Elevation of CA 19-9 in Mirizzi Syndrome in the Absence of Malignancy: A Case Report

Moshref, Leena; Mandili, Rasha Abdulaziz; Almaghrabi, Murouj; Abdulwahab, Rahaf A; Alosaimy, Rawan; Miro, Jameel

doi:10.12659/ajcr.931819

Cited by 12 publications

(12 citation statements)

References 11 publications

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“…As for the serum levels of the most commonly used gastrointestinal tumor markers such as CA19‐9, CA 125, AFP, CA 242, and CEA, our study presented a quite interesting result. CA19‐9, which was documented as an upper gastrointestinal malignancies closely associated tumor marker, 13 showed no significant difference between XGC and GBC. What is more, CA125, CA19‐9, CA125, and CA242, which are all reported as diagnostic markers in carcinoma of the gallbladder, 14 , 15 did not show a significant difference between XGC and GBC patients, either.…”

Section: Discussionmentioning

confidence: 90%

Noninvasive preoperative differential diagnosis of gallbladder carcinoma and xanthogranulomatous cholecystitis: A retrospective cohort study of 240 patients

et al. 2021

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Background: Xanthogranulomatous cholecystitis (XGC) is an extremely rare entity. Due to XGC's clinical and radiological resemblance to gallbladder carcinoma (GBC), intraoperative frozen section during cholecystectomy is often performed to exclude the diagnosis of GBC. Our study is aiming to find a noninvasive indicator of XGC. To our knowledge, this is the largest XGC cohort ever studied.Methods: This study retrospectively collected clinical characteristics, serological tests, and imaging features of 150 GBC patients and 90 XGC patients. The diagnosis of these 150 GBC patients and 90 XGC patients was based on intraoperative frozen section histopathology. T-test was utilized to compare differences between XGC and GBC. Receiver operating characteristic (ROC) curve was conducted and the area under the curve (AUC) was managed to evaluate the validity. Results:The carcinoembryonic antigen (CEA) level in blood tests was significantly elevated in GBC patients than in XGC patients (p = 0.007). The presence of submucosal hypo-attenuated nodules (80% in XGC, 16% in GBC, p < 0.001), low density border (60% in XGC, 21% in GBC, p = 0.001), and nodular thickening in the bottom of the gallbladder with calcification (70% in XGC, 37% in GBC, p = 0.004) is significantly associated with XGC patients, whereas massive hilar infiltration (0% in XGC, 21% in GBC, p < 0.001), multiple lymph nodes in the hilar area (10% in XGC, 72% in GBC, p = 0.001), and gallbladder mucosal line continuity (50% in XGC, 95% in GBC, p = 0.002) are highly associated with GBC patients. The ROC curve was performed and the gallbladder mucosal line continuity (AUC = 0.708) and the AUC of low density border around the occupation (AUC = 0.654) showed a good prediction of XGC.Conclusions: Gallbladder mucosal line continuity and low density border around the occupation presented good indication value for the diagnosis of XGC.Our study proposed a noninvasive differential diagnosis method for XGC and GBC.

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Section: Discussionmentioning

confidence: 90%

Noninvasive preoperative differential diagnosis of gallbladder carcinoma and xanthogranulomatous cholecystitis: A retrospective cohort study of 240 patients

et al. 2021

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“…Herein, we report six cases of patients with AIP, causing the elevation of CA 19-9 ranging from 1950 U/mL to 12,000 U/mL, and a case of a patient with liver steatosis and an increased CA 19-9 value to 1930 U/mL. When considering differential diagnosis due to the low specificity of tumor markers and lack of obvious radiological image, various diseases should be taken into consideration [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 68 , 69 ]; however, a mildly increased dimension of the pancreas in MRI with areas of fluid signals could correspond to past AIP that induced increased CA 19-9. According to the literature, about 25% of patients with AIP show values of CA 19-9 > 37 U/mL, and only around 12.2% of them show elevated levels > 100 U/mL [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL

