Giant Epithelial Splenic Cyst Mimicking a Pancreatic Cystic Neoplasm: Case Report

Splenic cysts are an uncommon entity, usually diagnosed incidentally due to their asymptomatic nature in clinical practice. Surgical treatment is essential in symptomatic cysts, those larger than 5 cm, or when malignancy cannot be excluded. Histopathological analysis is necessary to identify the splenic subtype and to rule out potential malignant transformation of the pluripotent epithelium. This report presents the case of a patient with a true giant splenic cyst that mimicked a pancreatic cystic neoplasm, diagnosed in the General Surgery Department of the High Specialty Medical Unit No. 25 of the Mexican Institute of Social Security. A 41-year-old woman presented with left upper quadrant abdominal pain, accompanied by postprandial fullness and weight loss, due to an 18 cm tumor causing a mass effect. CT imaging revealed a pancreatic cystic lesion, displacement of other intra-abdominal organs, and the presence of an accessory spleen. The patient was scheduled for surgical treatment due to the tumor size, with planned laparotomy, distal pancreatectomy, and splenectomy. However, based on intraoperative findings, total and accessory splenectomy and resection of the splenic cyst were performed. Histopathological examination confirmed an epithelial splenic cyst, negative for malignancy. Objective: To document the presentation of a splenic cyst as an intraoperative finding and describe the subsequent definitive surgical treatment. Materials And Methods: Descriptive observational study. A literature review was conducted on the PubMed platform, including reported cases from 2020 to 2025.