Abstract
A 36-year-old woman who was seen at our emergency clinic because of the abrupt onset of abdominal pain was found to have a 140-mm multilocular cyst in the spleen and ascites by computed tomography. Peritonitis caused by rupture of the splenic cyst was diagnosed. As blood analysis revealed absence of anemia and her symptoms were mild, she was determined to be a candidate for elective surgery. We performed embolization of the splenic artery followed by laparoscopic splenectomy because the cyst was huge and the splenic artery had significantly dilated. Biochemical study of the cystic fluid as well as preoperative blood analysis showed elevated levels of carbonhydrate antigen (CA) 19-9. Immunohistochemistry revealed positive staining for CA19-9 in the fluid component and squamous epithelial cells in the cyst. Her postoperative course was uneventful. The elevated CA19-9 level was confirmed to drop within reference range by blood examination. Rupture of a CA19-9 producing huge splenic cyst was diagnosed.
CA19-9 producing splenic cyst is so rare that only about 50 cases have been reported in Japan. Among of them, ruptured cases have come to only six, including present case, and here we report our case together with a review of the literature.
