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Ciesielka J, Jakimów K, Tekiela N, Peisert L, Kwaśniewska A, Kata D, Chudek J. Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL. J Clin Med 2024; 13:1263. [PMID: 38592088 PMCID: PMC10932348 DOI: 10.3390/jcm13051263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND CA 19-9 is a commonly assessed tumor marker, considered characteristic of pancreatic ductal adenocarcinoma (PDAC) and biliary tract cancers; however, the positive predictive value of CA 19.9 is too low, and the usage of CA 19.9 as a screening tool in the healthy population remains controversial. METHODS The presented case illustrates a reversed diagnosis of highly elevated serum CA 19-9 levels in a 54-year-old female complaining of pain in the epigastric region, shortly after COVID-19 vaccination. Laboratory tests showed a significantly elevated level of the CA 19-9 marker (>12,000 U/mL, reference value: <37 U/mL) with normal pancreatic enzyme activity. The patient underwent imaging examination, which showed no abnormalities, except for increased pancreatic dimension and areas of fluid signal in the pancreas in magnetic resonance imaging (MRI), which may correspond to autoimmune pancreatitis (AIP). The patient remains asymptomatic with a recommendation for a follow-up MRI in 12 months. RESULTS A literature review conducted revealed multi-causal CA 19-9 increases above 1000 U/mL, including non-cancerous diseases of the lung, pancreas, liver, ovary, kidney, and others. The median concentration of CA 19-9 regardless of the cause of disease was 2810 U/mL (IQR ± 6895). The median CA 19-9 values in men and women were 3500 (IQR ± 10,050) and 2455 (IQR ± 3927), respectively, and differ significantly between the compared groups (p < 0.05). There was no difference between CA 19-9 values and the categorized cause of the increase. CONCLUSIONS Conducting differential diagnosis, it should not be forgotten that most international guidelines recommend the use of CA 19-9 only in conjunction with pathology of pancreas in radiological imaging; however, even such a combination can point the diagnostic pathway in the wrong direction. A highly elevated CA 19-9 level, typically associated with PDAC, may be the result of benign disease including AIP related to COVID-19 vaccination.
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Affiliation(s)
- Jakub Ciesielka
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Krzysztof Jakimów
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Natalia Tekiela
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Laura Peisert
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Anna Kwaśniewska
- Department of Radiology, The Mielecki Hospital, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Dariusz Kata
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
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Wang Y, Yang S, Li B, Shuai C, Xiong X, Lu J. Epidemiology, risk factors, diagnosis, and treatment of intra-abdominal traumatic neuromas - a narrative review. BMC Gastroenterol 2023; 23:416. [PMID: 38017468 PMCID: PMC10683309 DOI: 10.1186/s12876-023-03049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
Traumatic neuroma (TN) is a disorganized proliferation of injured nerves arising from the axons and Schwann cells. Although TN rarely occurs in the abdominal cavity, the incidence of TN may be underestimated because of the large number of asymptomatic patients. TN can cause persistent pain, which seriously affects quality of life. TN of the biliary system can cause bile duct obstruction, leading to acute cholangitis. It is difficult to differentiate TN from malignancies or recurrence of malignancy, which results in a number of patients receiving aggressive treatment. We collected cases reports of intra-abdominal TN over the past 30 years form PubMed and cases diagnosed in our medical center over the past 20 years, which is the largest case series of intra-abdominal TN to the best of our knowledge. In this review, we discuss the epidemiology, pathophysiology, risk factors, classification, diagnosis, and management of intra-abdominal TN.
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Affiliation(s)
- Yaoqun Wang
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Sishu Yang
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Bei Li
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Cunyong Shuai
- Department of Hepatobiliary Surgery, Sichuan Provincial Corps Hospital, Chinese People's Armed Police Forces, Leshan, China.
