title: Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9.
abstract: Serum carbohydrate antigen 19-9 (CA 19-9), a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET)-computed tomography (CT) findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The C-reactive protein (CRP) level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3) without tumor shadows in the liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy.
authors.affiliation: Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institution of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Akimoto
authors.affiliation: Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Banshodani
authors.affiliation: Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nishihara
authors.affiliation: Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Nambu
authors.affiliation: Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kawaguchi
authors.affiliation: Department of Pathology, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Shimamoto
authors.affiliation: Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Dohi
authors.affiliation: Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Sugino
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institution of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
keywords: Acute cholecystitis; Carbohydrate antigen 19-9; High elevation; Positron emission tomography-computed tomography