Occurrence of Extremely High Level of Serum Carbohydrate Antigen 19-9 in a Patient Sufferring from Cholecystitis with Stones, and Liver Abscess -A Case Report-

Shinzo Kitahara, Kazuo Ueda, Tetsuro Ozawa, Yukio Tsugu, Motoshige Kudo¹⁾, Haruoki Tadokoro²⁾, Nobuyoshi Takasu²⁾

The Second Department of Surgery, Toho University
Pathology, Toho University¹⁾
Surgery, Urayasu Chuo Hospital²⁾

We experienced a case of extremely high level of serum carbohydrate antigen 19-9 (CA19-9) in a patient suffering from cholecystitis with a gall stone and liver abscess. The patient, a 53-year-old man, was admitted to the hospital with the chief complaint of epigastralgia. The clinical diagnosis on admission was cholecystitis and cholelithiasis. The echogram revealed that the stone was impacted at the neck, causing a marked distension of the gall bladder. An adjacent liver abscess was also suspected. Abnormal laboratory data included an extremely high CA19-9 serum titer (868, 094 U/ml), suggesting the presence of malignancy. At surgery, however, no malignant findings were observed and a simple cholecystecomy with drainage of the liver abscess was carried out. Pathologically, the gall bladder showed features of chronic cholecystitis with focally necrotic and granulomatous lesions. An immunohistochemical study using anti-CAl9-9 antibody showed strong positivity in the epithelium of the gall bladder and intraluminal secretory substance. The CA19-9 serum titer was postoperatively decreased to the normal range in 6 months. Therefore it is possible that the cause of such a high preoperative CA19-9 serum level is related to the benign lesions of the gall bladder and liver. The present case indicates that an abnormally high CA19-9 serum titer per se does not necessarily mean the presence of malignancy.

Key words
benign lesions of gall bladder and liver, extremely high serum carbohydrate antigen 19-9

Reprint requests
Shinzo Kitahara Second Department of Surgery, Toho University School of Medicine
6-11-1 Omori Nishi, Ota-ku, Tokyo, 143 JAPAN

Accepted
July 10, 1990

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