Laparoscopic resection of a benign true cyst of the spleen with the harmonic scalpel producing high levels of CA 19-9 and carcinoembryonic antigen.
Primary true cysts of the spleen constitute 10 per cent of all nonparasitic cysts of the spleen. These cysts have been managed with total or partial splenectomy or marsupialization. Previous series reported elevated serum levels of CA 19-9 and carcinoembryonic antigen (CEA). A 16-year-old male presented with left upper quadrant pain and was found to have a mass on palpation. An ultrasound and a CT scan of the abdomen showed a 20-cm cystic lesion in the spleen. The CA 19-9 and CEA serum levels were 1264 units/ml (nl <33 units/ml) and 7.5 ng/ml (nl <3.1 ng/ml), respectively. Laparoscopic resection of the cyst using the harmonic scalpel was performed. The pathology showed a benign true epithelial cyst of the spleen, with strongly immunoperoxidase stains for keratin, CA 19-9, and CEA. Levels of CA 19-9 and CEA in the cystic fluid were 48,275 units/ml and 96.6 ng/ml, respectively. This is the first case reported in the literature of a true benign splenic cyst producing high levels of CEA and CA 19-9 in serum and cystic fluid. The patient was discharged home on the 1st postoperative day without problems and returned to his normal daily activities with the 1st week after surgery. The CA 19-9 and CEA serum levels returned to normal levels.
Sardi
A
A
Department of Surgery, St. Agnes Healthcare, Baltimore, Maryland 21229, USA.
Ojeda
H F
HF
King
D
D
D000293:Adolescent; D018395:CA-19-9 Antigen / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D003560:Cysts / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007124:Immunoenzyme Techniques; D020706:Laparoscopes; D010535:Laparoscopy; D008297:Male; D013156:Splenectomy / Q000295:instrumentation / Q000379:methods*; D013158:Splenic Diseases / Q000097:blood* / Q000473:pathology / Q000601:surgery*
D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen