Giant splenic cyst over 17 cm with elevation of serum CA19-9 levels treated by hand-assisted laparoscopic splenectomy: a case report

Introduction and importance: Splenic cysts are rare, with a reported incidence of 0.07-0.3%. Although most cases are benign and asymptomatic, some may grow large, rupture, become infected, or cause internal hemorrhage. Elevated serum carbohydrate antigen 19-9 (CA19-9) levels may also be observed, raising concerns regarding malignancy. Nonetheless, their diagnosis remains challenging because of their rarity, and the optimal treatment strategy remains controversial. Herein, we report a case of a giant splenic epithelial cyst with elevated serum CA19-9 levels that was successfully treated with laparoscopy-assisted splenectomy. Presentation of case: We present the case of a 34-year-old female with a giant splenic epithelial cyst measuring >17 cm in diameter associated with elevated serum CA19-9 levels (122 U/mL). The cyst was initially discovered incidentally during imaging studies 3 years prior but had increased significantly in size. Recently, imaging revealed a multilocular cystic lesion with septations that prompted surgical resection owing to concerns of malignancy. Laparoscopic-assisted splenectomy was performed using a hand-assisted technique, following laparoscopic management of the splenic hilum. The cystic fluid CA19-9 level was markedly elevated at 10 832 U/mL; however, histopathology revealed a benign epithelial cyst. The postoperative recovery was uneventful, and the serum CA19-9 level normalized (8 U/mL) within 1 month. Three years after surgery, there were no signs of recurrence or complications. Clinical discussion: Splenic cysts are considered challenging to diagnose because splenic cysts are not common. However, proper management is needed. In cases of giant splenic cysts, pure laparoscopic surgery without rupture of the cyst presents challenges in accessing and dissecting the cranial side of the spleen owing to limited instrument maneuverability. In contrast, a planned hand-assisted approach may ensure safe and complete removal of the cyst without intraoperative rupture and spillage. Conclusion: Giant splenic cysts accompanied by elevated CA19-9 levels are rare and pose a diagnostic challenge. Laparoscopy-assisted splenectomy offers a safe and effective approach for complete resection while minimizing the risk of intraoperative rupture and spillage.