title: Spontaneously Ruptured Giant Splenic Cyst with Elevated Serum Levels of CA 19-9, CA 125 and Carcinoembryonic Antigen.
abstract: Splenic cyst is a relatively rare disease; however, the occurrence of complications associated with its rupture is even more rare. A 20-year-old female patient who had severe abdominal and left shoulder pain was admitted to our hospital. The patient's abdomen was hard and tender to the touch and she presented with a high fever. The patient's serum levels of the tumor markers carbohydrate antigen 19-9, cancer antigen 125 and carcinoembryonic antigen were high. Ultrasonography and computed tomography of the abdomen showed an 11-cm multilocular cystic lesion in the spleen and the presence of free intraperitoneal fluid. Peritonitis with ruptured splenic cyst was diagnosed, and the patient underwent an emergency laparotomy. The abdominal cavity was filled with purulent fluid. The cyst was localized to the spleen and had already ruptured. Total splenectomy and cyst resection were performed. The postoperative course was uneventful. The patient was discharged on day 9 following surgery. The histological findings showed the lesion to be a benign epidermoid cyst completely lined with inner stratified squamous epithelium with a capsule of connective tissue. In the immunostaining analyses, the squamous epithelium was positive for carcinoembryonic antigen. A ruptured splenic cyst causes sudden onset of severe peritonitis and elevation of serous tumor markers. An emergency operation is indicated as the treatment for a ruptured splenic cyst with peritonitis, after which a favorable outcome can be expected.
authors.affiliation: Department of Surgery, Nishi Isahaya Hospital, Isahaya, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Inokuma
authors.forename: Shigeki
authors.initials: S
authors.lastname: Minami
authors.forename: Kazuo
authors.initials: K
authors.lastname: Suga
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Kusano
authors.forename: Kenya
authors.initials: K
authors.lastname: Chiba
authors.forename: Masato
authors.initials: M
authors.lastname: Furukawa
references.citation: JAMA. 1965 Dec 6;194(10):1144-6
references.pmid: 5897798
references.citation: Am J Surg. 1960 Sep;100:475-9
references.pmid: 13811160
references.citation: J Clin Ultrasound. 1991 May;19(4):235-7
references.pmid: 1646230
references.citation: Arch Surg. 1967 Jul;95(1):74-8
references.pmid: 6027763
references.citation: Postgrad Med J. 1983 Jan;59(687):65
references.pmid: 6866878
references.citation: Pediatr Radiol. 1996 Dec;26(12):871-3
references.pmid: 8929299
references.citation: Surg Endosc. 2000 Sep;14(9):865
references.pmid: 11288000
references.citation: JSLS. 2005 Jul-Sep;9(3):349-51
references.pmid: 16121886
references.citation: Hepatogastroenterology. 1998 Sep-Oct;45(23):1884-6
references.pmid: 9840169
references.citation: Dig Liver Dis. 2001 Oct;33(7):595-9
references.pmid: 11816551
references.citation: Mo Med. 1970 Feb;67(2):106-7
references.pmid: 5412171
references.citation: Ann Surg. 1978 Mar;187(3):231-5
references.pmid: 637577
references.citation: Am J Hematol. 1989 Sep;32(1):57-60
references.pmid: 2667342
references.citation: Dig Dis Sci. 2006 Oct;51(10):1829-32
references.pmid: 16964545
references.citation: Am Surg. 1998 Dec;64(12):1149-54
references.pmid: 9843333
references.citation: Br J Surg. 1963 Sep;50:838-41
references.pmid: 14068634
references.citation: Am Surg. 1990 May;56(5):295-8
references.pmid: 2185675
references.citation: Surg Laparosc Endosc Percutan Tech. 2004 Dec;14(6):316-22
references.pmid: 15599294