Very high CEA level in a large pancreatic cyst: is it a surgical indication by itself?
BACKGROUND
Pancreatic mucinous cystic lesions might develop malignancy if untreated, or could harbor malignancy at the time of the diagnosis. Many reports stated that cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts.


METHODS
A man with a incidental pancretic cystic lesion of 35 mm in diameter was admitted to our Department. CT and EUS did not reveal solid components, main duct was not dilated and cyst fluid CEA was very high (1445 ng/ml).


RESULTS
The patient underwent a pancreatoduodenectomy and the surgical specimen showed a pseudocyst with columnar mucinous epithelium, consistent with low-grade PanIN.


CONCLUSIONS
Is it possible that the mucinous epithelium of panIN was responsible for the unexpectedly high CEA value? Clinicians should be aware of the usefulness of the CEA level in cystic fluid but even a very high CEA value should not be considered by itself to be evidence of a mucinous lesion.
Department of Surgery, Maggiore Hospital, L.go B. Nigrisoli 2, 40131-Bologna, Italy. nicozanini@gmail.com
Nicola
N
Zanini
Adele
A
Fornelli
Marta
M
Fiscaletti
Carlo
C
Fabbri
Raffaele
R
Lombardi
Anna Maria
AM
Polifemo
Paola
P
Baccarini
Michele
M
Masetti
Elio
E
Jovine
D002272:Carcinoembryonic Antigen / Q000032:analysis*; D020420:Cyst Fluid / Q000737:chemistry*; D019160:Endosonography; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000000981:diagnostic imaging / Q000473:pathology*; D010181:Pancreatic Cyst / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery
D002272:Carcinoembryonic Antigen