Supra-elevated CA 19-9 in a benign hepatic cyst adenoma

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Elevated cancer antigen 19-9 (CA 19-9) is observed in both benign liver cystadenomas and malignant cystadenocarcinomas.
• Distinguishing between benign and malignant hepatic cystic neoplasms based solely on CA 19-9 can be challenging.

Purpose of the Study:

• To evaluate the diagnostic utility of CA 19-9 in differentiating benign from malignant hepatic cystic neoplasms.
• To determine if elevated CA 19-9 levels should influence the decision for surgical resection of liver cystic lesions.

Main Methods:

• Case presentation of a 59-year-old woman with a right upper quadrant mass and significantly elevated CA 19-9.
• Diagnostic imaging including CT scan to characterize the cystic liver mass.
• Surgical resection (right hepatectomy) followed by pathological analysis.

Main Results:

• The patient presented with symptoms of abdominal pain, malaise, and weight loss.
• Preoperative CA 19-9 level was markedly elevated at 68,661 U/ml.
• Post-hepatectomy, CA 19-9 levels normalized, and pathological examination confirmed a benign cystadenoma, excluding malignancy.

Conclusions:

• An elevated CA 19-9 level in the context of hepatic cystic neoplasms is not a definitive marker for malignancy.
• High CA 19-9 levels should not deter clinicians from surgical intervention for suspected hepatic cystic neoplasms.
• Surgical resection remains a crucial management strategy for hepatic cystic neoplasms, regardless of CA 19-9 levels.