case_images: PMC11231066_01
case_images: Abdominal imaging of the splenic cyst before surgery. (A) Representative four-phase image (non-contrast, arterial, portal, and liver phase) of the splenic cyst on contrast-enhanced CT scan showed no nodule or disproportionate thickening on the cystic wall except for tiny calcification was observed. There was also no contrast enhancement for the whole lesion constantly. (B) PET/CT scan showed no 18F-FDG uptake by the splenic lesion.
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case_images: CECT and PET/CT scan showed that the CT value was 47 Hounsfield units within the cyst and tiny calcification was observed on the cystic wall without 18F-flurodeoxyglucose (18F-FDG) uptake for the whole lesion, which indicated that the splenic lesion might be a dermoid cyst or epidermoid cyst ( Figure 1 ).
case_images: Key surgical procedure of laparoscopic total splenectomy. (A) Overview of the spleen and the splenic cyst on laparoscopy. (B) Dissociation of the splenic artery using the right-angle clamp. (C) Ligation of the splenic artery by using the Hem-O-Lock clips. (D) Dissociation of the splenic vein using the right-angle clamp. (E) Ligation of the to-be-dissected distal part of the splenic vein by using one Hem-O-Lock clip. (F) Ligation of the to-be-preserved proximal part of the splenic vein by using 2 Hem-O-Lock clips.
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case_images: After that, the total spleen was dissociated and placed into a specimen bag, where the spleen was cut into pieces and taken out of the abdominal cavity through a dilated trocar port incision ( Figure 2 ).
case_images: Pathological examination of the splenic cyst. HE and IHC (CA19-9, CK5, CK7, CD31, and CD34) staining of the splenic cyst capsule at 400x magnification.
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case_images: The expressions of CEA, estrogen receptor (ER), and progesterone receptor (PR) were all negative ( Figure 3 ).
case_images: Dynamic changes of serum tumor marker levels before and after surgery. (A-C) The serum concentrations of CA19-9, CEA, and CA125 dropped quickly after laparoscopic total splenectomy until reaching the normal range 3 months later.
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case_images: The serum CEA level reached the normal range 1 month after surgery, followed by CA125, CA242, and CA50 levels after 1 more month, whereas the CA19-9 level reached the normal range after 3 months postoperatively ( Figure 4 ).