A Splenic Epithelial Cyst: Increased Size, Exacerbation of Symptoms, and Elevated Levels of Serum Carcinogenic Antigen 19-9 after 6-year Follow-up

Abstract

A 58-year-old man, who had presented with a large cyst between the pancreatic tail and splenic hilum 6 years previously, was referred to our hospital with exacerbation of abdominal distention. Computed tomography revealed a well-demarcated, unilocular cyst, with a beak sign for the pancreas, without wall thickening or nodules suggestive of a non-neoplastic cyst. Compared with 6 years previously, the cyst had increased in size from 14.7 cm to 19.5 cm, and the serum carcinogenic antigen 19-9 level had increased from 635 U/mL to 1,918 U/mL. To prevent spontaneous rupture, laparotomy was performed, and the cyst was pathologically diagnosed as a splenic epithelial cyst.

Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL

“…Herein, we report six cases of patients with AIP, causing the elevation of CA 19-9 ranging from 1950 U/mL to 12,000 U/mL, and a case of a patient with liver steatosis and an increased CA 19-9 value to 1930 U/mL. When considering differential diagnosis due to the low specificity of tumor markers and lack of obvious radiological image, various diseases should be taken into consideration [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 68 , 69 ]; however, a mildly increased dimension of the pancreas in MRI with areas of fluid signals could correspond to past AIP that induced increased CA 19-9. According to the literature, about 25% of patients with AIP show values of CA 19-9 > 37 U/mL, and only around 12.2% of them show elevated levels > 100 U/mL [ 70 ].…”

Carbohydrate antigen 19-9-producing splenic cyst: a case report

“…True splenic cysts can be associated with high production of tumor antigens, including carcinoembryonic antigen, CA19-9, CA125, and CA50, detectable in both in the serum and cystic contents [21] . Because the inner epithelial cells of the cyst produce CA19-9, which is then retained within the cyst, increased intracystic pressure may drive exudation of CA19-9 into the bloodstream through the surrounding splenic tissues [22] . Matsui et al.…”

“…Matsui et al. reported a splenic epithelial cyst resected after 6 years of follow-up [22] . In that case, compared with the baseline 6 years previously, the cyst had increased in size from 14.7 cm to 19.5 cm, and serum CA19-9 level had increased from 635 U/ml to 1,918 U/ml.…”

“…In the present case, follow-up was continued for about 5 years from a state in which the lesion was relatively small and serum CA19-9 levels were normal. The natural history of the splenic cysts remains unclear because most reported cases have been surgically resected, rather than followed up [22] .…”

Bilateral Endometriotic Cystic Ovaries and Huge Splenic Epithelial Cyst With Elevated CA-125, CA19-9: A Report of a Rare Case

“…In cases where increased serum levels of CA19-9 and CA125 are present, it is difficult to differentiate between benign SCs and malignant tumors [ 5 ]. However, it is primarily benign and can generally be differentiated from malignant variants using clinical imaging [ 6 ]. Here, we report and discuss a new case of bilateral endometriotic cystic ovaries and huge SCs.…”