Biliary Obstruction Induces Extremely Elevated Serum CA 19-9 Levels: Case Report

Abstract

Background: Assessment of carbohydrate antigen (CA) 19-9 levels is used for diagnosis and follow-up of pancreaticobiliary cancers, and high levels of this biomarker are suggestive of a malignancy. CA 19-9 may also be elevated in patients with conditions other than tumors, such as cholestasis, biliary obstruction, and cholecystitis. Case Report: A 50-year-old male patient presented with jaundice and elevated CA 19-9 levels (161,902 IU/ml). Repeated biopsies of the common bile duct revealed no malignancies. Radiological findings indicated a mass protruding through the common bile duct. Positron emission tomography demonstrated increased ¹⁸F-fluoro2-deoxy-D-glucose uptake in the liver and a mass resembling metastasis was detected. A Whipple procedure was performed and demonstrated no tumor. Postoperatively, CA 19-9 levels decreased to within normal limits (27 IU/ml). Conclusion: These results indicate that CA 19-9 levels should not be the sole criterion for a diagnosis of malignancy. Although other analytical tools may aid diagnosis, surgical exploration may be required in some instances to avoid misdiagnosis and determine whether radiological results are falsely positive.

Clinical utility of determining tumor markers in patients with signs and symptoms of cancer

“…The use of group-specific cut-off points rather than a single cut-off point for all patients improved sensitivity in all the groups. The group without hepatic or renal dysfunctions according to laboratory parameters showed lower concentrations for all markers than patients with abnormalities, corroborating previous reports in the literature [9][10][11][12][13].…”