Michael Heffernan, MD, Edward Cay, DO, Sheila Eswaran, MD, MS Rush University Medical Center, Chicago, IL
Introduction: Elevations of carbohydrate antigen (CA) 19-9 are associated with pancreatobiliary cancers, hepatocellular cancer, and rarely gastric, ovarian, and colorectal cancers. The most common benign conditions associated with an elevated CA 19-9 are cholestatic diseases. This case represents a rare instance of an elevated CA 19-9 associated with a benign liver cyst, in a patient with no evidence of malignancy.
Case Description/Methods: A 69 year-old woman with past medical history of laparoscopic removal of pancreatic cyst, hypertension, dyslipidemia, chronic constipation, presented to the emergency department for progressively worsening abdominal pain and associated bloating and nausea for several months. Contrast enhanced computed tomography showed a 13 x 10 x 13 cm complex hepatic cyst. Her liver chemistries were within normal limits, however, CA 19-9 was 7,213 U/mL. Patient subsequently underwent aspiration of liver cyst with interventional radiology, with 1,100 mL of brown fluid removed. She had improvement of her abdominal pain, shortness of breath, and early satiety. Fluid studies were negative for infection or malignancy. Repeat CA 19-9 measured at 254 U/mL. Follow-up magnetic resonance imaging 4 weeks later showed recurrence of complex cyst at 15 x 11 x 13 cm at the left hepatic lobe and return of the patient’s symptoms. Upon discussion at a multidisciplinary tumor board, the patient was referred for left hepatectomy.
Discussion: CA 19-9 elevation in patients without evidence of malignancy represents a rare clinical scenario in which guidelines are not well defined. CA 19-9 elevations have been seen in other benign conditions including hepatitis, cirrhosis, and cholecystitis. She did not have evidence of these conditions given otherwise normal serologic and imaging evaluation. This patient had improvement of her CA 19-9 level after aspiration of the cyst and her fluid studies were negative for malignancy. However, the association between the cyst and the elevated CA 19-9 is unclear, given lack of evidence in the literature. This presents a unique scenario in which a decision must be made for long term monitoring of her CA 19-9 and a need for developing specific guidelines to appropriately manage similar patient scenarios.
Figure: Figure 1. (A) MRI and (B) CT imaging demonstrating a large complex cyst in the left hepatic lobe.
Disclosures:
Michael Heffernan indicated no relevant financial relationships.
Edward Cay indicated no relevant financial relationships.
Sheila Eswaran indicated no relevant financial relationships.
Michael Heffernan, MD, Edward Cay, DO, Sheila Eswaran, MD, MS. P1417 - CA 19-9 Elevation in a Benign Hepatic Cyst, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
