A case of transitional cell carcinoma of the renal pelvis with adenocarcinoma producing CEA and CA19-9

We report a case of invasive renal pelvic tumor with high serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9). An 86-year-old man presented with macrohematuria. Retrograde pyelography demonstrated a filling defect in right upper calyx, suspected of renal pelvic tumor. The levels of serum CEA and CA 19-9 were elevated to 28.0 ng/ml and 122 U/ml, respectively. No abnormalities were found in the gastrointestinal tract. Right nephroureterectomy was performed, and histopathological diagnosis was transitional cell carcinoma, grade 2>grade 3, accompanied with adenocarcinoma immuno-stained for CEA and CA19-9. A part of the tumor showed a tubular growth pattern. Both serum levels of CEA and CA 19-9 immediately decreased to the normal range after the operation, but increased again with lung and hepatic metastases.     

Superficial urothelial carcinoma of ureter with elevated serum CA19-9 and CEA

We report a 77-year-old Japanese man with superficial ureteral carcinoma with elevation of serum CA19-9 and carcinoembryogenic antigen (CEA) at recurrence. We performed radical nephroureterectomy and partial bladder resection for the right ureteral carcinoma. Pathological diagnosis was UC, G2 > G1, pTa, NO, MO (according to UICC classification). Eighteen months later, local recurrence and multiple metastases were observed, accompanied by the elevation of serum CA19-9 and CEA. His autopsy specimens showed positive immunostaining for serum CA19-9 and CEA. In Ki-67 labeling index, the autopsy specimens showed higher scores than the surgical specimen.     

A case of transitional cell carcinoma of renal pelvis with an extremely high serum carcinoembryonic antigen (CEA) level]

A case of urothelial tumor with extremely high serum carcinoembryonic antigen (CEA) levels is described. A 68-year-old female presented with macroscopic hematuria and left flank pain. Laboratory examination revealed an extremely high serum level of CEA (194 ng/ml) and elevated levels of serum CA 19-9 (235 U/ml) and squamous cell carcinoma (SCC)-Antigen (10.7 ng/ml), while urine CEA remained within normal limits. No abnormal findings were recognized in gastrointestinal and respiratory systems, but left renal pelvic tumor (T4N2M0) was discovered. Nephroureterectomy with regional lymph node dissection was done. The pathologic anatomy was infiltrating non-papillary transitional cell carcinoma (TCC, G2 = G3, pT4N2M0). More than 30% of the tumor cells were positive for CEA by ABC-peroxidase staining. Levels of tumor markers remained higher than normal after the operation and were normalized after M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy. However, 6 months after the operation, levels of tumor markers rose again and lung metastases appeared. She died 10 months after the operation.     

Papillary adenocarcinoma of the renal pelvis and ureter producing carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125

We report a case of advanced renal pelvis and ureter adenocarcinoma producing carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125). A 72-year-old woman was diagnosed with right renal pelvic and ureter tumor with para-aortic lymph node swelling. Biopsy of the ureteral mass revealed papillary adenocarcinoma. Serum levels of CEA, CA19-9 and CA125 were extremely elevated. The patient was successfully treated with paclitaxel/carboplatin chemotherapy followed by surgery.     

A case of CA19-9 producing transitional cell carcinoma of the ureter

We report a case of CA19-9 producing urothelial carcinoma of the right ureter. A 61-year-old male patient who had an extremely high value of serum CA19-9 (1,185 U/ml) with right hydronephrosis was referred to us. Magnetic resonance urography and retrograde ureterography revealed a long irregular filling defect in the right distal ureter. Under the diagnosis of right ureteral tumor, we performed right total nephroureterectomy and pelvic lymphadenectomy. The tumor was histologically diagnosed as grade 1 transitional cell carcinoma and pelvic lymphnodes were positive (pT1N2M0). The tumor cells showed positive immunostaining for CA19-9. The serum CA19-9 level was normalized after the operation and successive adjuvant chemotherapy (M-VAC 2 course). No recurrence was found for 15 months after operation. In this case, the serum CA19-9 level was useful as a tumor marker.     

