PDF(Pubmed)
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.
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.
摘要：
背景：CA19-9是一种常用的肿瘤标志物，被认为是胰腺导管腺癌（PDAC）和胆道癌的特征；然而，CA19.9的阳性预测值太低，在健康人群中使用CA19.9作为筛查工具仍存在争议.
方法：该病例说明了一名54岁女性主诉上腹部疼痛的血清CA19-9水平高度升高的反向诊断，在COVID-19疫苗接种后不久。实验室测试表明CA19-9标记物的水平显着升高（>12,000U/mL，参考值：<37U/mL），胰腺酶活性正常。患者接受了影像学检查，没有异常，除了在磁共振成像（MRI）中增加的胰腺尺寸和胰腺中的液体信号区域，这可能对应于自身免疫性胰腺炎（AIP）。患者仍无症状，建议在12个月内进行MRI随访。
结果：进行的文献综述显示，多重因果CA19-9增加超过1000U/mL，包括非癌症的肺部疾病，胰腺,肝脏,子房,肾,和其他人。与疾病原因无关，CA19-9的中位浓度为2810U/mL（IQR±6895）。男性和女性的中位数CA19-9值分别为3500（IQR±10,050）和2455（IQR±3927），分别,两组间差异显著(p<0.05)。CA19-9值与增加的分类原因之间没有差异。
结论：进行鉴别诊断，不应忘记，大多数国际指南建议在放射成像中仅将CA19-9与胰腺病理学结合使用;即使这样的组合也可能将诊断途径指向错误的方向。高度升高的CA19-9水平，通常与PDAC相关，可能是良性疾病的结果，包括与COVID-19疫苗接种相关的AIP。
方法：该病例说明了一名54岁女性主诉上腹部疼痛的血清CA19-9水平高度升高的反向诊断，在COVID-19疫苗接种后不久。实验室测试表明CA19-9标记物的水平显着升高（>12,000U/mL，参考值：<37U/mL），胰腺酶活性正常。患者接受了影像学检查，没有异常，除了在磁共振成像（MRI）中增加的胰腺尺寸和胰腺中的液体信号区域，这可能对应于自身免疫性胰腺炎（AIP）。患者仍无症状，建议在12个月内进行MRI随访。
结果：进行的文献综述显示，多重因果CA19-9增加超过1000U/mL，包括非癌症的肺部疾病，胰腺,肝脏,子房,肾,和其他人。与疾病原因无关，CA19-9的中位浓度为2810U/mL（IQR±6895）。男性和女性的中位数CA19-9值分别为3500（IQR±10,050）和2455（IQR±3927），分别,两组间差异显著(p<0.05)。CA19-9值与增加的分类原因之间没有差异。
结论：进行鉴别诊断，不应忘记，大多数国际指南建议在放射成像中仅将CA19-9与胰腺病理学结合使用;即使这样的组合也可能将诊断途径指向错误的方向。高度升高的CA19-9水平，通常与PDAC相关，可能是良性疾病的结果，包括与COVID-19疫苗接种相关的AIP。
