Giant Epidermoid Cyst of the Spleen with Elevated CA 19-9 Production Managed Laparoscopically: Report of a Case

Hoshino, Arichika; Nakamura, Yoshiharu; Suzuki, Hideyuki; Mizutani, Satoshi; Chihara, Naoto; Matsunobu, Takeshi; Maejima, Kentaro; Miura, Katsuhiro; Hanawa, Hideki; Nomura, Satoshi; Toyoda, Tetsutaka; Yamagishi, Seiji; Nakata, Ryosuke; Muraki, Akira; Uchida, Eiji

doi:10.1272/jnms.80.470

Cited by 13 publications

(13 citation statements)

References 15 publications

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“…The mechanism responsible for the elevated tumor marker levels seen in such cases remains unclear. The intracystic and serum CA19–9 levels were high in most cases, but the CEA levels were markedly elevated in the cystic fluid whereas normal in the serum in some cases [27, 28, 32]. The inner epithelial cells of splenic cysts were immunohistochemically positive for CA19–9 in most cases and CEA in some cases [15, 18], so they can produce tumor markers and over time these markers become concentrated in the cysts, which are closed cavities.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic fenestration for a large ruptured splenic cyst combined with an elevated serum carbohydrate antigen 19–9 level: a case report

et al. 2019

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Background Non-parasitic splenic cysts are associated with elevated serum carbohydrate antigen (CA) 19–9 levels. We report a case in which a 23-year-old female exhibited a large ruptured splenic cyst and an elevated serum CA19–9 level. Case presentation The patient, who experienced postprandial abdominal pain and vomiting, was transferred to our hospital and was found to have a large splenic cyst during an abdominal computed tomography (CT) scan. On physical examination, her vital signs were stable, and she demonstrated rebound tenderness in the epigastric region. An abdominal CT scan revealed abdominal fluid and a low-density region (12 × 12 × 8 cm) with enhanced margins in the spleen. The patient’s serum levels of CA19–9 and CA125 were elevated to 17,580 U/mL and 909 U/mL, respectively. A cytological examination of the ascitic fluid resulted in it being categorized as class II. Finally, we made a diagnosis of a ruptured splenic epidermoid cyst and performed laparoscopic splenic fenestration. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 5. The cystic lesion was histopathologically diagnosed as a true cyst, and the epithelial cells were positive for CA19–9. Follow-up laboratory tests performed at 4 postoperative months showed normal CA19–9 (24.6 U/L) and CA125 (26.8 U/L) levels. No recurrence of the splenic cyst was detected during the 6 months after surgery. Conclusion Laparoscopic fenestration of a ruptured splenic cyst was performed to preserve the spleen, after the results of abdominal fluid cytology and MRI were negative for malignancy.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic fenestration for a large ruptured splenic cyst combined with an elevated serum carbohydrate antigen 19–9 level: a case report

et al. 2019

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“…Abnormally high CA19-9 was reported in splenic ECs [7–9]. There has also been evidence of positive CA19-9 staining in craniopharyngioma, rathke cyst and cystic pituitary adenoma [5].…”

Section: Discussionmentioning

confidence: 99%

“…In a small group of 7 patients diagnosed with IEC or dermoid cyst, Takeshita M. found that the preoperative serum levels were mildly to moderately elevated [6]. Others have reported abnormally high serum CA19-9 level in splenic ECs [7–9]. All these trivial evidences point to the possible diagnostic value of CA19-9 in IEC.…”

Section: Introductionmentioning

confidence: 99%

The implication of tumor biomarker CA19-9 in the diagnosis of intracranial epidermoid cyst

Wang

Yan

et al. 2016

Oncotarget

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ObjectThe diagnosis of intracranial epidermoid cyst (IEC) relies solely on MRI, which is time and money consuming. The application of tumor biomarkers in IEC has never been systematically studied. Here we screened a group of commonly used tumor biomarkers to assess their diagnostic value in IEC.ResultsSerum tumor biomarkers were assessed in 42 IECs and 42 paired healthy controls. Only serum CA19-9 level was significantly higher in the IEC group (median 20.3U/ml vs. 6.5U/ml, p < 0.001). Area under curve for CA19-9 was 0.806 (95% CI 0.700–0.912), with cutoff value of 13.15 U/ml (sensitivity 71.4%, specificity 97.6%). Tumor size was significantly different between CA19-9 positive and CA19-9 negative groups(64.14 ± 67.91cm3 vs. 19.43 ± 13.76 cm3, p = 0.04) and linear regression analysis revealed a positive correlation. Neither the extent of resection nor recurrence rate showed any significant difference between the two groups.MethodsThis is a retrospective study of IEC patients treated between 2009 and 2014. We analyzed the expression of common serum tumor biomarkers, including carbohydrate antigen 19–9 (CA19-9), carcinoembryonic antigen, carbohydrate antigen125 and squamous cell carcinoma in both IEC and healthy control group. Receiver operating characterisitics curves were constructed to evaluate the diagnostic accuracy.ConclusionsOur data indicated that for serum CA19-9 level higher than 13.15U/ml, after excluding the possibility of gastrointestinal system tumor, lung cancer, inflammation and other related diseases, the existence of IEC should be considered. Further prospective study is needed to gain more understanding of the value of CA19- 9 in postoperative evaluation and surveillance.

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“…But there has not been any report of simultaneous appearance of about both renal and liver cysts. Other cysts, including huge splenic cysts, oesophageal cysts and bronchogenic cysts, have also been reported . The mechanism is not clear, but probably related to the cyst fluid leaking out into the circulation .…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…Other cysts, including huge splenic cysts, oesophageal cysts and bronchogenic cysts, have also been reported. [21][22][23][24][25][26] The mechanism is not clear, but probably related to the cyst fluid leaking out into the circulation. 17 In the reported cases, immunohistochemical staining showed positive expression of CA19-9 in the cyst epithelia.…”

Section: Details Of the Casementioning

confidence: 99%

Astragalus membranaceus as a cause of increased CA19-9 and liver and kidney cysts: a case report

Tong

Yao

et al. 2014

J Clin Pharm Ther

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Giant Epidermoid Cyst of the Spleen with Elevated CA 19-9 Production Managed Laparoscopically: Report of a Case

Cited by 13 publications

References 15 publications

Laparoscopic fenestration for a large ruptured splenic cyst combined with an elevated serum carbohydrate antigen 19–9 level: a case report

Laparoscopic fenestration for a large ruptured splenic cyst combined with an elevated serum carbohydrate antigen 19–9 level: a case report

The implication of tumor biomarker CA19-9 in the diagnosis of intracranial epidermoid cyst

Astragalus membranaceus as a cause of increased CA19-9 and liver and kidney cysts: a case report

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