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Increased serum CA19-9 in patients with xanthogranulomatous cholecystitis
1Department of Surgery, Saiseikai Yahata General Hospital, Kitakyushu, Japan.
Insights
Xanthogranulomatous cholecystitis (XGC) can elevate serum carbohydrate antigen 19-9 (CA19-9) levels, mimicking malignancy. Early diagnosis and treatment are crucial for patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Xanthogranulomatous cholecystitis (XGC) is a rare, severe form of chronic cholecystitis.
- Elevated serum carbohydrate antigen 19-9 (CA19-9) levels are often associated with gastrointestinal malignancies, particularly pancreatic and biliary cancers.
Observation:
- Three elderly female patients presented with symptoms suggestive of biliary disease and significantly elevated serum CA19-9 levels.
- All patients had gallstones impacted in the gallbladder neck, a common finding in XGC.
- Histopathological examination confirmed XGC following cholecystectomy.
Findings:
- Preoperative CA19-9 levels ranged from 87 to 709 U/ml.
- Post-treatment CA19-9 levels normalized in two patients who recovered well.
- One patient experienced a recurrence of elevated CA19-9 and succumbed to cholangitis, highlighting potential complications.
Implications:
- XGC should be considered in the differential diagnosis of elevated CA19-9 levels, especially in elderly patients with gallstones.
- Accurate diagnosis and timely surgical intervention are vital for managing XGC and improving patient prognosis.
- This highlights the importance of considering benign conditions that can mimic malignant markers.
Abstract:
We present three cases of xanthogranulomatous cholecystitis (XGC) with an increased serum carbohydrate antigen 19-9 (CA19-9). All of the patients were elderly females and had gallstones lodged in the neck of the gallbladder. Preoperative serum CA19-9 levels were 709 U/ml, 87 U/ml, and 400 U/ml, respectively. A cholecystectomy with or without bile duct exploration was performed, and the histological diagnosis of XGC was made. Serum CA19-9 levels fell to normal levels in two patients who recovered uneventfully, but rose again in one patient who died of cholangitis. Clinicians must remember that XGC is a possible cause of increased serum CA19-9 levels.