[Persistent elevation of Ca 19-9 and an unexpected finding. A case report].
BACKGROUND
Tumour markers are substances produced by the tumour itself, or by the host in response to a tumour. These markers could be measured either in the blood or in body secretions. One of the most common tumour markers used in gastrointestinal diseases is Ca 19-9. It is the marker most used for pancreatic cancer, but can be elevated in many benign processes. Thus, it is not a specific marker.


METHODS
The case is presented of a male patient with 4 years of moderate abdominal pain, weight loss, and persistent elevation of Ca 19-9. After an extensive work-up, renal and hepatic cysts were found, as well as steatosis and, apparently, a gallbladder polyp. With these findings and the persistent elevation of Ca 19-9, it was decided to operate the patient. An exploratory laparoscopy was performed showing multiple, yellowish nodular lesions all over the hepatic surface suggestive of metastases, as well as simple hepatic cysts. Pathology reported biliary hamartomas, steatosis, and chronic cholecystitis. After 2years of follow up, although there is no evidence of malignant neoplasia, there is still an elevation of Ca 19-9.


CONCLUSIONS
The persistent elevation of Ca 19-9 is probably due to the presence of multiple benign diseases such as steatosis, urolithiasis, hepatic and renal cysts, and cholecystitis. An algorithm is needed for healthy patients with elevated levels of Ca 19-9 marker, in order to lower costs, avoid misdiagnoses, and improve management.
Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México. Electronic address: lmsg1987@hotmail.com.
Luis Manuel
LM
Souza-Gallardo
Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Mauricio
M
de la Fuente-Lira
Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Roberto
R
Galaso-Trujillo
Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
José Luis
JL
Martínez-Ordaz
D018395:CA-19-9 Antigen / Q000097:blood*; D002764:Cholecystitis / Q000097:blood / Q000150:complications; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000097:blood / Q000150:complications / Q000473:pathology; D006222:Hamartoma / Q000097:blood* / Q000150:complications / Q000473:pathology / Q000601:surgery; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000150:complications; D008107:Liver Diseases / Q000097:blood* / Q000150:complications / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000150:complications
D018395:CA-19-9 Antigen
Benign; Benigno; Biliar; Biliary; Ca 19-9; Hamartomas; Von Meyenburg