Persistent Elevation of Serum CA 19-9 without Evidence of Malignant Disease

Ventrucci M, Pozzato P, Cipolla A

Department of Internal Medicine and Gastroenterology, Bentivoglio Hospital. Bologna, Italy

Context Serum CA 19-9 is a marker widely used for digestive malignancies. However, in various benign diseases its elevation can also be observed; obstructive jaundice, liver disease, acute and chronic pancreatitis, diabetes mellitus, interstitial pulmonary disease and collagen vascular disease are such examples. We report a case of marked and persistent increase of serum CA-19-9 in a patient, currently in healthy conditions, who was admitted to our hospital because of severe diarrhoea.

Case report A 70-year-old woman was referred to our unit in 2002 for acute watery diarrhoea, lower left quadrant pain, vomit and fever. In her past medical history there was an episode of acute diarrhoea in 1960 and an endoscopic resection of a villous adenoma measuring 1.5 cm with low grade dysplasia in 1981. At admission, blood tests were normal except for C-reactive protein (17.5 mg/dL), haemoglobin (11.4 g/dL), albumin 2.2 g/dL, and CA 19-9 (514 U/mL). Abdominal ultrasonography, upper gastrointestinal series and endoscopy were negative. Abdominal CT-scan revealed normal liver and pancreas, but thickened wall of the right colon and a paracolic fluid collection. Colonoscopy showed lesions that were characterized by having a cobblestone surface, and exudative yellow plaques from the transverse colon to cecum with hyperaemia and focal haemorrhage. Histology demonstrated the presence of chronic, non specific, inflammation of the lamina propria. Initial treatment with mesalazine and antibiotics was ineffective, while methylprednisolone, 60 mg i.v. dramatically ameliorated the symptoms within 2 weeks. The patient was discharged in apparently healthy conditions. Serum CA 19-9 was determined repeatedly: initially values fluctuated from 620 U/mL to normal values (in two sessions), but starting from 2003 levels were consistently elevated and a test performed in march 2005 showed markedly high values (1,331 U/mL). During follow up she underwent abdominal ultrasonographies, upper and lower GI endoscopies and CT scans which were always normal. A positron emission tomography performed in 2004 with 18F-FDG was also negative. At present, the patient is in an apparently healthy condition, her weight is stable, appetite is conserved and bowel movements are regular. Current blood tests are normal except for high triglyceride (264 mg/dL) and cholesterol (225 mg/dL) levels. Nitrites, leukocyte and bacteria are present in urine. Serum CA 19-9 value is 528 U/mL, while all the other tumour markers are normal. MRCP and endoscopic ultrasonography for the study of the pancreas will be performed in the near future.

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