A Ruptured Epidermoid Cyst of the Spleen Presenting with High Levels of Tumor Antigens

Hikaru Izawa, Songtae Kim, Masayoshi Nishihara, Tetuya Yoshida, Tikara Ebisui, Toshio Kanai and Takayoshi Fujimoto

Department of Surgery, Hyogo Prefectural Nishinomiya Hospital

Over five hundred cases of splenic cysts have been reported in Japan. Epidermoid cysts are comparatively rare, accounting for about 10% of all splenic cysts. This paper reports a very rare case of a ruptured epidermoid cyst of the spleen presenting as generalized peritonitis and associated with high levels of tumor antigens. A 24-year-old female was admitted to the Gynecological & Obstetrical Department of our hospital because of a lower abdominal pain. Ultrasonography, magnetic resonance imaging and computed tomography revealed several ascites in the pelvic cavity and an irregular-shaped cyst in contact with the spleen. A diagnosis of peritonitis as a result of a ruptured splenic cyst was made. High levels of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were also detected, so additional examinations targeting the digestive tract were performed. However, no other abnormal findings were found. Although the abdominal pain disappeared and the serum tumor antigen levels decreased to within a normal range after conservative treatment, the primary splenic cyst increased in size. Since a secondary rupture was expected to occur, a splenectomy was performed. The cyst had a diameter of 9.5 cm and was localized in the central segment of the spleen. Microscopically, the cyst conteined a stratified squamous epithelium on the inner surface and was diagnosed as an epidermoid cyst of the spleen. The contents of the cyst included high levels of CEA and CA 19-9.

Key words
rupture of splenic epidermoid cyst, carcinoembryonic antigen, carbohydrate antigen 19-9

Reprint requests
Hikaru Izawa Department of Surgery, Hyogo Prefectural Nishinomiya Hospital 13-9 Rokutanji-cho, Nishinomiya-shi, 662-0918 JAPAN

Accepted
June 28, 2000

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