Case Rep Gastroenterol 2016;10:410–416 DOI: 10.1159/000448068 Published online: August 9, 2016
© 2016 The Author(s) Published by S. Karger AG, Basel www.karger.com/crg
This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.
Single Case
Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9 Shuji Akimotoa, d Masataka Banshodani b Masahiro Nishiharaa Junko Nambu a Yasuo Kawaguchia Fumio Shimamoto c Kiyohiko Dohia Keizo Suginoa Hideki Ohdan d a
Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan; Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, c Hiroshima, Japan; Department of Pathology, Faculty of Human Culture and Science, d Prefectural University of Hiroshima, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institution of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan b
Keywords Acute cholecystitis · Carbohydrate antigen 19-9 · High elevation · Positron emission tomography-computed tomography Abstract Serum carbohydrate antigen 19-9 (CA 19-9), a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET)computed tomography (CT) findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The Creactive protein (CRP) level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3) without tumor shadows in the
Masataka Banshodani Department of Artificial Organs, Akane-Foundation Tsuchiya General Hospital, 3-30, Nakashimacho, Naka-ku Hiroshima 730-8655 (Japan) E-Mail [email protected]
411
Case Rep Gastroenterol 2016;10:410–416 10.1159/000448068
© 2016 The Author(s). Published by S. Karger AG, Basel www.karger.com/crg
Akimoto et al.: Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9
liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy. © 2016 The Author(s) Published by S. Karger AG, Basel
Introduction
Carbohydrate antigen 19-9 (CA 19-9), which was first described by Koprowski et al. [1] in 1979, is produced in the biliary and pancreatic ductal cells. A CA 19-9 level of
© 2016 The Author(s) Published by S. Karger AG, Basel www.karger.com/crg
This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.
Single Case
Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9 Shuji Akimotoa, d Masataka Banshodani b Masahiro Nishiharaa Junko Nambu a Yasuo Kawaguchia Fumio Shimamoto c Kiyohiko Dohia Keizo Suginoa Hideki Ohdan d a
Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan; Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, c Hiroshima, Japan; Department of Pathology, Faculty of Human Culture and Science, d Prefectural University of Hiroshima, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institution of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan b
Keywords Acute cholecystitis · Carbohydrate antigen 19-9 · High elevation · Positron emission tomography-computed tomography Abstract Serum carbohydrate antigen 19-9 (CA 19-9), a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET)computed tomography (CT) findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The Creactive protein (CRP) level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3) without tumor shadows in the
Masataka Banshodani Department of Artificial Organs, Akane-Foundation Tsuchiya General Hospital, 3-30, Nakashimacho, Naka-ku Hiroshima 730-8655 (Japan) E-Mail [email protected]
411
Case Rep Gastroenterol 2016;10:410–416 10.1159/000448068
© 2016 The Author(s). Published by S. Karger AG, Basel www.karger.com/crg
Akimoto et al.: Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9
liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy. © 2016 The Author(s) Published by S. Karger AG, Basel
Introduction
Carbohydrate antigen 19-9 (CA 19-9), which was first described by Koprowski et al. [1] in 1979, is produced in the biliary and pancreatic ductal cells. A CA 19-9 level of
