Giant simple hepatic cyst with multiple elevated serum tumor markers: A case report

Area of Science:

• Hepatology
• Oncology
• Radiology

Background:

• Simple hepatic cysts are common, often asymptomatic incidental findings in adults.
• Large hepatic cysts can occasionally cause symptoms and may be associated with elevated serum biomarkers.
• Elevated protein induced by vitamin K absence (PIVKA)-II, cancer antigen (CA) 12-5, and CA19-9 typically suggest malignant liver or bile duct tumors.

Observation:

• An 84-year-old woman presented with abdominal distension, poor appetite, and weight loss.
• Laboratory tests revealed significantly increased serum levels of PIVKA-II, CA12-5, and CA19-9.
• CT scan showed a giant hepatic cyst (20.1 cm) in the right lobe with mild intrahepatic bile duct dilatation.

Findings:

• This case presents the first report of a hepatic cyst associated with elevated PIVKA-II and CA12-5 levels.
• Percutaneous drainage and sclerotherapy of the giant cyst led to symptom relief.
• Post-treatment, the elevated serum tumor markers PIVKA-II, CA12-5, and CA19-9 dramatically normalized.

Implications:

• Giant hepatic cysts can mimic malignant conditions by causing significant elevation of tumor markers.
• Potential mechanisms for marker elevation include hepatocyte injury from cyst compression and expression of tumor-associated antigens on inflammatory cells.
• This case highlights the importance of considering benign cystic lesions in the differential diagnosis of elevated tumor markers.