| | - Xianze Xiong
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Jiong Lu
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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Vassos N, Perrakis A, Schmid A, Croner RS, Gruetzmann R, Agaimy A. Diffuse Neuromatosis of Intrahepatic and Extrahepatic Bile Ducts as a Rare Cause of Jaundice. Visc Med 2020; 37:226-232. [PMID: 34250082 DOI: 10.1159/000510486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background Neuroma of the biliary tree is extremely rare with no more than 100 cases reported so far. They mostly present with obstructive jaundice and have been commonly described after surgery or abdominal trauma. Although involvement of the extrahepatic bile duct is far more common, occurrence in the intrahepatic ducts has not so far been reported. Case Report We describe 3 cases of diffuse biliary tree neuroma affecting 3 females aged 53-68 years. None had a history of neurofibromatosis type1. All presented with progressive obstructive jaundice with no evidence of gallstones. A history of previous surgery was noted in 2 patients. Initial impression on clinical and imaging examination was highly suspicious for bile duct carcinoma in 2 patients. Histology showed diffuse neuromatous proliferation replacing and thickening the bile duct walls. The third patient had concurrent neuroma and recurrent cholangiocarcinoma causing great clinical confusion as initial biopsy showed only benign neuroma, but CA 19-9 was steadily increasing, necessitating a second biopsy which then confirmed recurrent carcinoma. Conclusion This uncommon cause of long-distance bile duct stenosis and progressive jaundice should be included in the differential diagnosis of bile duct neoplasms, in particular when there is a previous surgical history in this abdominal region.
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Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany.,Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | | | - Axel Schmid
- Department of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Roland S Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Gruetzmann
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, University Hospital Erlangen, Erlangen, Germany
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Kim DH, Park JH, Cho JK, Yang JW, Kim TH, Jeong SH, Kim YH, Lee YJ, Hong SC, Jung EJ, Ju YT, Jeong CY, Kim JY. Traumatic neuroma of remnant cystic duct mimicking duodenal subepithelial tumor: A case report. World J Clin Cases 2020; 8:3821-3827. [PMID: 32953859 PMCID: PMC7479553 DOI: 10.12998/wjcc.v8.i17.3821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/22/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastrointestinal subepithelial tumors (GSTs), incidentally detected during upper gastrointestinal (GI) endoscopy, may be lesions derived from the GI wall or may be caused by compression from external organs. In general, traumatic neuroma is a benign nerve tumor that results from postoperative nerve injury, occurring in the bile duct as one of the complications after cholecystectomy. This is the first case report demonstrating that neuroma of the cystic duct can be incorrectly perceived as a duodenal subepithelial tumor by compressing the duodenal wall.
CASE SUMMARY We report the case of a 72-year-old man with traumatic neuroma of the cystic duct after cholecystectomy. This tumor was mistaken for a duodenal subepithelial tumor on preoperative upper GI endoscopy and endoscopic ultrasonography due to external compression of the GI wall. The patient had no symptoms, and his laboratory test results were normal. However, in a series of follow-up endoscopies, the tumor was found to have grown in size, so it was surgically resected. The lesion was completely removed by laparoscopic endoscopic cooperative surgery. The patient was discharged on postoperative day 7 without complications.
CONCLUSION Traumatic neuroma of the cystic duct can be mistaken for GSTs in GI endoscopy.
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Affiliation(s)
- Dong-Hwan Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Jin-Kyu Cho
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Jung-Wook Yang
- Department of Pathology, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Tae-Han Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Young-Hye Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
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Lalchandani P, Korn A, Lu JG, French SW, Hou L, Chen KT. Traumatic bile duct neuroma presenting with acute cholangitis: A case report and review of literature. Ann Hepatobiliary Pancreat Surg 2019; 23:282-285. [PMID: 31501819 PMCID: PMC6728252 DOI: 10.14701/ahbps.2019.23.3.282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/11/2019] [Accepted: 02/21/2019] [Indexed: 12/20/2022] Open
Abstract
Traumatic neuroma of the biliary tree has been previously reported as isolated case reports. In literature, these typically present following prior liver transplant or cholecystectomy, wherein the bile ducts have been disrupted in some form. Here we report the case of a 41-year old male who initially presented with acute cholangitis ten years after an open cholecystectomy complicated by a bile leak. Endoscopic retrograde cholangiography revealed a stricture within the mid distal common hepatic duct. The patient temporarily resolved his initial episode with stent placement, and he was eventually taken to the operating room for bile duct resection and hepaticojejunostomy given a persistent stricture and concern for underlying malignancy. Final pathology demonstrated a traumatic bile duct neuroma. This unusual entity should be considered in patients with benign appearing strictures presenting years after surgery, and awareness may aid in preoperative counseling as well.
