Epidermoid cyst of the spleen with elevated levels of CA125 and carcino-embryonic antigen

Abstract

Epidermoid splenic cyst is characterised by a single layer of epithelium. Although specific findings can be depicted with ultrasonography (USG) and CT, elevated levels of carcino-embryonic antigen (CEA), CA19–9 or CA125 in serum and cyst fluids have recently been used in the diagnosis [1,2]. A 12-year-old female patient was admitted with swelling and pain on the left side of abdomen. Abdominal USG and CT revealed that the spleen was enlarged and contained two cysts. The larger cyst was very close to the hilum (Fig. 1). Serum analysis revealed high levels of CA125 (35 ng/ml) and CEA (150 U/ml). She underwent total splenectomy because the tributaries of splenic artery and vein overlaying the hilar cyst prevented an alternative operative procedure. Examination of cyst fluid also revealed high levels of CA125 (70 ng/ ml) and CEA (1500 U/ml). Both cysts were thin-walled and lined with a single layer of squamous epithelium in histologic examination. CA125 and CEA returned to normal levels within 3 months. Epidermoid cysts are lined by stratified squamous epithelium. It is thought that they develope after invagination of the capsular surface mesothelium with subsequent squamous metaplasia [3]. Mostly they give signs and symptoms in late childhood and may regress completely. Cysts larger than 5 cm require resection because of their progressive growth and in order to prevent the potential severe complications such as rupture and haemorrhage [3]. Higaki et al. [1] reported that serum CEA, CA19–9 and CA125 levels had been elevated in patients with epidermoid cyst in whom epithelium was positive for anti-CEA and anti-CA19–9 antibodies. This finding shows that these markers are products of the squamous epithelium and leak into the bloodstream, presumably as a result of trauma or increasing pressure within the cyst.