A pancreatic mass and extreme elevation of CA 19–9: a benign masquerade of cholangiocarcinoma. Issue 2 (16th February 2022)

• Record Type: Journal Article
• Authors: Hall, Catherine; McLaren, Mairi; Mosse, Charles
• Is Part Of: Journal of surgical case reports. Volume 2022:Issue 2(2022)
• Publication Date: 2022-02-16
• Subjects: Surgery -- Periodicals; Surgery -- Case studies -- Periodicals; 617.005
• DOI: 10.1093/jscr/rjac018
• Languages: English
• ISSNs: 2042-8812

Abstract

Abstract: Carbohydrate antigen 19–9 (CA 19–9) is a specific tumour marker for pancreato-biliary malignancy. Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition in which IgG4 deposits infiltrate various organs, including the biliary tract manifesting IgG4 sclerosing cholangitis and pseudotumours. An 83-year-old woman presented with severe obstructive jaundice, weight loss and an extreme elevation of CA 19–9 level of 3295 kU/L. Magnetic resonance cholangiopancreatography (MRCP) revealed a pancreatic mass amputating the biliary tree. Liver function tests revealed a cholestatic pattern and severe hyperbilirubinaemia (289umol/L). IgG4 level was found to be high at 7.97 g/L. After treatment with high-dose corticosteroids, repeat MRCP 2 months later revealed disappearance of the pancreatic mass. There was also normalization of the bilirubin and a dramatic decrease of CA 19–9. This case reports the highest published benign elevation of Ca19.9 level in the setting of IgG4 disease. Differentiation between cholangiocarcinoma and IgG4-RD is important, as the treatment is vastly different.