Gallbladder mass with a carbohydrate antigen 19-9 level in the thousands: malignant or benign pathology? Report of a case.
Tumor markers such as carbohydrate antigen 19-9 (CA 19-9) are commonly measured in the serum of patients with suspected pancreaticobiliary malignancies. Moderate elevations of CA 19-9 may be seen in benign disease, but levels in the thousands are indicative of malignancy. We report the case of a 64-year-old man with an elevated CA 19-9 of 5791 U/ml and radiological findings suggestive of metastatic gallbladder carcinoma. The patient underwent cholecystectomy and excision of a common bile duct stricture, with hepaticojejunostomy and liver biopsy. The final surgical pathology was consistent with xanthogranulomatous cholecystitis (XGC) and the elevated CA 19-9 returned to normal postoperatively. Thus, an elevated CA 19-9 level, even in the thousands, should not preclude patients from an operation if a mass is deemed resectable. Thorough investigation and treatment may result in a curative operation even if unresectable malignant disease is initially suspected.
Clarke
Tatyan
T
Division of Hepatobiliary/Pancreatic Surgery and Abdominal Organ Transplantation, Keck School of Medicine, University of Southern California, University Hospital, Los Angeles, CA 90033, USA.
Matsuoka
Lea
L
Jabbour
Nicolas
N
Mateo
Rodrigo
R
Genyk
Yuri
Y
Selby
Rick
R
Gagandeep
Singh
S
D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D002763:Cholecystectomy; D002764:Cholecystitis / Q000097:blood* / Q000601:surgery; D003937:Diagnosis, Differential; D006099:Granuloma / Q000097:blood* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D014973:Xanthomatosis / Q000097:blood* / Q000601:surgery
D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen