Re-evaluation of histological findings of nonparasitic splenic cysts

Our plain-English summary of Re-evaluation of histological findings of nonparasitic splenic cysts, by P. Vajda, L. Kereskai, P. Czauderna, et al (European Journal of Gastroenterology & Hepatology, 2012).

The study

• Authors: P. Vajda, L. Kereskai, P. Czauderna, K. Schaarschmidt, A. Kalman, J. Koltai, A. Engelis, E. Kalman, K. Lewicki, T. Verebely, M. Jainsch, A. Petersons, A.B. Pinter
• Journal: European Journal of Gastroenterology & Hepatology
• Published: 2012;24(3):316-9
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The pathogenesis of nonparasitic splenic cysts (NPSCs) has not been clarified completely. The aim of this multinational and multicentre retrospective study was to further elucidate the origin of NPSCs.

Methods: From 1980 to 2006, 50 children and adolescents were surgically treated for NPSC at six paediatric surgical centres in four European countries. The initial histology report of 35 NPSCs, 22 epidermoid cysts, 11 pseudocysts or post-traumatic cysts and two mesothelial cysts was available. Additional re-evaluation, including immunohistochemistry, to detect cytokeratin, carcino-embrionic antigen and mesothelioma antibody in the inner surface of the cysts was carried out. Special attention was given to the possibility of preceding trauma to the splenic area and whether it played a role in the genesis of NPSC.

Results: The pathological re-evaluation showed 30 epidermoid cysts, four mesothelial cysts and one pseudocyst. Immunohistology revealed eight epidermoid and two mesothelial linings of the cysts in those 11 patients in whom pseudocyst was diagnosed originally. No pseudocyst was documented in those patients who had a history of previous blunt abdominal trauma but was not proved by ultrasound and computed tomography scan.

Conclusion: In contrast with the prevailing belief, it has been demonstrated that NPSCs are congenital in origin, and there is no clinically proven evidence that trauma does play a role in their genesis.

In plain English

This article is not about asbestos. It is a retrospective study of nonparasitic splenic cysts (fluid-filled cysts of the spleen not caused by parasites) in children and adolescents treated surgically from 1980 to 2006 at six paediatric surgical centres in Berlin, Budapest, Frankfurt, Gdansk, Pecs and Riga. The phrase "mesothelioma antibody" refers only to a laboratory stain (HBME-1). Tissue from 35 of the 50 patients was re-examined by two pathologists who did not know the original diagnoses. All 22 epidermoid cysts and 2 mesothelial cysts were confirmed. Of 11 cysts first called pseudocysts, which are usually linked to injury, the re-examination found 8 epidermoid cysts, 2 mesothelial cysts and 1 pseudocyst. That one patient had no history of abdominal injury. The authors noted that the inner lining of some cysts had shed, which may explain the earlier misdiagnoses. They concluded that these cysts are mainly congenital and that trauma probably does not play a role. They also said evidence is hard to gather because few patients have documented cysts developing after injury.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Multinational, multicentre retrospective study re-examining stored tissue from surgically removed splenic cysts (histology and immunohistochemistry)
• Who was studied: 50 children and adolescents (aged 1 to 17, mean 11.9 years; 26 male, 24 female) surgically treated for nonparasitic splenic cysts between 1980 and 2006 at six paediatric surgical wards in Berlin, Budapest, Frankfurt, Gdansk, Pecs and Riga. Tissue was available for re-evaluation in 35 of them.
• Exposure: No asbestos or fiber exposure was studied. The factor examined was a history of previous blunt abdominal trauma, reported by parents in 11 of the 35 re-investigated patients. None of these patients needed clinical investigation or imaging.
• Main results:
  • Overall, the re-evaluation of 35 cysts found 30 epidermoid cysts, 4 mesothelial cysts and 1 pseudocyst.
  • All 22 cysts first diagnosed as epidermoid and both cysts first diagnosed as mesothelial were confirmed on re-evaluation.
  • Of the 11 cysts originally diagnosed as pseudocysts, immunohistology showed an epidermoid lining in 8 and a mesothelial lining in 2. Only 1 remained a pseudocyst.
  • The one patient whose pseudocyst diagnosis was reconfirmed had no history of abdominal trauma.
  • No pseudocyst was found among the patients with a history of previous mild blunt abdominal trauma. The results section gives this group as eight patients.
  • None of the 35 patients had a splenic injury proven by ultrasound or CT scan that was followed by development of a splenic cyst.
  • In some specimens the inner lining of the cyst had shed or disappeared, which the authors said might have led to earlier misdiagnosis as pseudocysts.
• The authors' conclusion: The authors concluded that nonparasitic splenic cysts are mainly congenital in origin and that trauma probably does not play a role in their origin. The abstract states this more strongly, saying it has been demonstrated that the cysts are congenital.
• Limitations the authors state:
  • Evidence about whether splenic cysts are congenital or acquired is hard to gather because few patients have properly documented cysts that developed after injury.
  • The authors stated that the true cause of post-traumatic splenic (pseudo) cysts remains unknown and that prospective studies are needed.

Topics

Medical terms in this study, explained in our Lexicon: Histology, Immunohistochemistry, Mesothelioma, Ultrasound.

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