Laparoscopic Splenectomy as the Definitive Investigation for Differential Diagnosis of Elevated Serum CA 19-9 Levels Associated with a Splenic Cyst: Case Report and Review of the Literature

Splenic cysts are relatively rare entities. The differential diagnosis for these lesions includes parasite infections, results of previous trauma or infarction, congenital forms, primary splenic neoplasm or cystic metastasis. They can be either symptomatic, causing mainly abdominal pain, or asymptomatic, thus being diagnosed as incidental findings during radiological examinations for other clinical reasons: among these, a raised serum level of CA 19-9 can be a case. It has been demonstrated that epidermoid and mesothelial congenital cysts can be associated with a pathological level of this tumor marker which is usually correlated to biliopancreatic and colonic carcinomas. The aim of the present study is to present the case of an asymptomatic epidermoid splenic cyst associated with a continuous increase of CA 19-9. We describe the applied clinical workup and surgical management by laparoscopic total splenectomy. Moreover, we conducted a systematic review of the literature to analyze the demographic, clinical and pathological data of these infrequent lesions and to compare our therapeutic management with that of the other reported cases.