A Case of Cholecystitis with Markedly Elevated Level of Serum CA19-9

Satoru Akashi, Masatoshi Yamamoto, Takasumi Hosoi, Masahiro Tsutsumi* and Atsushi Imagawa

Department of Surgery and Department of Pathology*, Saiseikai Chuwa Hospital

A 54-year-old woman admitted for epigastralgia and fever, was found in abdominal ultrasonography (US) to have cholecystitis due to cholecystolithiasis. Laboratory data on admission showed serum CA19-9 to be extremely high at 26,780 U/ml. Antibiotics reduced inflammation and serum CA19-9 fell to 10,060 U/ml. Because no other examinations suggested the presence of a malignant tumor, the elevated serum CA19-9 was due to cholecystitis. Serum CA19-9 dropped significantly lower to 49 U/ml after laparoscopic cholecystectomy. Histopathological findings showed severe inflammation in the gallbladder wall, and immunohistological staining of CA19-9 was strongly positive at the epithelium of Rokitansky-Aschoff sinus. Serum CA19-9 may be high in benign disease, but is usually within 100 U/ml, with cases up to 10,000 U/ml extremely rare. An analysis of cases with high CA19-9 indicates that the main factor in elvated serum CA19-9 in cholelithiasis is biliary tract inflammation.

Key words
CA19-9, cholecystitis

Reprint requests
Satoru Akashi Medical Center for Emergency and Critical Care, Nara Prefectural Nara Hospital
1-30-1 Hiramatsu, Nara, 631-0846 JAPAN

Accepted
September 27, 2006

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