Pulmonary Sequestration Presenting Elevated CA19-9 and CA125 with Ovarian Cysts

Elevated tumor markers in a benign lung disease

BACKGROUND

This study aimed to determine the underlying pathophysiologic mechanism of elevated carbohydrate antigen 19-9 (CA19-9) in pulmonary sequestration (PS) patients.

MATERIALS AND METHODS

Four pulmonary sequestration patients, 12 pneumonia patients and 12 healthy adult volunteers were prospectively studied. Specimens from another 34 pulmonary sequestration patients were retrospectively analyzed. Serum CA19-9 levels of 4 patients were tested before and 1 week, 1 month and 3 months after surgery. The CA19-9 levels of 12 pneumonia patients and 12 healthy adult volunteers were tested as controls. The expression and localization of CA19-9 in diseased lesions and corresponding normal lung tissues were analyzed by Immunohistochemical (IHC). Hematoxylin-eosin (HE) staining was performed to observe the pathological changes in pulmonary sequestration tissues.

RESULTS

Serum CA19-9 levels were significantly higher in the 4 patients (797.3 ± 316 IU/ml) than in the pneumonia patients (10.07 ± 5.01 IU/ml) and healthy volunteers (9.85 ± 4.12 IU/ml). In addition, serum CA19-9 levels decreased dramatically after the focus was removed. Positive staining of CA19-9 was found in 70% (24/34) of pulmonary sequestration tissues, and CA19-9 was mainly expressed in the bronchial mucus. In the 4 diseased lesions, deformed alveolar structure and inflammatory cell infiltration were observed, and the degree of damage was positively correlated with serum CA19-9 levels.

CONCLUSIONS

CA19-9 could be generated by abnormal columnar epithelia in pulmonary sequestration tissues and was transported into circulation after alveoli damage. CA19-9 could serve as an adjuvant diagnostic marker in pulmonary sequestration.

Thoracic Endometriosis: A Review Comparing 480 Patients Based on Catamenial and Noncatamenial Symptoms

OBJECTIVE

This review aimed to categorize thoracic endometriosis syndrome (TES) according to whether the presenting symptoms were catamenial and to evaluate whether such a categorization enables a better management strategy.

DATA SOURCES

An electronic search was conducted using the PubMed/Medline database.

METHODS OF STUDY SELECTION

The following keywords were used in combination with the Boolean operators AND OR: "thoracic endometriosis syndrome," "thoracic endometriosis," "diaphragm endometriosis," and "catamenial pneumothorax."

TABULATION, INTEGRATION, AND RESULTS

The initial search yielded 445 articles. Articles in non-English languages, those whose full texts were unavailable, and those that did not present the symptomatology clearly were further excluded. After these exclusions, the review included 240 articles and 480 patients: 61 patients in the noncatamenial group and 419 patients in the catamenial group. The groups differed significantly in presenting symptoms, surgical treatment techniques, and observed localization of endometriotic loci (p <.05).

CONCLUSION

This review points out the significant differences between patients with TES with catamenial and noncatamenial symptoms. Such categorization and awareness by clinicians of these differences among patients with TES can be helpful in designing a management strategy. When constructing management guidelines, these differences between patients with catamenial and noncatamenial symptoms should be taken into consideration.

Association of pulmonary sequestration with elevated serum cancer antigen 125 levels: a case report

Pulmonary sequestration is a rare congenital lung anomaly that is characterized by a nonfunctioning pulmonary parenchyma, which typically lacks connection to the tracheobronchial airways, and thus has an anomalous systemic blood supply. Here we report the case of a 37-year-old man who was diagnosed with pulmonary sequestration and also presented with high levels of the serum tumor marker cancer antigen 125 (CA125). Computed tomography of the chest indicated the presence of a heterogeneous mass with low attenuation in the right S10 region that had a single aberrant artery supplying blood from the descending aorta. The patient eventually underwent thoracoscopic surgery with resection of the right sequestrated lung. Immunohistochemistry showed positive staining for CA125 in bronchial epithelial and epithelioid cells. After surgery, CA125 levels returned to the normal range. In summary, this report describes a case of pulmonary sequestration associated with elevated serum CA125 levels, and further provides relevant literature for this presentation.

