PMC3016817_01
Anterior view of patient's abdomen before surgery, showing an obvious mass in the left upper quadrant.
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F1
Physical examination revealed a large firm, fixed, non-tender, left upper quadrant mass (Figures 1 and 2); the rest of the physical examination was unremarkable.
Lateral view of patient's abdomen before surgery, showing a large protrusion anteriorly in the abdominal wall.
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F2
Physical examination revealed a large firm, fixed, non-tender, left upper quadrant mass (Figures 1 and 2); the rest of the physical examination was unremarkable.
Computed tomography scan of the abdomen showing the cyst and its mass effect on the surrounding structures. A small rim of splenic tissue can be seen at the posterior aspect of the cyst.
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F3
A computed tomography (CT) scan of the abdomen confirmed a single splenic cyst measuring 20 x 25 cm, exerting a significant mass effect on the surrounding organs (Figure 3).
Laparoscopic view of the giant splenic cyst with a thin covering of omentum. An aspiration needle was inserted for decompression.
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F4
The abdomen was explored, and a giant splenic cyst was identified (Figure 4).
Laparoscopic view of the cystic cavity and debris.
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F5
After unroofing, the trabecular cyst lining was visualized and debris was removed (Figure 5); thus, complete marsupialization was achieved.
Laparoscopic view of the unroofed cyst with omental packing.
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F6
Although the omentum had been stretched thin by the mass effect from the cyst, sufficient omentum was available to pack the cavity and obliterate the dead space (Figure 6).
Fragments of the cyst wall after specimen retrieval.
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F7
Gross pathologic examination showed a dark brown cyst lining and hemorrhagic debris (Figure 7).
Microscopic view of the cyst wall with identification of a segment of mesothelial lining (inset).
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F8
In most of the cyst wall, no epithelium could be identified; but in a small area, a mesothelial lining was found (Figure 8).