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Gastroscopy showed a bulge at the posterior wall of the fundus. The computed tomography scan identified a homogeneous cystic lesion of the spleen, 6×8 cm in diameter, of liquid density. Endoscopic ultrasound showed an anechoeic cyst with a thin wall and septas. She underwent splenectomy. At histology (fig 4), the cystic wall consisted of fibrous tissue covered with a non-keratinised squamous lining. The final diagnosis was epidermoid cyst.

Non-parasitic splenic cysts (NPSC) are uncommon. The first classifications were performed by Fowler1 and Martin.2 Morgenstern3 proposed a new classification based on the gross appearance and type of cellular lining. Seventy five per cent of NPSC are pseudocysts with only fibrous tissue lining, with a history of trauma in most people. The remainder are true cysts with cellular lining, including epidermoid cysts, and are thought to be congenital.4 Non-operative treatment is recommended for small asymptomatic cysts.

Figure 4

 Histology of the spleen.

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