A Case of Liver Cyst with Abnormally High Level of CA19-9 in the Serum and Cystic Fluid Coexcisting Early Gastric Cancer

Makoto Kammori, Kaoru Kobayashi, Takuro Nakamura, Ichiro Konagaya, Yamaguchi Hirokazu, Norio Kaminishi, Takeshi Ohara, Hisako Endo*, Takeshi Sasaki*

The Third Department of Surgery, Faculty of Medicine, University of Tokyo
*The Department of Pathology, The University of Tokyo Branch Hospital

The patient was a 70-year-old female. Early gastric cancer IIc was detected in the gastric pylorus vestibular apparatus department by upper gastrointestinal endoscopy and she was admitted to our hospital for an operation. Before the operation, we detected a 3 cm cyst in the S2, 3 area of the liver by abdominal CT and ultrasonography besides the early gstric cancer found in the pylorus vestibular apparatus department. CA19-9 was present at the high level of 106.2 U/ml in the serum. We believed that the high serum level of CA19-9 was derived from the benign liver cyst, because we could not find any other forcus, for example a pancreatic or ovarian lesion. We performed distal gastrectomy and D2 lymphectomy. Liver cyst aspiration was performed simultaneously then, and 7 ml of uncolored, clear, serousliver cyst fluid was removed. The liver cyst fluid had an abnormaly high level of CA19-9, 21,280 U/ml. Histological examination of the cyst revealed a large amount of well-differentiated adenocarcinoma and in part a cribriform pattern (moderately differentiated adenocarcinoma) in the gastrectomy preparation. Three months after the operation, serum CA19-9 nomalized to 26.7 U/ml. But it was at a high level of 43.5 U/ml in 6 months and is maintaining a high level, 37 U/ml, at present. This is a case of quite rare liver cyst withan abnormally high level of CA19-9 in the serum, complicating early gastric cancer.

Key words
liver cyst, tumor marker CA19-9, early gastric cancer

Reprint requests
Makoto Kammori The Third Department of Surgery, University of Tokyo
3-28-6, Mejirodai, Buukyo-ku, Tokyo, 112 JAPAN

Accepted
January 10, 1996

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