent (only 25% of all splenic cysts in pediatric patients), predominantly in females. According to the different features of the covering epithelium, cysts are further classified into: mesothelial, epidermoid and dermoid cysts. Epidermoid cysts are the most common, thus named for the presence of a wall covered with stratified Malphigian epithelium. In recent years at the Paediatric Surgery Division of the Department of Paediatrics, Obstetrics and Reproductive Medicine from the University of Siena 4 cases of epithelial cysts have been observed in adolescents. The diagnostic path relies on the clinical history for ruling out both parasitic and traumatic causes of the disease, on laboratory tests for the exclusion of pancreatic conditions, and on serological diagnosis for echinococcosis and hematocytometric data for diagnosis of hypersplenism. Given the spontaneous regression observed by some Authors, a "waiting strategy" is advisable with periodic ultrasonographic monitoring of true congenital small asymptomatic and uncomplicated cysts. The therapeutic approach to these cases has been controversial mainly in relation to the choice between a so-called "waiting strategy" and a prompt surgical intervention, and also for the ongoing development of minimally invasive techniques such as videolaparoscopy which decreases postoperative pain.