Case of a Liver Cyst with Elevated CA19-9 Level in the Cystic Fluid and Difficult to Differentially Diagnose as Different from Biliary Cystadenoma and Cystadenocarcinoma

Hisamitsu Zaha, Hiroki Sunagawa*, Osamu Kakazu, Mikiko Watanabe, Mikiko Higa, Koji Kawakami, Susumu Inamine, Tetsuo Touyama, Naoto Oshiro and Ken Nakama**

Department of Surgery, Nakagami Hospital
Division of Digestive and General Surgery, Faculty of Medicine, University of the Ryukyus*
Division of Pathology, Nakagami Hospital**

A 66-year-old woman was found to have an asymptomatic cystic lesion 16×12 cm in diameter in the right hepatic lobe in abdominal ultrasound tested in a regular health checkup. The cystic lesion showed internal septations and a solid component. Percutaneous cystic fluid aspiraion was done to differentially diagnose between a cyst with an old hemorrhage and cystadenoma or cystadenocarcinoma. Because of radiologic characteristics and markedly elevated cystic CA19-9 (280,000 U/ml), cystadenoma and cystadenocarcinoma could not be denied and surgery was undertaken. Operative findings showed a cystic nodule which was encapsulated with a thick fibrous capsule and enucleation was performed. The defenitive diagnosis was a simple cyst with an old hemorrhage. Caution is therefore needed when interpreting elevated tumor markers in the cystic fluid of patients with cystic lesions of the liver.

Key words
liver cyst, CA19-9, cystadenoma

Reprint requests
Hisamitsu Zaha Department of Surgery, Nakagami Hospital
6-25-5 Chibana, Okinawa, 904-2195 JAPAN

Accepted
January 30, 2008

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