Unusually high serum CA19.9 in gastric carcinoma: A case report

We describe a case of poorly differentiated adenocarcinoma of stomach, which did not present typical symptoms of gastrointestinal malignancy on first visit. The patient, a 62 year old smoker presented with shortness of breathe and pain in right lumbar region with no history of fever. Bone scans revealed multiple hot spots in skull, sternum, lumbar vertebrae and both iliac crests. A series of tumor markers were ordered which include PSA, CEA, CA19.9, CA 72.4 and AFP. Serum PSA and AFP concentrations were within normal range. Serum CEA and CA 72.4 were raised significantly. Markedly elevated levels of serum CA19.9 were found (>45000 U/ml) in this patient. CT chest and bronchoscopic examination ruled out the possibility of cancer lung. Upper GI tract endoscopy was done to find out lesion in GI tract. An ulcerative lesion was found in lesser curvature of stomach. Histopathological examination of endoscopic biopsy revealed a poorly differentiated adenocarcinoma of stomach. An unusually high serum CA19.9 (>45000U/ml) in case of gastric carcinoma has not been reported earlier.