Renal cell carcinoma presenting high serum level of CA19-9 due to hydronephrosis: a case report

A 58-year old female was referred to our hospital due to left renal cyst that was pointed out at her health check-up. Abdominal CT scan showed left hydronephrosis with a 20 x 12 x 11cm tumor. The serum CA19-9 level elevated to 4,400 U/ml. Urinary cytology in the left renal pelvis was negative, therefore we could not diagnose whether the mass was renal cell carcinoma or renal pelvic tumor before surgery. She underwent left radical nephrectomy, and frozen section revealed renal cell carcinoma. Immunohistological stain clarified CA19-9 was limited to epithelium lining the renal pelvis and was not contained in carcinoma cells. After the surgery, the serum CA19-9 decreased to the normal range. Serum CA19-9 is known to be sometimes elevated in patients with urothelial carcinoma, but rarely elevated in those with renal cell carcinoma. We thought that hydronephrosis by tumor occlusion caused CA19-9 elevation in our case.     

Carcinoembryonic antigen and carbohydrate antigen 19-9-producing adenocarcinoma of the prostate: report of an autopsy case

Prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) are well known as specific tumor markers of prostate cancer, but carcinoembryonic antigen (CEA)- and carbohydrate antigen 19-9 (CA19-9)-producing adenocarcinoma originating in the prostate is rare. We report here a case of prostatic adenocarcinoma positive for these 4 tumor markers in a 50-year-old man who had initially complained about chest pain due to metastatic bone tumor. In spite of the extensive treatment involving hormone and radiation therapy, the patient died of rapid tumor extension only 4 months after initial diagnosis. Autopsy revealed multiple metastases to the bone, liver, lungs and lymph nodes. Histologically, two types of adenocarcinoma were involved in both primary prostate and metastatic sites: one was a poorly differentiated adenocarcinoma positive for PSA and PAP but not CEA or CA19-9, and the other one was a less differentiated adenocarcinoma partially positive for CEA and CA19-9 but not for PSA or PAP. Based on this case and previous cases by review of the literature, CEA- and CA19-9-producing adenocarcinoma of the prostate was suggested to rapidly progress with multiple metastases and to show poor prognosis with strong resistance to any treatment.     

Metastatic prostate cancer with elevated serum levels of CEA and CA19-9

Prostate-specific antigen (PSA) is well known as a specific tumor marker for prostate cancer, but carcinoembryonic antigen (CEA)- and carbohydrate antigen 19-9 (CA19-9)-elevating adenocarcinomas originating in the prostate gland are rare. We report a case of metastatic adenocarcinoma of the prostate gland with a high serum level of CEA and CA19-9 in a 78-year-old man in whom prostate cancer (T3N1M1) had been diagnosed 2 years ago and who was treated with androgen deprivation therapy. He visited the emergency department because of a loss of appetite and abdominal pain. The serum CEA and CA19-9 levels were increased to 218.9 ng/mL (normal, <5 ng/mL) and 212 ng/mL (normal, <27 ng/mL), respectively. The serum PSA level was slightly elevated (4.41 ng/mL). Computed tomography demonstrated multiple liver metastases, para-aortic lymph node enlargement, and lung metastases. A liver biopsy was performed and the specimen showed high-grade adenocarcinoma with focal positive staining for PSA. Despite chemotherapy with docetaxel, the patient died 3 months after treatment. Based on this case and a review of the literature, an aggressive variant of prostatic carcinoma with a high serum level of CEA and CA19-9 and a low PSA level was shown to progress rapidly with a poor prognosis.     

结直肠癌患者术前CEA、CA19-9浓度与临床病理特征及预后的关系

目的:探讨结直肠癌患者术前CEA、CA19-9浓度与临床病理特征及预后的关系。方法:收集2007年1月—2008年7月收治并行根治性手术的356例结直肠癌患者的临床病理资料,分析血清CEA、CA19-9与临床病理特征及生存率的关系。结果:单因素分析结果显示,血清CEA浓度升高与肿瘤浸润深度、淋巴结转移、病理类型、肝转移、周围脏器受累有关(均P<0.05);血清CA19-9浓度升高与肿瘤浸润深度、腹膜转移、肝转移有关(均P<0.05)。生存分析结果显示,血清CEA浓度升高患者生存率低于血清CEA浓度正常患者(P<0.05);血清CA19-9浓度升高患者与血清CA19-9浓度正常患者生存率差异无统计学意义(P>0.05);血清CEA、CA19-9浓度同时升高患者与血清CEA升高或血清CA19-9升高患者生存率差异无统计学意义(均P>0.05),但明显低于血清CEA、CA19-9均正常患者(P<0.05)。结论:血清CEA、CA19-9浓度同时升高可能是结直肠癌的晚期事件,提示患者预后不良。     