Ciesielka,

Jakimów,

Tekiela

et al. 2024

JCM

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Background: CA 19-9 is a commonly assessed tumor marker, considered characteristic of pancreatic ductal adenocarcinoma (PDAC) and biliary tract cancers; however, the positive predictive value of CA 19.9 is too low, and the usage of CA 19.9 as a screening tool in the healthy population remains controversial. Methods: The presented case illustrates a reversed diagnosis of highly elevated serum CA 19-9 levels in a 54-year-old female complaining of pain in the epigastric region, shortly after COVID-19 vaccination. Laboratory tests showed a significantly elevated level of the CA 19-9 marker (>12,000 U/mL, reference value: <37 U/mL) with normal pancreatic enzyme activity. The patient underwent imaging examination, which showed no abnormalities, except for increased pancreatic dimension and areas of fluid signal in the pancreas in magnetic resonance imaging (MRI), which may correspond to autoimmune pancreatitis (AIP). The patient remains asymptomatic with a recommendation for a follow-up MRI in 12 months. Results: A literature review conducted revealed multi-causal CA 19-9 increases above 1000 U/mL, including non-cancerous diseases of the lung, pancreas, liver, ovary, kidney, and others. The median concentration of CA 19-9 regardless of the cause of disease was 2810 U/mL (IQR ± 6895). The median CA 19-9 values in men and women were 3500 (IQR ± 10,050) and 2455 (IQR ± 3927), respectively, and differ significantly between the compared groups (p < 0.05). There was no difference between CA 19-9 values and the categorized cause of the increase. Conclusions: Conducting differential diagnosis, it should not be forgotten that most international guidelines recommend the use of CA 19-9 only in conjunction with pathology of pancreas in radiological imaging; however, even such a combination can point the diagnostic pathway in the wrong direction. A highly elevated CA 19-9 level, typically associated with PDAC, may be the result of benign disease including AIP related to COVID-19 vaccination.

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“…Tumor antigens and ectopic hormones, such as CEA, AFP, NSE, CA50, CA724, CA125, etc., are currently the most often utilized tumor biomarkers in clinic [27][28][29][30][31]. CEA is a broad-spectrum tumor marker that can be used to assess e cacy, monitor disease progression, and predict prognosis in lung cancer, colorectal cancer, breast cancer, and other cancers [32][33][34].…”

Section: Discussionmentioning

confidence: 99%

A simple and available measurement of onco-exosome dsDNA to protein ratio as a potential tumor marker

Sun

Zhang

et al. 2023

Preprint

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Background: Exosomes have great potential as new biomarkers in liquid biopsy. However, due to the limitations of exosome extraction and component analysis procedures, further clinical applications of exosomes are hampered. Carcinoembryonic antigen (CEA) is a commonly used broad-spectrum tumor marker that is strongly expressed in a variety of malignancies. Results: In this study, CEA+ exosomes were directly separated from serum using immunomagnetic beads, and the nucleic acid to protein ultraviolet absorption ratio (NPr) of CEA+ exosomes was determined. It was found that the NPr of CEA+ exosomes in tumor group was higher than that of healthy group. We further analyzed the exosome-derived nucleic acid components using fluorescent staining and found that the concentration ratio of double-stranded DNA to protein (dsDPr) in CEA+ exosomes was also significantly different between the two groups, with a sensitivity of 100% and a specificity of 41.67% for the diagnosis of pan-cancer. The AUC of dsDPr combined with NPr was 0.87 and the ACU of dsDPr combined with CA242 could reach 0.94, showing good diagnostic performance for pan-cancer. Conclusions: This study demonstrates that the dsDPr of CEA+ exosomes can effectively distinguish exosomes derived from tumor patients and healthy individuals, which can be employed as a simple and cost-effective non-invasive screening technology to assist tumor diagnosis.

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Elevation of CA 19-9 in Mirizzi Syndrome in the Absence of Malignancy: A Case Report

Cited by 12 publications

References 11 publications

Noninvasive preoperative differential diagnosis of gallbladder carcinoma and xanthogranulomatous cholecystitis: A retrospective cohort study of 240 patients

Noninvasive preoperative differential diagnosis of gallbladder carcinoma and xanthogranulomatous cholecystitis: A retrospective cohort study of 240 patients

Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL

A simple and available measurement of onco-exosome dsDNA to protein ratio as a potential tumor marker

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