Extralobar pulmonary sequestration with elevated serum neuron-specific enolase: A case report and review of the literature

RATIONALE

Pulmonary sequestration (PS) presenting with elevated serum tumor markers is rare, and it might be misdiagnosed as malignancy.

PATIENT CONCERNS

A 26-year-old asymptomatic male patient was admitted because the x-ray showed an intrathoracic lesion. Meanwhile, the serum neuron-specific enolase (NSE) was elevated. Three-dimensional computed tomography angiography revealed an isolated feeding vessel arising from the aorta.

DIAGNOSES

Extralobular PS was confirmed by computed tomography angiography and postoperative pathological staining.

INTERVENTIONS

Two-port thoracoscopic resection of the sequestrated lobe was performed.

OUTCOMES

The serum NSE decreased to within the normal range and persisted during the follow up of 10 months.

LESSONS

A thorough work-up should be considered for the PS patients presenting with abnormal serum NSE. Detailed knowledge regarding the relationship between NSE and PS necessitates further studies.

Pulmonary sequestration associated with a synchronous elevation of carbohydrate antigen 50 and 19-9: a case report

This report describes a 37-year-old woman who experienced elevated serum carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 50 (CA50). Intralobar pulmonary sequestration was confirmed via enhanced chest computed tomography (CT) scanning and positron emission tomography/computed tomography (PET/CT), which indicated two abnormal vessels arising from the descending thoracic aorta. Lobectomy of the left inferior lobe was performed as the optimal surgical approach and the pathological analysis met the diagnosis of intralobar pulmonary sequestration. Review of the patient's serum levels of CA50 and CA19-9 showed that these two tumor markers significantly decreased after surgery and finally went down to normal values. Therefore, the synchronically significant elevation of serum CA50 and CA19-9 was due to intralobar pulmonary sequestration.

Pulmonary sequestration associated with significant elevation of serum carbohydrate antigen 19-9: report of two cases

This report presents two young women were admitted to the department of thoracic surgery, Beijng Chao-Yang Hospital because of the extremely elevation of the serum Carbohydrate antigen 19-9 (CA19-9). The enhanced Computed Tomography scan showed that the lesion of the lung and the anomalous artery, and diagnosis of the pulmonary sequestration was made. The positron emission tomography/computed tomography (PET/CT) scan was taken to exclude any kind of malignant tumor. Both of them had the lobectomy operation confirmed our preoperative diagnosis. After the operation, the serum level of CA19-9 decreased to normal range rapidly. Therefore, in these two cases, the markedly elevation of serum CA19-9 level may have resulted from the pulmonary sequestration.

A Case Report and a Short Literature Review of Pulmonary Sequestration Showing Elevated Serum Levels of Carbohydrate Antigen 19-9

Pulmonary sequestration is a type of bronchopulmonary malformation defined as an isolated portion of lung tissue with systemic arterial supply and no bronchial communication. Carbohydrate antigen 19-9 (CA19-9) has been used for diagnosis and follow-up of gastrointestinal tumors. The current study presents a rare case of intralobar pulmonary sequestration associated with the marked elevation of CA19-9. A 39-year-old female patient was admitted to our hospital due to acute liver injury with marked elevation of serum CA19-9 (3,051.1 μmol/mL), and was then diagnosed with intralobar pulmonary sequestration after examination and surgery. After the pulmonary resection, the serum CA19-9 levels decreased to normal ranges. We briefly reviewed the literature on elevated serum CA19-9 levels and pulmonary sequestration since 1988. We found that serum CA19-9 levels are increased not only in patients with digestive tract cancers but also in those with nonmalignant diseases such as pulmonary sequestration.