Giant Splenic Cyst with High Serum Concentration of CA 19-9 Failure of Treatment with Percutaneous Transcatheter Drainage and Injection of Tetracycline

Yoshikane, Hiroaki; Suzuki, Toshiyuki; Yoshioka, Nobutaka; Ogawa, Yoshitaka; Hayashi, Yoshinori; Hamajima, Eiji; Yokoi, Takeshi

doi:10.3109/00365529609006776

Cited by 29 publications

(22 citation statements)

References 18 publications

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“…Cysts derived from the accessory spleen are very rare, with all reported cases located in the pancreas . No intraabdominal cyst derived from the accessory spleen in the greater omentum, similar to our case, has been reported in the literature.…”

Section: Discussionsupporting

confidence: 69%

“…Although the histogenesis of splenic epithelial cysts is controversial, there are two main hypotheses: one is embryonic inclusion of epithelial cells from adjacent structures, and the other is invagination of capsular surface mesothelium. Recently, several cases of epithelial splenic cysts associated with high serum concentrations of CA19‐9 have been reported 1,2,10. CA19‐9 is known to be present in normal epithelial cells, such as ductal cells of the salivary glands, biliary epithelium, pancreatic ductal epithelium, and metaplastic mesothelial cells.…”

Section: Discussionmentioning

confidence: 99%

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Giant epithelial cyst of the accessory spleen

Mori

Ishii

Iida

et al. 2003

J Hepatobiliary Pancreat Surg

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Splenic cysts are uncommon, and cysts derived from the accessory spleen are rare. We report a case of a huge splenic cyst derived from the accessory spleen in the omentum, concomitant with multiple epithelial cysts of the primary spleen. Both serum and cystic fluid concentrations of carbohydrate antigen (CA)19‐9 were markedly elevated. A huge monolocular cyst occupied the entire abdomen. A total of 71 of aspirated cystic fluid was turbid and yellowish‐brown. The cyst wall, which consisted of CA19‐9‐positive squamous epithelium, contained approximately 2 × 3 × 1 cm of splenic tissue. There was a separate multicystic 16 × 8‐cm spleen in the normal position. The CA19‐9 serum level returned to normal postoperatively.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Giant epithelial cyst of the accessory spleen

Mori

Ishii

Iida

et al. 2003

J Hepatobiliary Pancreat Surg

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“…All types of splenic cysts are rare [3]. In a review of 42,327 autopsies, splenic cysts were found to have an incidence of 0.07% [8]. All the same, even after trauma, posttraumatic splenic cysts are rarely seen [9].…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic splenic cysts treated with laparoscopy: two case reports

Avgerinos

Kyriakopoulos

Konstantinopoulou

et al. 2009

Cases J

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IntroductionToday, laparoscopy tends to become a useful alternative to open procedure for the surgical treatment of spleen disorders, offering at the same time a conservative approach for the management of selected spleen lesions such as posttraumatic cysts.Case presentationThis article describes two cases of posttraumatic splenic cysts, one of which was treated with laparoscopic total splenectomy and the second with laparoscopic cystectomy. The procedure was carried out successfully with no complications in both cases, and the patients were discharged a few days after the operation.ConclusionLaparoscopy with preservation of functional splenic parenchyma, when feasible, should be the procedure of choice in cases of posttraumatic splenic cysts, as it provides safe and definite treatment with all of the other advantages of minimally invasive surgery.

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“…From 1978 less than 1,000 cases of true splenic cysts [21]and, more recently, less than 20 cases with elevated CA 19-9 serum levels have been reported [6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. CA 19-9 is produced by both normal and tumoural human epithelial cells; by immunohistochemical analysis, the epithelium lining a true splenic cyst may be demonstrated to produce this cancer antigen, its production depending on the degree of proliferation of the epithelium and the capsule thickness and the presence of capillaries in the connective tissue surrounding the cyst [6].…”

Section: Discussionmentioning

confidence: 99%

“…However, its usefulness is rather limited, since elevated serum levels of CA 19-9 may be encountered in patients with benign disorders with a sensitivity of 77% and a specificity of 88% [4, 5]. Moreover, elevated basal CA 19-9 serum levels have also been described in patients with splenic cysts [6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. This is not surprising, since CA 19-9 is commonly produced by normal human epithelial cells from organs such as pancreas, salivary glands, colon, bronchial glands, endometrium, and biliary tract [16]; moreover, it has been suggested that the epithelium lining splenic cysts may produce this antigen [12, 13, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

A True Splenic Cyst Producing Carbohydrate Antigen 19-9 and Cancer Antigens 50 and 125, but Not Interleukin 10

Galizia¹,

Lieto²,

Ferraraccio³

et al. 2003

Dig Surg

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A giant cystic lesion of the left upper abdomen associated with a smaller ovarian cyst in a young female patient is reported. Laboratory data revealed elevated serum levels of carbohydrate antigen 19-9 (CA 19-9), carcino-embryonic antigen (CEA), cancer antigens 50 and 125, and tissue polypeptide antigen. In contrast, the serum levels of interleukin 10, a cytokine involved in modulating immune responses and produced by many cancer histotypes, were normal. Since ovarian cancer or cystic adenocarcinoma of the tail of the pancreas were not ruled out, the patient underwent laparotomy. After splenectomy and ovariectomy, the tumour marker serum levels normalized. Histology and immunohistochemical analysis revealed a true splenic cyst with the inner epithelium strongly positive for CA 19-9 and CEA and high levels of cancer antigens in the fluid. The ovarian lesion was a serous cystadenoma. The inner epithelium showed no immunoreactivity for tumour markers which were not measurable in the fluid. True cysts of the spleen are rare; in a few cases, high serum levels of CA 19-9 and CEA have been reported. In such instances, cyst resection or splenectomy is indicated to rule out malignant lesions and to remove the cancer antigen producing epithelium. The reported case shows that the epithelium lining true splenic cysts may produce, besides CA 19-9 and CEA, other tumour markers, in particular cancer antigens 50 and 125. In addition, normal serum values of interleukin 10 correctly predicted the benign nature of the lesion.

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Giant Splenic Cyst with High Serum Concentration of CA 19-9 Failure of Treatment with Percutaneous Transcatheter Drainage and Injection of Tetracycline

Abstract: The accumulation of cystic fluid in splenic epithelial cysts may be attributable not only to the secretion of the lining cells but also to influx from the splenic sinuses.

Cited by 29 publications

References 18 publications

Giant epithelial cyst of the accessory spleen

Giant epithelial cyst of the accessory spleen

Post-traumatic splenic cysts treated with laparoscopy: two case reports

A True Splenic Cyst Producing Carbohydrate Antigen 19-9 and Cancer Antigens 50 and 125, but Not Interleukin 10

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