A Case of Common Bile Duct Stone with Cholangitis Presenting an Extraordinarily High Serum CA19-9 Value.

Abstract

A 63-year-old male complainined of right upper abdominal pain and jaundice. Laboratory data on admission showed hyperbilirubinemia, elevation of biliary enzymes and an extra ordinarily high value of serum CA19-9 (60,000 U/ml). Diagnostic imaging modalities including abdominal ultrasonogram, abdominal CT and PTC suggested a stone impaction of the common bile duct. Jaundice subsided after PTC-drainage in association with decreasing serum CA19-9 value, which returned to the normal level six weeks later. Spontaneous delivery of the stone via the fistula was confirmed by cholangiography through the drainage tube. Though there are few reports of such a high serum CA19-9 level, the possibility of benign biliary tract disease should be considered in patients showing an extraordinarily high serum CA19-9 value.

Extremely Elevated CA19-9 in Acute Cholangitis

“…Surprisingly, extremely elevated serum CA19-9 in patients with acute cholangitis like the reported case may occur [11]. Murohisa et al [11] presented a case of common bile duct stone with cholangitis and high serum CA 19-9 level (60,000 U/mL).…”

“…Murohisa et al [11] presented a case of common bile duct stone with cholangitis and high serum CA 19-9 level (60,000 U/mL). Jaundice subsided after PTC-drainage in association with decreasing serum CA 19-9 value, which retuned to the normal level 6 weeks later.…”

Hepatic Inflammatory Pseudotumor With Elevated Serum CA19-9 Level Mimicking Liver Metastasis From Rectal Cancer: Report of a Case

“…12 Nevertheless, false-positive results owing to benign disease such as pancreatitis 13 or acute cholangitis have been reported. 14 In the current case, we diagnosed the liver mass as IPT because of spontaneous regression of the tumor size and reduction in serum CA19-9. The reasons for extreme elevation of the serum CA19-9 elevation in the current case are unclear.…”

Extraordinarily elevated serum levels of CA 19-9 and rapid decrease after succesfull therapy: A case report and review of literature

“…Moderately high serum levels of CA 19-9 can be detected during benign diseases of the liver, pancreas and biliary tract, but enormously high serum levels of CA 19-9 for these diseases were found in only a few cases, such as cirrhosis and acute cholangitis (16,19,20). The duration for normalization of elevated CA 19-9 level is varied.…”

“…A CA 19-9 value of >1,000 U/ml usually indicates a digestive cancer and has been reported to have a specificity over 99% for pancreatic cancer (16); nevertheless, falsepositive results owing to benign diseases such as pancreatitis or liver cirrhosis have been noted (17,18). Murohisa et al (19) reported a case of acute cholangitis with a CA 19-9 level of 6000 IU/ml, which had decreased in six weeks after successful biliary drainage.…”