Meningeal carcinomatosis preceded by a rapid increase in serum CA19-9 levels in a patient with breast cancer

Abstract

We report a patient with breast cancer who developed meningeal carcinomatosis that was preceded by a rapid increase in the serum level of carbohydrate antigen (CA) 19-9. A 60-year-old woman was admitted for primary breast cancer with multiple metastases to the vertebrae. She received cyclophosphamide 400 mg/m(2), epirubicin 40 mg/m(2), and 5-fluorouracil (5-FU) 400 mg/m(2) (CEF) chemotherapy every 3 weeks. Upon admission, her serum concentrations of carcinoembryonic antigen (CEA) and CA19-9 were 28.6 ng/ml and 99.2 U/ml, respectively. After three cycles of CEF therapy, her serum CEA decreased, and metastases to the vertebrae were attenuated. Her serum CA19-9 rapidly increased, however. A modified radical mastectomy was performed, but her serum CA19-9 levels still remained high (>500 U/ml). After four cycles of CEF therapy, she experienced headaches and vomiting due to an increase in cerebrospinal pressure, and she was diagnosed with meningeal carcinomatosis. At the time of this diagnosis, the concentration of CA19-9 in her cerebrospinal fluid was greater than 500 U/ml, and immunohistochemical examination revealed that carcinoma cells in the cerebrospinal fluid overexpressed CA19-9. To our knowledge, this is the first report of the development of meningeal carcinomatosis from CA19-9-producing breast cancer cells, showing thatCA19-9 expression was associated with breast tumor progression.

Optimal cut-off values for tumor markers in cerebrospinal fluid with ROC curve analysis

“…Tumor markers in cerebrospinal fluid may be used for the early diagnosis of meningeal carcinomatosis (1)(2). However, normal reference values for these markers have not yet been established.…”

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

“…CA 19-9 is most valuable as a serum marker for pancreatic and biliary cancer, but increased concentrations occur in several other gastrointestinal (GI) malignancies, e.g., gastric, colorectal and liver cancer and also in breast, lung and gynecological cancers (4)(5)(6)(7)(8)(9)(10). However, elevated levels may also occur in benign diseases (11)(12)(13)(14)(15).…”