{
  "abstract": "Introduction\n\nPrimary splenic epidermoid cysts typically occur in young adults as unilocular lesions and are usually distinguished from lymphangiomas on histopathology, although preoperative imaging differentiation remains challenging. A multiloculated presentation in an older patient is uncommon and can be mistaken for a lymphangioma.Case presentation\n\nHerein, we report a 75-year-old asymptomatic woman with a multiloculated splenic cyst that was managed conservatively for approximately 10 years. CT and MRI favored a lymphangioma, and surgical resection was performed because of interval growth. Laparoscopic distal pancreatectomy with splenectomy (DP-S) was required because the cyst was firmly adherent to the pancreas. Histopathological examination revealed a 3.7 × 3.1-cm multiloculated cyst within the splenic capsule, lined by stratified squamous epithelium and associated with foamy histiocytes and cholesterol crystal clefts. Immunohistochemistry demonstrated negativity for CD31, CD34, and D2-40, and positivity for AE1/AE3, cytokeratin (CK) 5/6, and CK7, confirming a primary splenic epidermoid cyst. Negativity for calretinin and Wilms tumor 1 (WT-1) excluded a mesothelial cyst, whereas basal p63 positivity and carbohydrate antigen 19-9 expression supported the multilayered subtype. A postoperative pancreatic fistula was managed conservatively, and the patient was discharged on POD 34.Conclusions\n\nIntegrated clinicopathological assessment, rather than any single marker, is needed to distinguish a multiloculated splenic epidermoid cyst from a lymphangioma; comprehensive immunohistochemistry, including D2-40, calretinin, WT-1, and p63, is a useful adjunct. This case also shows that a benign splenic cyst may require distal pancreatectomy: when dense pancreatic adhesion is encountered intraoperatively, en bloc DP-S can become an unavoidable step toward safe and complete resection, and postoperative pancreatic fistula remains a relevant complication to anticipate.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.",
    "Department of Genomic Medicine, Mie University Hospital, Tsu, Mie, Japan.",
    "Pathology Division, Mie University Hospital, Tsu, Mie, Japan.",
    "Department of Pathology and Laboratory Medicine, JA Suzuka General Hospital, Suzuka, Mie, Japan.",
    "Department of Surgery, Suzuka Kaisei Hospital, Suzuka, Mie, Japan."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Ryotaro Hashizume"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Hiroshi Imai"
    },
    {
      "affs": [
        3
      ],
      "name": "Tetsuya Murata"
    },
    {
      "affs": [
        4
      ],
      "name": "Yasuo Okura"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c4haw8pgs31gm.bib",
  "cited_by": 0,
  "doi": "10.70352/scrj.cr.26-0466",
  "fulltext_url": "https://europepmc.org/articles/PMC13709332",
  "id": "c4haw8pgs31gm",
  "issns": [
    "2198-7793"
  ],
  "landing_url": "https://europepmc.org/article/MED/42936885",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Teratomas and Epidermoid Cysts"
    ]
  ],
  "openalex": "W7223275316",
  "pdf_url": "https://europepmc.org/articles/PMC13709332?pdf=render",
  "pmcid": "PMC13709332",
  "pmid": "42936885",
  "published": "2026-10-24",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/c4haw8pgs31gm.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:22:12Z",
      "native_id": "MED:42936885",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42936885"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Teratomas and Epidermoid Cysts",
      "subfield": "surgery"
    }
  ],
  "title": "Laparoscopic Distal Pancreatectomy with Splenectomy for a Multiloculated Primary Splenic Epidermoid Cyst Mimicking a Lymphangioma in an Older Woman: A Case Report.",
  "title_text": "Laparoscopic Distal Pancreatectomy with Splenectomy for a Multiloculated Primary Splenic Epidermoid Cyst Mimicking a Lymphangioma in an Older Woman: A Case Report.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:22:12Z",
  "url": "https://research.draconitic.com/paper/c4haw8pgs31gm",
  "venue": "Surgical case reports",
  "versions": []
}