title: A recurrent epidermoid cyst of the spleen: report of a case and literature review.
abstract: BACKGROUND
  Splenic cysts are rare disease. Epidermoid cysts of the spleen belong to the primary nonparasitic splenic cysts group. They are an unusual event in surgical practice. Usually, epidermoid cysts occur in children and young female. Most often, they are asymptomatic, but they may present with abdominal discomfort.
  
  
  METHODS
  We are reporting a rare case of a 23-year-old female came to our attention with history of intermittent pain and previously undergone two times to laparoscopic decapsulation of the cyst in others institutions. During hospitalization, serum and intracystic levels of tumor marker CA19-9 increased. Enhanced CT of the abdomen showed recurrent large cyst in the upper pole of the spleen with satellite nodules. Laparotomic total splenectomy was performed. Histopathological and immunoreactive examinations were executed, and they revealed stratified squamous epithelium on the inner surface of cystic wall, which was positive for EMA, CEA, and CA19-9. The diagnosis of epidermoid cyst was confirmed.
  
  
  CONCLUSIONS
  Recently, the surgical approach is changing towards conservative treatments in order to save the spleen in young patients for immunological reasons. Sometimes, this target is not achievable. In such circumstances, like recurrent large cyst, anomalous anatomical relationship to the surrounding tissues, total splenectomy is safe and necessary.
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto str 1, 71122, Foggia, Italy. ciancidoc1@virgilio.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Cianci
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto str 1, 71122, Foggia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Tartaglia
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto str 1, 71122, Foggia, Italy.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Altamura
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto str 1, 71122, Foggia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fersini
authors.affiliation: Department of Clinical and Experimental Medicine, University of Foggia, 71122, Foggia, Italy.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Vovola
authors.affiliation: Department of Clinical and Experimental Medicine, University of Foggia, 71122, Foggia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sanguedolce
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto str 1, 71122, Foggia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ambrosi
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto str 1, 71122, Foggia, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Neri
mesh_terms: D000328:Adult; D004814:Epidermal Cyst / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D011379:Prognosis; D012008:Recurrence; D013156:Splenectomy; D013158:Splenic Diseases / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: Carbohydrate antigen 19-9; Epidermoid cyst; Immunohistochemistry; Laparoscopic surgery; Splenic cysts