血清CA19-9が高値を示した胆嚢結石症の1例

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  • A CASE OF CHOLECYSTOLITHIASIS WITH HIGH VALUE OF SERUM CA19-9

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A 73-year-old male was seen at the hospital because of a fever and jaundice. Laboratory tests on admission revealed leukocytosis, jaundice, and an elevation in serum CA19-9 (530U/ml). An abdominal ultrasonography and computed tomography showed wall thickening, an elevated lesion in the gallbladder and cholecystolithiasis. Entertaining a possibility of malignancy of the gallbladder, we performed cholecystectomy under a diagnosis of cholangitis with cholecystolithiasis after improvement of cholangitis. The postoperative level of serum CA19-9 fell rapidly into the normal range. Pathologic examination revealed chronic cholecystitis, but did not reveal any malignancy. Immunohistochemical staining of CA199 revealed positive reaction on the epithelium of the gallbladder. It is suggested that CA19-9 may be secreted from the gallbladder epithelium and flows back into blood in a situation of cholecystitis or obstruction of the bile duct. It is known that CA19-9 is a tumor marker indicating biliary malignancies, however, it also increases with benign disease such as cholecystolithiasis in which CA19-9 decreases with disappearance of jaundice like this case. We should carefully make a diagnosis for a patient with an increased CA19-9 after overall consideration of imagings and clinical course.

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