[Splenic cysts. Their morphology, diagnosis and therapy]

Area of Science:

• Gastroenterology
• Surgical Pathology
• Oncology

Background:

• Splenic cysts are uncommon, with varied etiologies including developmental, neoplastic, and traumatic origins.
• Epidermoid and mesothelial cysts are the most common benign types, while pseudocysts result from trauma or infarction.
• Tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9), are occasionally elevated in patients with splenic cysts.

Purpose of the Study:

• To investigate the clinical presentation, pathological findings, and surgical management of splenic cysts.
• To evaluate the significance of tumor markers (CEA, CA 19-9) in splenic cysts and their potential origin.
• To establish criteria for surgical intervention in splenic cyst management.

Main Methods:

• Retrospective review of nine patients who underwent surgery for splenic cysts over a 10-year period.
• Analysis of clinical data, including symptoms, diagnostic imaging (ultrasound), and surgical procedures.
• Immunohistochemical examination of cyst wall tissue for CEA and CA 19-9 expression.

Main Results:

• Six epidermoid, two mesothelial, and one pseudocyst were identified. Six patients were symptomatic, while three had incidental findings.
• Elevated CEA and/or CA 19-9 levels were observed in three patients with epidermoid cysts.
• Immunohistochemistry confirmed CEA and/or CA 19-9 in the epithelial layer of benign epidermoid cysts, suggesting a mesothelial origin.
• Surgical management included complete extirpation (splenectomy, hemisplenectomy, enucleation) in five cases and cyst resection in four.
• One patient with residual cyst post-resection showed no change over an 8-year follow-up.

Conclusions:

• Splenic cysts, particularly epidermoid types, can express tumor markers (CEA, CA 19-9) without indicating malignancy, likely originating from mesothelial cells.
• Most splenic cysts are benign and do not necessitate surgical removal.
• Surgical intervention is indicated for symptomatic cysts, complications (e.g., rupture), or asymptomatic cysts exceeding 5 cm in diameter due to rupture risk.
• Rare parasitic or infective splenic cysts require surgical sterilization.