A Case Report of the Splenic Cyst with Spontaneous Rupture

Mika Morita, Masato Sato, Nobumichi Hosoda, Takashi Koreeda

Department of Surgery, Kansai Medical University, Otokoyama Hospital

An extremely rare case of mucinous cystadenoma of the spleen is presented. The patient was a 56-year-old man whose chief complaint was a feeling of fullness. His spleen was palpable three finger breadths below the left costal margin. Laboratory studies showed that plasma CA19-9 and CEA levels were elevated. During celiotomy, gross examination of the abdominal cavity revealed a gelatinous mass within the parietal peritoneum and the serosa of the bowel. The spleen was found to be the size of a child's head, with an uneven surface, and was partially ruptured. The cecum was in a post-appendectomy condition and grossly normal. A splenectomy was performed; the spleen weighed 785 g. The postoperative course was uneventful, and he was discharged on the 22nd day after surgery. Microscopically, the cyst lining was found to be a layer of mucous-secreting columnar epithelial cells. The nuclei of these cells were in a basal position. Since Sekino first reported on mucinous cystadenoma of the spleen in 1986, 3 such reports have become available in Japan. The characteristic clinical feature is a low-grade histologic malignancy, but mucinous implants developing on the peritoneal surface and the omentum often result in pseudomyxoma peritonei, which aggravates the malignancy. Treatment of splenic cysts has included sclerotherapy, marsupialization, and partial and total splenectomy. However, if possible, total splenectomy should be avoided to prevent any future complications. The genesis of mucinous cystadenoma of the spleen has been presumed to be migration of the mesoderm in the embryonic period.

Key words
mucinous cystadenoma, splenic cyst, pseudomyxoma peritonei

Reprint requests
Mika Morita Department of Surgery, Kansai Medical Univerisy
1 Fumizono, Moriguchi, 570 JAPAN

Accepted
December 12, 1990

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