Yoh Tomoaki, Wada Seidai, Kobayashi Atsushi, Nakamura Yuya, Kato Tatsushi, Nakayama Hiroyuki, Okamura Ryuji
Department of surgery Yamatotakada municipal hospital, Nara, Japan.
Int J Surg Case Rep. 2013;4(3):319-21. doi: 10.1016/j.ijscr.2013.01.003. Epub 2013 Jan 17.
Because splenic cysts are rare, a definitive treatment regime for these cysts remains unclear. We report a case of a large multilocular splenic cyst with elevated carbohydrate antigen 19-9 (CA19-9) levels, which was successfully treated with laparoscopic splenectomy.
A 22-year-old female was admitted to our hospital with severe left upper abdominal pain. Serum CA19-9 level was mildly elevated (65U/ml). Computed tomography revealed a 25-cm long spleen with multilocular cystic lesions, for which an emergency laparoscopic splenectomy was performed. Histological findings revealed that the lesion was a benign true cyst, and immunostaining analyses showed that the epithelium was CA19-9-positive.
Although some spleen-preserving approaches have been reportedly used, splenic cyst recurrence usually occurs in true cyst cases, wherein the cyst is incompletely removed. Most reported cases of splenic cysts producing CA19-9 are true cysts.
The treatment approach should be decided on the basis of the type, shape, location, and even CA19-9 levels of the splenic cyst.
由于脾囊肿罕见，针对这些囊肿的明确治疗方案仍不明确。我们报告一例伴有糖类抗原19-9（CA19-9）水平升高的巨大多房性脾囊肿病例，该病例通过腹腔镜脾切除术成功治愈。
一名22岁女性因左上腹剧痛入院。血清CA19-9水平轻度升高（65U/ml）。计算机断层扫描显示脾脏长25厘米，伴有多房囊性病变，遂行急诊腹腔镜脾切除术。组织学检查结果显示该病变为良性真性囊肿，免疫染色分析显示上皮细胞CA19-9呈阳性。
尽管据报道已采用一些保留脾脏的方法，但脾囊肿复发通常发生在真性囊肿病例中，即囊肿未完全切除的情况。大多数报道的产生CA19-9的脾囊肿病例为真性囊肿。
治疗方案应根据脾囊肿的类型、形态、位置甚至CA19-9水平来决定。
