A. Montanelli

D. Cucchiari

G. Graziani

M.A. Podesta&apos

V. Quagliuolo

English

AIR Universita degli studi di Milano

Abdominal Pain and Increased CA19-9
Giorgio Graziani,1* David Cucchiari,1 Manuel A. Podesta`,1 Vittorio Quagliuolo,2
and Alessandro Montanelli3
CASE DESCRIPTION
A 32-year-old man with an unremarkable medical history presented to the ambulatory clinic with complaints
of nonlocalized abdominal pain. The results of a physical examination were unremarkable. The results
obtained from liver, pancreatic, and renal testing were within the reference intervals, and the results of both
a fecal occult blood test and an investigation for parasites in the stool were negative. Laboratory investigations
also revealed a plasma carbohydrate antigen 19-9 (CA19-9) concentration of 3103 IU/mL (reference interval,
2– 40 IU/mL). After this finding, abdominal ultrasonography and nuclear magnetic resonance imaging eval-
uations were made.
1 Department of Internal Medicine and Nephrology, 2 Department of Oncological
Surgery, and 3 Clinical Investigation Laboratory, Humanitas Clinical and Re-
search Center, Milan, Italy.
* Address correspondence to this author at: Istituto Clinico Humanitas IRCCS,
Via Manzoni 56, 20089 Rozzano, Milano, Italy. Fax 39-02-8224-4590;
e-mail giorgio.graziani@humanitas.it.
Received January 22, 2013; accepted March 1, 2013.
DOI: 10.1373/clinchem.2013.203885
Fig. 1. Imaging study showing the splenic cyst (arrow).
Clinical Chemistry 59:11
1678–1689 (2013)
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QUESTIONS
1. Is CA19–9 increased only in malignancy?
2. What nonmalignant conditions can give rise to increased plasma CA19–9?
The answers are below.
ANSWERS
CA19–9 can be increased in malignant and nonmalig-
nant disease. Nonmalignant causes include biliary tract
obstruction, cholangitis, inflammatory bowel disease,
acute or chronic pancreatitis, cirrhosis, and cystic fi-
brosis. Imaging (Fig. 1) and histologic findings were
consistent with a giant benign epidermoid splenic cyst
(13.5 cm in diameter). One month after total splenec-
tomy, the CA19–9 concentration was within the refer-
ence interval. Owing to its low diagnostic specificity
(1 ), the measurement of CA19–9 is suggested only for
the follow-up of known gastrointestinal, biliary, or
pancreatic cancers (2, 3 ); however, splenic cyst is a rare
benign cause of CA19–9 increase (4, 5 ) that should not
be overlooked.
AuthorContributions:All authors confirmed they have contributed to
the intellectual content of this paper and have met the following 3 re-
quirements: (a) significant contributions to the conception and design,
acquisition of data, or analysis and interpretation of data; (b) drafting
or revising the article for intellectual content; and (c) final approval of
the published article.
Authors’ Disclosures or Potential Conflicts of Interest:No authors
declared any potential conflicts of interest.
Acknowledgments: The authors acknowledge Drs. D. Strada and T.
Brambilla for their contribution to data collection.
References
1. Xu Q, Zhang TP, Zhao YP. Advances in early diagnosis and therapy of
pancreatic cancer. Hepatobiliary Pancreat Dis Int 2011;10:128–35.
2. Cabrera-Abreu JC, Smellie WS, Bowley R, Shaw N. Best practice in primary
care pathology: review 13. J Clin Pathol 2012;65:97–100.
3. Steinberg W. The clinical utility of the CA 19–9 tumor-associated antigen.
Am J Gastroenterol 1990;85:350–5.
4. Robbins FG, Yellin AE, Lingua RW, Craig JR, Turrill FL, Mikkelsen WP. Splenic
epidermoid cysts. Ann Surg 1978;187:231–5.
5. Morgenstern L. Non parasitic splenic cysts: pathogenesis, classification and
treatment. J Am Coll Surg 2002;194:306–14.
What Is Your Guess?
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Abdominal pain and increased CA19-9

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Abdominal pain and increased CA19-9

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