A CASE OF INFECTIOUS EPIDERMOID CYST OF THE SPLEEN WITH HIGH SERUM CA19-9 AND CA125 LEVELS

Abstract

Infectious epidermid cysts of the spleen with high serum levels of CA19-9 and CA125 are rare. We successfully performed a laparoscopic splenectomy for a 20-year-old woman who was diagnosed as having the disease. The patient was admitted to the hospital becuse of high fever and left hypochondralgia. After a workup of ultrasonography, CT and magnetic resonance imaging, she was diagnosed as having infectious splenic cyst. In addition, malignancy was suspected because serum levels of CA19-9 and CA125 were as high as 1.1×106U/ml and 1.8×104U/ml, respectively. Immunological stainings indicated that CA19-9 might escape from epithelium of the cystic wall to the blood. CA19-9 and CA125 decreased to 100U/ml and <35U/ml respectively 6 months after the operation. As a diagnostic therapy, a laparoscopic splenectomy was performed. Histological examination revealed infectious epidermoid cyst without malignancy. We have great difficulty in differentiation between benign and malignancy before surgery in such cases, and hence splenectomy may be an appropriate therpy. We think, however, that less invasive and diagnostic therapy by laparoscopic splenectomy should precede it. Postoperative course was uneventful and she was discharged from the hospital 7 days after the surgery.