Epidermoid cyst within an intrapancreatic accessory spleen exhibiting abrupt changes in serum carbohydrate antigen 19-9 level: a case report

Abstract

Background: Epidermoid cyst within an intrapancreatic accessory spleen (ECIAS) is a rare disease. While the detection of solid components relevant to an accessory spleen is a key diagnostic finding, the differential diagnosis between ECIAS and malignant tumors is difficult without resection in patients with no other findings of an accessory spleen. Case presentation: A 73-year-old male was found to have an elevated carbohydrate antigen (CA) 19-9 level (95 U/mL) at an annual checkup, and a cystic lesion in the pancreatic tail was located by abdominal ultrasound. Abdominal magnetic resonance imaging (MRI) revealed a multicystic mass, 24 mm in diameter, which exhibited varying intensities on T2-weighted images. There were no findings suggesting solid components on contrast-enhanced computed tomography and magnetic resonance imaging. Re-evaluation of serum CA 19-9 level revealed a rapid increase to 901 U/mL, which declined to 213 U/mL 3 weeks later. Ruling out the lesion's malignant potential was difficult, and the patient underwent distal pancreatectomy with splenectomy. Histological findings revealed an ECIAS including multiple cysts, with the mucinous component of each cyst exhibiting different stages of biological reaction; one ruptured cyst exhibited inflammatory changes. Conclusions: Careful observation for changes in serum CA 19-9 level and MRI findings might facilitate the diagnosis of ECIAS without a solid component by imaging studies.

A lymphoepithelial cyst in the pancreatic accessory spleen: A case report

“…However, a cyst occurring in a pancreatic accessory spleen is extremely rare, with only 57 reported cases (Table 1). 8‐53 The lesion site was the pancreatic tail in all 57 cases. The primary complaints were abdominal pain and vomiting, although 33 of the 57 cases were asymptomatic.…”

Abrupt elevation of tumor marker levels in a huge splenic epidermoid cyst, a case report

“…However, not all cases reported the dynamic changes of tumor markers. Takagi et al reported a case of epidermoid cyst within an intrapancreatic accessory spleen, which showed a sharp increase of CA19-9 before surgery and a normal serum CA19-9 level 4 weeks after surgical resection (12). Okuno et al reported an elevation of serum CEA levels in a patient with ruptured splenic epidermoid cyst, which was normalized 3 months after decapsulation (8).…”

“…Takagi et al. reported a case of epidermoid cyst within an intrapancreatic accessory spleen, which showed a sharp increase of CA19–9 before surgery and a normal serum CA19–9 level 4 weeks after surgical resection ( 12 ). Okuno et al.…”