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Ciesielka J, Jakimów K, Tekiela N, Peisert L, Kwaśniewska A, Kata D, Chudek J. Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL. J Clin Med 2024; 13:1263. [PMID: 38592088 PMCID: PMC10932348 DOI: 10.3390/jcm13051263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND CA 19-9 is a commonly assessed tumor marker, considered characteristic of pancreatic ductal adenocarcinoma (PDAC) and biliary tract cancers; however, the positive predictive value of CA 19.9 is too low, and the usage of CA 19.9 as a screening tool in the healthy population remains controversial. METHODS The presented case illustrates a reversed diagnosis of highly elevated serum CA 19-9 levels in a 54-year-old female complaining of pain in the epigastric region, shortly after COVID-19 vaccination. Laboratory tests showed a significantly elevated level of the CA 19-9 marker (>12,000 U/mL, reference value: <37 U/mL) with normal pancreatic enzyme activity. The patient underwent imaging examination, which showed no abnormalities, except for increased pancreatic dimension and areas of fluid signal in the pancreas in magnetic resonance imaging (MRI), which may correspond to autoimmune pancreatitis (AIP). The patient remains asymptomatic with a recommendation for a follow-up MRI in 12 months. RESULTS A literature review conducted revealed multi-causal CA 19-9 increases above 1000 U/mL, including non-cancerous diseases of the lung, pancreas, liver, ovary, kidney, and others. The median concentration of CA 19-9 regardless of the cause of disease was 2810 U/mL (IQR ± 6895). The median CA 19-9 values in men and women were 3500 (IQR ± 10,050) and 2455 (IQR ± 3927), respectively, and differ significantly between the compared groups (p < 0.05). There was no difference between CA 19-9 values and the categorized cause of the increase. CONCLUSIONS Conducting differential diagnosis, it should not be forgotten that most international guidelines recommend the use of CA 19-9 only in conjunction with pathology of pancreas in radiological imaging; however, even such a combination can point the diagnostic pathway in the wrong direction. A highly elevated CA 19-9 level, typically associated with PDAC, may be the result of benign disease including AIP related to COVID-19 vaccination.
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Affiliation(s)
- Jakub Ciesielka
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Krzysztof Jakimów
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Natalia Tekiela
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Laura Peisert
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Anna Kwaśniewska
- Department of Radiology, The Mielecki Hospital, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Dariusz Kata
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
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Cleva M, Vaivoda A, Boscarelli A, Codrich D, Spezzacatene A, Murru FM. Giant non-parasitic mixed splenic cyst in a child. J Paediatr Child Health 2023; 59:175-177. [PMID: 36124936 DOI: 10.1111/jpc.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/30/2022] [Accepted: 08/27/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Mirco Cleva
- Department of Radiology, University of Trieste, ASUGI, Ospedale di Cattinara, Trieste, Italy
| | - Anna Vaivoda
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessandro Boscarelli
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Daniela Codrich
- Department of Pediatric Surgery and Urology, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Anita Spezzacatene
- Radiology Department, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Flora M Murru
- Radiology Department, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
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Shinkawa N, Horinouchi H, Shinkawa N, Imamura N, Fukushima T. Carbohydrate antigen 19-9-producing splenic cyst: a case report. Radiol Case Rep 2022; 17:19-22. [PMID: 34760035 PMCID: PMC8567163 DOI: 10.1016/j.radcr.2021.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
We describe the case of a 40s woman with a carbohydrate antigen (CA)19-9-producing splenic cyst. The lesion was detected incidentally at the splenic hilum, and resected after 5 years of follow-up. Size of the lesion was enlarged from 1.6 cm to 5.3 cm, and serum CA19-9 was elevated from the normal range to 1766 U/ml. Microscopically, CA19-9-producing splenic cyst was diagnosed. It was mimicked pancreatic malignancy due to its location at the splenic hilum. Benign lesions with elevated serum CA19-9 also to be differential diagnosis.