肿瘤标志物在胃癌患者中的诊断及预后价值

目的 探讨肿瘤标志物CEA、CA19-9、CA72-4及CA242在胃癌诊断及预后判断中的应用价值.方法 回顾性分析2002-2007年间在北京肿瘤医院就诊的160例胃癌患者血清肿瘤标志物、临床病理参数以及预后资料.结果 160例胃癌患者中CEA、CA19-9、CA72-4及CA242的初诊阳性率分别为37.7％、26.7％、37.6％及21.3％,4种标志物联合检测阳性率为62.9％.CEA阳性与淋巴结转移有关（P=0.029）;CA72-4阳性与脉管浸润及Ⅲ、Ⅳ期胃癌有关（P=0.039,P=0.011）.CA19-9阳性和阴性患者中位生存期分别为17.0和32.0个月,CA72-4阳性和阴性患者中位生存期分别为14.8和37.5个月,差异有统计学意义（P＜0.01）.多因素生存分析提示,CA72-4可以作为独立预后因子（P=0.012）,CA72-4阳性患者的死亡危险系数是阴性患者的2.147倍.结论 肿瘤标志物CEA、CA19-9、CA72-4及CA242在胃癌患者的诊断和预后判断中有重要价值,联合检测可提高阳性率;其中CA72-4可以作为独立预后因子,CA19-9及CA72-4与胃癌患者预后相关.     

术前联合检测血清肿瘤标志物诊断消化系统肿瘤的临床价值

目的探讨几种血清肿瘤标志物术前检测在消化系统肿瘤诊断中的应用价值。方法回顾性分析90例已确诊的消化系统恶性肿瘤的术前血清的及37例对照者的肿瘤标志物AFP、CEA、CA50、CA19-9和CA242的水平,应用放射免疫分析技术检测这些肿瘤标志物的含量。结果胃癌组的阳性率分别为AFP(12.00%)、CEA(68.00%)、CA50(28.00%)、CA19-9(48.00%)和CA242(12.00%);肝癌组的阳性率分别为AFP(81.25%)、CEA(12.50%)、CA50(62.50%)、CA19-9(50.00%)和CA242(6.25%);胰腺癌组的阳性率分别为AFP(55.56%)、CEA(41.18%)、CA50(27.78%)、CA19-9(72.22%)和CA242(88.89%);结肠癌组的阳性率分别为AFP(22.58%)、CEA(35.48%)、CA50(83.87%)、CA19-9(90.32%)和CA242(29.03%);对照组的阳性率分别为AFP(8.11%)、CEA(2.70%)、CA50(5.41%)、CA19-9(0.00%)和CA242(0.00%);联合检测的阳性率分别为76.00%、68.75%、94.44%和93.55%。结论多种肿瘤标志物联合检测可以提高消化系统恶性肿瘤诊断的阳性率,在肿瘤的术前诊断中有较高的临床应用价值。     

Lung adenocarcinoma presented with reticular pattern in which both CA19-9 and carcinoembryonic antigen( CEA) were recognized as markers

A 79-year-old male whose chest X-ray revealed a localized reticular shadow in health check was once treated medically with a diagnosis of interstitial pneumonia. Regardless of the treatment, the shadow increased in its size. Positron emission tomography (PET)-computed tomography(CT) was suggestive of a primary lung cancer in clinical stage IIIA. CA19-9 and CEA were 3,568.5 U/ml and 178.2 ng/ml respectively, and a left lower lobectomy was performed. The postoperative course was uneventful. Both tumor markers declined shortly after the surgery. But they increased in 8 months after the surgery associated with tumor recurrence. In spite of chemotherapy, the patient was expired 15 months following the surgery. Immunohistochemical staining showed the tumor was a well differentiated adenocarcinoma with positive findings of both CEA and CA19-9.     

