Primary epithelial splenic cyst with micro-rupture and raised carbohydrate antigen CA 19-9: a paradigm of management

Abstract

SummaryEpithelial splenic cysts are rare entities that surgeons might not have previously encountered and their management is based on historical studies.A 21-year-old female presented with a cyst of the spleen that produced a high serum concentration of carbohydrate antigen CA 19-9. A partial splenectomy with the removal of the entire cyst and preservation of splenic parenchyma by laparotomy was performed and the patient made an uneventful recovery. A microscopic rupture of the wall of the cyst and degradation of blood in the fluid of the cyst were confirmed. Eighteen months following surgery a functional splenic parenchyma was documented. There was no episode of infection during this follow-up time.Partial surgical splenectomy with resection of the entire cyst prevents recurrence and preserves splenic function. BACKGROUND

Persistent High Level of Urinary Tumor Marker Carbohydrate Antigen 19-9 in Prenatally Diagnosed Dysplastic Kidney

“…Remarkably, the present case represents a different pattern compared to previous studies; it is the first report of MCDK with high levels of CA 19-9 level in cystic fluid, postpartum first voided urine, and amniotic fluid. The increased level of CA 19-9 in other cysts including spleen, esophageal, hepatic, and parathyroid cysts is not comparable to the prominently high levels observed in this case (more than 1000 U/mL) [ 1 – 4 , 13 ]. On the other hand, the high levels of CA 19-9 either in cystic content or serum returned to normal levels after surgical resection during several weeks; conversely in this case persistent high levels of urinary CA 19-9 were observed despite surgical aspiration.…”

“…In addition, its diagnostic and prognostic values in other cases have been evaluated. Increased cystic fluid or serum CA 19-9 levels have been described in various cystic fluids including hepatic, splenic, esophageal, and parathyroid cysts [ 1 – 4 ].…”

Spontaneous rupture of a non-parasitic splenic cyst

“…However, as ruptured cysts are even more uncommon, we concluded that 20 studies have been published addressing 21 cases with ruptured non-parasitic splenic cysts, the oldest study being published in 1960 (table 2). 8–26 Age varies from 6 to 46 years old with our study presenting the oldest patient. All cases presented with abdominal pain which was sometimes accompanied by left shoulder pain, nausea or vomiting.…”

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

“…Other cases of primary splenic cysts without epithelial lining have also been reported [ 16 , 17 ]. Some cases have been reported without immunostaining for CA19-9 [ 10 , 18 , 19 ]. Buda et al.…”