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Pseudomyxoma peritonei with high serum CA19-9: report of three cases
C M Kuo1, C H Kuo, C S Changchien
1Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Abstract:
Pseudomyxoma peritonei (PMP) is an unusual form of intraabdominal neoplasm that produces a large amount of extracellular mucin. It is often associated with mucinous tumors of gastrointestinal tract or ovary. Herein, we report 3 patients with pseudomyxoma peritonei with high serum carbohydrate antigen 19-9 (CA19-9) levels. The first patient, who had a CA19-9 level of 1132 U/ml, had well-differentiated rectal cancer and died of chemotherapy complications, pneumonia and septic shock; one month after admission. The other 2 cases with CA19-9 levels of 2520 U/ml and 679 U/ml had tumors of unknown origins and had survived more than 1 year and 3 months after treatment, respectively. Usually, elevated serum CA19-9 levels are found in patients with pancreatic, biliary, colorectal, gastric or liver cancers. However, many studies have shown high serum CA19-9 levels are associated with mucinous carcinoma. Immunochemical studies also showed positive staining of CA19-9 in mucinous tumors. PMP is composed of large amounts of mucin, therefore, we suggest that serum and ascites CA19-9 levels should be routinely checked in patients with PMP.
Insights
Pseudomyxoma peritonei (PMP) is a rare abdominal cancer producing mucin. High serum levels of carbohydrate antigen 19-9 (CA19-9) were observed in PMP patients, suggesting its utility as a biomarker.
Area of Science:
- Oncology
- Gastroenterology
- Pathology
Background:
- Pseudomyxoma peritonei (PMP) is a rare intra-abdominal neoplasm characterized by extensive extracellular mucin production.
- PMP is frequently associated with mucinous tumors originating from the gastrointestinal tract or ovaries.
Observation:
- This report details three pseudomyxoma peritonei cases presenting with significantly elevated serum carbohydrate antigen 19-9 (CA19-9) levels.
- One patient with rectal cancer and a CA19-9 level of 1132 U/ml experienced a fatal outcome due to chemotherapy complications.
- Two patients with PMP of unknown origin and CA19-9 levels of 2520 U/ml and 679 U/ml demonstrated survival exceeding one year and three months post-treatment, respectively.
Findings:
- Elevated serum CA19-9 is typically linked to pancreatic, biliary, colorectal, gastric, or liver cancers.
- Research indicates a strong association between high serum CA19-9 levels and mucinous carcinomas.
- Immunochemical analyses confirm positive CA19-9 staining in mucinous tumors, consistent with PMP's mucin-rich composition.
Implications:
- The findings suggest that serum and ascites CA19-9 levels may serve as valuable biomarkers in patients diagnosed with pseudomyxoma peritonei.
- Routine monitoring of CA19-9 in PMP patients could aid in disease assessment and management.
- Further investigation into CA19-9 as a diagnostic and prognostic marker for PMP is warranted.