Is it reasonable to add preoperative serum level of CEA and CA19-9 to staging for colorectal cancer?

BACKGROUND: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most common tumor markers for colorectal cancer. The aim of this study was to evaluate the possibility of adding them into the current staging system by analyzing their prognostic significance. MATERIALS AND METHODS: The study population was patients (n = 574, 67.1 +/- 11.3 years old, 397 males) who received potentially curative resection of colorectal adenocarcinoma (stage I-III) between January 1994 and August 2002, including preoperative measurements of CEA and CA19-9. Clinicopathological characteristics and associated follow-up data were retrospectively collected by reviewing available medical charts. CEA higher or equal to 5 ng/ml was defined as abnormal (CEA+). The CA19-9 level was set at 37 U/ml (CA19-9+). Patients were further divided into four groups (1, 2, 3, 4) according to the results of these two markers (CEA/CA19-9: -/-, -/+, +/-, and +/+). Survival was analyzed for AJCC staging, CEA (+) versus (-), CA19-9 (+) versus (-), and four groups. RESULTS: CEA and CA19-9 survival curves were not significantly different. However, the combined use of the two markers revealed a significant survival benefit (P = 0.035) of group 1 ("-" for both markers) over 4 ("+" for both) in stage II. CONCLUSIONS: Patients with an elevated level of both CEA and CA19-9 in stage II of colorectal cancer have a significantly poorer prognosis than those with normal levels of these markers. We recommend adding both CEA and CA19-9 to the current staging system.     

Metastatic bladder tumor from gastric carcinoma: a case report]

A 63-year-old man with a two-month history of nocturia and dysuria consulted his family doctor. As renal dysfunction and bilateral hydronephrosis were indicated, he was admitted to our hospital on November 28, 1988. Cystoscopy revealed a non-papillary and flat tumor from the ureteral orifice to the back wall of the bladder. A biopsy of the bladder wall revealed signet-ring cell carcinoma. A metastatic bladder tumor was suspected and laboratory tests of tumor markers showed a carcinoembryonic antigen value (CEA) of 1,000 ng/ml and CA19-9 of 12,210 U/ml. Upper gastrointestinal examination revealed carcinomatosis involving the stomach. A biopsy specimen of the stomach revealed the same pathological finding as the bladder wall. A metastatic bladder tumor was confirmed. The patient died of pulmonary emboli on December 11, 1988.     

Significance of measurement of a carbohydrate antigenic determinant 19-9 (CA 19-9) for monitoring colorectal cancer patients

The significance of measurement of serum CA 19-9 levels and the correlation between the serum levels of CA 19-9 and CEA in 61 patients with colorectal cancer were investigated. CA 19-9 levels above 37 U/ml were found in 24.6 per cent, while CEA levels above 5 ng/ml were observed in 34.4 per cent. Elevation of one or both of two antigens was found in 44.3 per cent. In patients with elevated CA 19-9 levels, the CA 19-9 levels returned to normal after curative resections, whereas patients with normal levels of this antigen showed only slight or no differences after curative resections. Measurements of this antigen were useful for the evaluation of the effect of surgery, especially in patients with normal CEA levels and elevated CA 19-9 levels. Combination assays of these antigens may be more useful than CEA alone for monitoring colorectal cancer patients.     

Serum CA 19-9 and CA 50 antigens in hemodialysis patients

Serum concentrations of monoclonal antibody-defined tumor markers CA 19-9 and CA 50 were measured in 64 uncomplicated hemodialysis patients (Group 1) and in 8 hemodialysis patients with cancer (Group 2) in comparison with corresponding CEA determinations. From our results in Group 1 patients it appears that both CA 19-9 and CA 50 maintained an excellent specificity in these patients. As to the sensitivity of these tests, our findings in Group 2 patients are comparable with those reported in patients with cancer and normal renal function. It is concluded that, unlike CEA, these new tumor markers maintain their clinical value in chronic renal failure.     

