Clarke Tatyan, Matsuoka Lea, Jabbour Nicolas, Mateo Rodrigo, Genyk Yuri, Selby Rick, Gagandeep Singh
Division of Hepatobiliary/Pancreatic Surgery and Abdominal Organ Transplantation, Keck School of Medicine, University of Southern California, University Hospital, Los Angeles, CA 90033, USA.
Surg Today. 2007;37(4):342-4. doi: 10.1007/s00595-006-3377-4. Epub 2007 Mar 26.
Tumor markers such as carbohydrate antigen 19-9 (CA 19-9) are commonly measured in the serum of patients with suspected pancreaticobiliary malignancies. Moderate elevations of CA 19-9 may be seen in benign disease, but levels in the thousands are indicative of malignancy. We report the case of a 64-year-old man with an elevated CA 19-9 of 5791 U/ml and radiological findings suggestive of metastatic gallbladder carcinoma. The patient underwent cholecystectomy and excision of a common bile duct stricture, with hepaticojejunostomy and liver biopsy. The final surgical pathology was consistent with xanthogranulomatous cholecystitis (XGC) and the elevated CA 19-9 returned to normal postoperatively. Thus, an elevated CA 19-9 level, even in the thousands, should not preclude patients from an operation if a mass is deemed resectable. Thorough investigation and treatment may result in a curative operation even if unresectable malignant disease is initially suspected.
肿瘤标志物，如糖类抗原19-9（CA 19-9），常用于检测疑似胰胆恶性肿瘤患者的血清。CA 19-9轻度升高可见于良性疾病，但数千的水平则提示恶性肿瘤。我们报告一例64岁男性，其CA 19-9升高至5791 U/ml，影像学检查结果提示转移性胆囊癌。该患者接受了胆囊切除术及胆总管狭窄切除术，并进行了肝空肠吻合术和肝脏活检。最终手术病理结果符合黄色肉芽肿性胆囊炎（XGC），术后升高的CA 19-9恢复正常。因此，如果肿块被认为可切除，即使CA 19-9水平升高至数千，也不应排除患者接受手术的可能。即使最初怀疑为不可切除的恶性疾病，经过全面检查和治疗仍可能实现根治性手术。
