A rare case of giant epithelial splenic cyst causing abdominal pain and anemia in a 10-year-old girl.

Background: Splenic cystic lesions are rare, especially in children, and are often discovered incidentally. These lesions can present with abdominal pain, swelling, or complications such as intra-cystic bleeding, rupture, or infection. Epithelial cysts, a subtype of non-parasitic splenic cysts, account for approximately 20% of cases and are managed based on size and symptoms. Case presentation: A 10-year-old female presented with vague abdominal pain lasting two days, accompanied by pallor, due to anemia caused by intra-cystic hemorrhage, decreased appetite, shortness of breath with exertion, and significant weight loss over six months. Examination revealed a 15-cm immobile mass in the left upper abdomen, and laboratory tests showed anemia. Imaging identified a 17-cm splenic cyst replacing most of the splenic parenchyma. Hydatid serology and tumor markers were negative. Due to the cyst's size, mass effect, and adherence to the diaphragm, an open splenectomy was performed. Postoperative recovery was uneventful, and histopathological examination confirmed an epithelial splenic cyst with hemorrhage. Discussion: Epithelial splenic cysts are rare, with varied presentations depending on their size. Larger cysts can compress adjacent structures or present with complications. Imaging modalities such as ultrasound and CT are crucial for diagnosis, but histopathological examination is essential for definitive classification. Treatment is generally indicated for symptomatic or large cysts, with options ranging from partial splenectomy to total splenectomy. Conclusion: This case highlights the importance of a multidisciplinary approach in managing large splenic cysts in pediatric patients. Surgical intervention remains the treatment of choice for symptomatic or complicated cysts.