A case of two patients with primary lung cancer secreting CA19-9

We experienced two primary lung cancer patients who showed high levels of CA19-9 (Carbohydrate Antigen 19-9). One case was small cell carcinoma and the other was adenocarcinoma. In contrast to malignancies of digestive organ origin, rare CA19-9 positive cases are reported in lung cancer. To get evidences that these lung cancer tissues were producing CA19-9, PAP stain (Peroxidase anti peroxidase method: Sternberger) was performed, and positive stains were obtained in tumors surgically removed from these two patients. Especially in a patient who showed very high level of CA19-9 (27,369 U/ml), almost every tumor cell was positively stained. From these findings, we suggest the importance of checking CA19-9 in patients with lung cancer.     

血清学肿瘤标志物与胰腺癌诊断及分期的关系

目的 探索血清学肿瘤标志物CA19-9、CEA及CA50与胰腺癌的早期诊断及分期的关系.方法 通过收集分析安徽医科大学附属省立医院普外科2013年1月-2015年10月收治入院的51例胰腺癌患者、10例胰腺良性肿瘤患者、12例慢性胰腺炎患者血清中CA19-9、CEA及CA50的测量值,比较它们在不同分期的胰腺癌及其他胰腺疾病中血清含量的不同.结果 CA19-9在不同分期胰腺癌及其他胰腺疾病中表达差异有统计学意义(P＜0.05).CEA及CA50在胰腺癌与胰腺其他疾病中表达差异具有统计学意义(P＜0.05).但CEA在Ⅰ期与Ⅱ期、Ⅰ期与Ⅲ期、Ⅱ期与Ⅲ期患者血清中的表达差异无统计学意义(P＞0.05).CA50在胰腺癌Ⅰ期与Ⅲ期、Ⅱ期和Ⅳ期中表达差异无统计学意义(P＞0.05).CA19-9诊断胰腺癌的阳性率高于CEA及CA50,CA19-9、CEA及CA50三者同时检测诊断胰腺癌的阳性率最高.结论 CA19-9、CEA及CA50在血清中的表达水平对于胰腺癌的早期诊断有一定的相关性,在胰腺癌分期中CA19-9的诊断价值最高.     

同时性结直肠癌肝转移的临床病理特征分析

目的遴选同时性结直肠癌肝转移的危险因素，为预测和早期诊断肝转移提供参考依据。方法收集2003年1月至2006年12月间收治的367例原发性结直肠癌患者的临床病理资料，对患者的年龄、性别、血型、肿瘤家族史、是否合并肝炎肝硬化、有无合并肠梗阻、术前癌胚抗原（CEA）和CA19－9、原发肿瘤部位和大小、分化程度、肿瘤侵及深度、有无淋巴结转移、肿瘤分期等19项因素进行统计分析。结果本组发生同时性结直肠癌肝转移56例．占同期结直肠癌患者的15．3％。在发病年龄、是否有肠梗阻、是否有盆腔转移结节及肿瘤浸润深度方面，肝转移和无肝转移两组患者之间差异有统计学意义（P〈0．05）。右侧结肠癌肝右叶转移瘤者明显多于左叶，而左侧结肠癌转移瘤多分布于全叶。当术前CEA大于22．1μg／L时，患者发生肝转移的可能性增加。结论结直肠癌同时性肝转移与患者年龄、是否存在肠梗阻、盆腔有无转移及CEA水平存在密切关系。     

CA19-9对胰腺癌手术可切除性的预测价值

目的探讨肿瘤标志物CA19-9等对胰腺癌手术可切除性的术前预测价值。方法回顾性分析病理证实的胰腺癌手术病人221例,据手术方式分为根治性胰十二指肠切除术组（PD）和姑息性手术组;将有术前血清CA19-9检测结果的病人分为CA19—9正常、轻度升高和异常升高组,根据术中情况进行TNM分期。结果CA19—9升高率在PD组为64．41％,在姑息组为79．45％。所有胰腺癌病人CA19—9异常升高率为82．86％;PD组CA19—9水平显著性低于胰腺癌不能切除组（P=0．035）。结论不能行根治性切除的胰腺癌病人血清CA19-9水平显著的高于能行根治性手术的病人,血清CA19-9〉1000u／ml可做为判定胰腺癌难以行根治性手术切除的参考指标。联合检测肿瘤标志物无助于早期诊断和预测胰腺癌的可切除性。