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Affiliation(s)
- Priti Lalchandani
- Department of General Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Abraham Korn
- Department of General Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jiajie G Lu
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Samuel W French
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Linda Hou
- Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of General Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
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Farina A. Proximal fluid proteomics for the discovery of digestive cancer biomarkers. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2014; 1844:988-1002. [DOI: 10.1016/j.bbapap.2013.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/15/2013] [Accepted: 10/22/2013] [Indexed: 12/13/2022]
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Neuroma of the bile duct: a late complication after cholecystectomy. J Gastrointest Surg 2009; 13:1517-9. [PMID: 19184244 DOI: 10.1007/s11605-009-0814-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 01/12/2009] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Extrahepatic biliary obstruction with a mass in the common bile duct and elevated CA 19-9 level is often due to cholangiocarcinoma. CASE REPORT We present a case of a 71 year-old woman who presented with an extrahepatic biliary obstruction and a mass in the common bile duct 45 years after cholecystectomy. Pathologic analysis revealed a bile duct neuroma. We present the preoperative imaging, operative management, pathologic diagnosis, and literature review of this rare condition.
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Qin XL, Wang ZR, Shi JS, Lu M, Wang L, He QR. Utility of serum CA19-9 in diagnosis of cholangiocarcinoma: In comparison with CEA. World J Gastroenterol 2004; 10:427-32. [PMID: 14760772 PMCID: PMC4724921 DOI: 10.3748/wjg.v10.i3.427] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: The diagnosis of cholangiocarcinoma is often difficult, making management approaches problematic. A reliable serum marker for cholangiocarcinoma would be a useful diagnostic test. The aims of our study were to evaluate the usefulness of a serum CA19-9 determination in the diagnosis of cholangiocarcinoma.
METHODS: We prospectively measured serum CA19-9 and CEA concentrations in patients with cholangiocarcinoma (n = 35), benign biliary diseases (n = 92), and healthy individuals (n = 15). Serum CA19-9 and CEA concentrations were measured by an immunoradiometric assay without knowledge of the clinical diagnosis.
RESULTS: The sensitivity of a CA19-9 value > 37 KU·L-1 and a CEA value > 22 μg·L-1 in diagnosing cholangiocarcinoma were 77.14% and 68.57%, respectively. When compared with the benign biliary diseases group, the true negative rates of serum CA19-9 and CEA were 84.78% and 81.52%, respectively. The false positive rates of serum CA19-9 and CEA were 15.22% and 18.48%, whereas the accuracy of serum CA19-9 and CEA were 82.68% and 77.95%, respectively. Serum CA19-9 and CEA concentrations were significantly elevated (P < 0.001 and P < 0.05) in patients with cholangiocarcinoma (290.31 ± 5.34 KU·L-1 and 36.46 ± 18.03 μg·L-1) compared with patients with benign biliary diseases (13.38 ± 2.59 KU·L-1 and 13.84 ± 3.85 μg·L-1) and healthy individuals (12.78 ± 3.69 KU·L-1 and 11.48 ± 3.37 μg·L-1). In 15 patients undergoing curative resection of cholangiocarcinoma, the mean serum CA19-9 concentration was decreased from a preoperative level of 286.41 ± 4.36 KU·L-1 to a postoperative level of 62.01 ± 17.43 KU·L-1 (P < 0.001), and the mean serum CEA concentration from 39.41 ± 24.35 μg·L-1 to 28.69 ± 11.03 μg·L-1(P < 0.05). In patients with cholangiocarcinoma, however, no correlation was found between serum CEA and CA19-9 concentrations (r = 0.036).
CONCLUSION: These data suggest that the serum CA19-9 determination is a useful addition to the available tests for the differential diagnosis of cholangiocarcinoma. Serum CA19-9 is an effective tumor marker in diagnosing cholangiocarcinoma, deciding whether the tumor has been radically resected and monitoring effect of treatment.
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Affiliation(s)
- Xing-Lei Qin
- Department of Hepatobiliary Surgery, First Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
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