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Affiliation(s)
- Norihiro Shinkawa
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
- Section of Legal Medicine, Department of Social Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiromi Horinouchi
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Ninako Shinkawa
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoya Imamura
- Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tsuyoshi Fukushima
- Section of Oncopathology and Regenerative Biology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Imoto Y, Einama T, Fukumura M, Kouzu K, Nagata H, Matsunaga A, Hoshikawa M, Nishikawa M, Kimura A, Noro T, Aosasa S, Shimazaki H, Ueno H, Yamamoto J. Laparoscopic fenestration for a large ruptured splenic cyst combined with an elevated serum carbohydrate antigen 19-9 level: a case report. BMC Surg 2019; 19:58. [PMID: 31146770 PMCID: PMC6543565 DOI: 10.1186/s12893-019-0517-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 05/14/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Non-parasitic splenic cysts are associated with elevated serum carbohydrate antigen (CA) 19-9 levels. We report a case in which a 23-year-old female exhibited a large ruptured splenic cyst and an elevated serum CA19-9 level. CASE PRESENTATION The patient, who experienced postprandial abdominal pain and vomiting, was transferred to our hospital and was found to have a large splenic cyst during an abdominal computed tomography (CT) scan. On physical examination, her vital signs were stable, and she demonstrated rebound tenderness in the epigastric region. An abdominal CT scan revealed abdominal fluid and a low-density region (12 × 12 × 8 cm) with enhanced margins in the spleen. The patient's serum levels of CA19-9 and CA125 were elevated to 17,580 U/mL and 909 U/mL, respectively. A cytological examination of the ascitic fluid resulted in it being categorized as class II. Finally, we made a diagnosis of a ruptured splenic epidermoid cyst and performed laparoscopic splenic fenestration. The patient's postoperative course was uneventful, and she was discharged on postoperative day 5. The cystic lesion was histopathologically diagnosed as a true cyst, and the epithelial cells were positive for CA19-9. Follow-up laboratory tests performed at 4 postoperative months showed normal CA19-9 (24.6 U/L) and CA125 (26.8 U/L) levels. No recurrence of the splenic cyst was detected during the 6 months after surgery. CONCLUSION Laparoscopic fenestration of a ruptured splenic cyst was performed to preserve the spleen, after the results of abdominal fluid cytology and MRI were negative for malignancy.
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Affiliation(s)
- Yoshitaka Imoto
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takahiro Einama
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Makiko Fukumura
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Keita Kouzu
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiromi Nagata
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ayano Matsunaga
- Laboratory Department, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Mayumi Hoshikawa
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Makoto Nishikawa
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Akifumi Kimura
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takuji Noro
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Suefumi Aosasa
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hideyuki Shimazaki
- Laboratory Department, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Hideki Ueno
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Junji Yamamoto
- Surgery Department, National Defense Medical College, Tokorozawa, Saitama, Japan
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Pinder RM, Thomas R, Lyndon PJ, Chapple KS. Nonelevation of Serum CA 19-9 Level in a True NonParasitic Splenic Cyst. Surg Laparosc Endosc Percutan Tech 2006; 16:190-4. [PMID: 16804468 DOI: 10.1097/00129689-200606000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The diagnosis and management of true nonparasitic splenic cysts has markedly changed in recent years. The use of serum CA 19-9 has been increasingly advocated for diagnosis, while the advent of minimally invasive surgery has radically altered surgical management. We present the first case of a true nonparasitic splenic cyst in which serum CA 19-9 was not elevated. Treatment was by laparoscopic cyst decapsulation utilising the endoscopic Ligasure.
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Affiliation(s)
- Richard M Pinder
- Department of Surgery, Dewsbury and District Hospital, Mid-Yorkshire NHS Trust, Halifax Road, Dewsbury, West Yorkshire, WF13 4HS.
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Lieto E, Castellano P, Ferraraccio F, Orditura M, De Vita F, Romano C, Pignatelli C, Galizia G. Normal interleukin-10 serum level opposed to high serum levels of carbohydrate antigen 19-9 and cancer antigens 125 and 50 in a case of true splenic cyst. Arch Med Res 2003; 34:145-8. [PMID: 12700012 DOI: 10.1016/s0188-4409(02)00468-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
True cysts of the spleen are rare. In a few cases, high serum levels of carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) have been reported. It has been suggested that they are produced by inner epithelium of the cyst. In such instances, cyst resection or splenectomy is indicated to rule out malignant lesions and to remove cancer antigen-producing epithelium. Furthermore, a high serum level of interleukin (IL)-10, an immunosuppressive cytokine, has been described in many neoplastic diseases, suggesting it as a potential new diagnostic method. Giant cystic lesion of the left upper abdomen associated with ovarian tumor was diagnosed in a young patient. Laboratory data revealed elevated serum levels of several tumor markers [CA 19-9, CEA, cancer antigens (CA) 125 and 50, and tissue polypeptide antigen]. In contrast, IL-10 serum level was normal. After splenectomy and ovariectomy, tumor marker serum levels normalized. Histology and immunohistochemical analysis revealed true splenic cyst with inner epithelium strongly positive for CA 19-9, CEA, and high levels of cancer antigens in fluid. Ovarian lesion was a serous cystoadenoma; its inner epithelium showed no immunoreactivity for tumor markers that were not measurable in fluid. The reported case showed that epithelium lining true splenic cysts may produce, in addition to CA 19-9, CEA, and other tumor markers, in particular CA 125 and CA 50. When malignant disease is suspected, IL-10 serum level could be useful to correctly predict the nature of the lesion.
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Affiliation(s)
- Eva Lieto
- Division of Surgical Oncology, F. Magrassi and A. Lanzara" Department of Clinical and Experimental Medicine, School of Medicine, Second University of Naples, Naples, Italy
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