Intralobar pulmonary sequestration presenting increased serum CEA, CA 19-9, and CA 125, and associated with asymptomatic pulmonary aspergillosis]

A 44-year-old woman was admitted to our hospital for further evaluation of a consolidated shadow in the left lower lobe and the evaluation of serum tumor markers (CEA 46.3 ng/ml, CA 19-9 1911 U/ml, and CA 125 103 U/ml). Chest computed tomography revealed an irregular shaped, low density mass shadow in the left S10 region, suggesting the diagnosis of pulmonary sequestration or bronchial atresia. However digital subtraction angiography failed to demonstrate an anomalous feeding artery. We could not rule out the possibility that a malignant lesion was included in the consolidated shadow. A left thoracotomy revealed an intralobar pulmonary sequestration of the left lower lobe. Hyphae of aspergillus were found in the lumen of the cystic bronchus of the resected lung. Immunohistochemical studies showed strong expression of CEA, CA 19-9, and CA 125 by bronchial epithelia in the pulmonary sequenstration. The serum values of tumor markers returned to their normal ranges after surgery.     

Intralobar pulmonary sequestration presenting as a psoas abscess

Intralobar pulmonary sequestration is a relatively rare congenital anomaly. The commonest clinical presentation is with chronic cough, expectoration and recurrent attacks of pneumonia. An unusual presentation with a psoas abscess is reported.     

血清CA125,CA19-9,CA50含量对消化系肿瘤的诊断价值

目的评价血清CA125,CA19-9,CA50含量对消化系肿瘤的诊断价值.方法消化系肿瘤患者158例,其中肝癌38例,食管癌21例,胃癌56例,结直肠癌36例,胰腺癌7例;消化系良性疾病患者106例,其中肝硬变57例,消化性溃疡49例;正常对照者40例.全部受测对象均空腹抽静脉血,分离血清,-20℃贮存备测.采用RIA法测定血清CA125,CA19-9,CA50含量,使用国产SN-695型γ计数仪.数据均用()±s表示,以正常()±2s作为上限计算阳性率.结果肝癌、胃癌、胰腺癌、结直肠癌和食管癌血清(CA含量均以kU/L表达)CA125(分别为222±116,79±17,135±79,69±23和72±26),CA19-9(237±108,281±132,838±224,252±136和273±146)和CA50含量(25±9,20±7,18±9,18±8和17±7)显著高于正常对照组及消化道良性病变组(P＜0.01).消化道肿瘤有腹腔及远处转移者,其血清CA125,CA19-9,CA50含量升高更为明显.结论血清CA125,CA19-9,CA50均为较好的肿瘤标记物,有助于诊断消化系统肿瘤.     

Intralobar pulmonary sequestration presenting as congestive heart failure in a neonate.

We recently evaluated a premature infant with intralobar pulmonary sequestration which presented with signs of CHF. The infant initially underwent ligation of a PDA but subsequently developed tachycardia, tachypnea, and a continuous murmur which radiated to the back. The diagnosis of a pulmonary sequestration was suggested by Doppler echocardiography and confirmed by aortography. The sequestration was successfully treated by surgical removal of the involved lobe.     

Assessment of serum and bile levels of CA19-9 and CA125 in cholangitis and bile duct carcinoma

In this study, CA19-9 and CA125 in serum and bile were measured to evaluate their diagnostic value in cholangitis and bile duct carcinoma. Patients were classified into three groups: group A, the control group, had cholelithiasis without infection (n = 23), group B had acute cholangitis (n = 25) and group C had bile duct carcinoma without bacterial infection (n = 18). All patients had undergone surgery, and bile and serum of the patients were measured for the two tumour markers by radio-immunoassay. The positivity rate for serum CA19-9 was 4.4% in the control group, 28.0% in group B and 61.1% in group C. The positivity rates for serum CA125 in groups control, B and C were 0%, 4% and 27.78% respectively. The diagnostic accuracy for bile duct carcinoma was 67.4% for both CA19-9 or CA125. The concentration of CA19-9 in bile was more than 1200 ng/mL in 72% of patients with acute cholangitis, in 61.1% of all patients with bile duct carcinoma and 0% in the control group. The frequency of concentrations of CA125 in bile greater than 200 ng/mL was 38.89% in bile duct carcinoma and none was observed in the control or acute cholangitis groups. In conclusion, the concentration of CA19-9 was increased not only by the tumour itself, but also by infection. In the diagnosis of bile duct carcinomas, the sensitivity of CA125 was low but its specificity was very high.     

联合CA19-9、CA125和CEA检测在AFP阴性的ICC鉴别诊断中的应用价值

目的探讨血清癌抗原19-9（CA19-9）、癌抗原125（CA125）和癌胚抗原（CEA）联合检测在甲胎蛋白（AFP）阴性的肝内胆管细胞癌（ICC）患者诊断中的价值。方法2014年6月~2016年6月我院收治的ICC患者60例,根据AFP检测结果,将其分为AFP阴性组和AFP阳性组,每组分别为30例。采用微阵列酶联免疫分析法（Array-ELISA）检测血清CA19-9、CA125和CEA,采用受试者工作特征曲线（ROC）下面积（AUC）分别对各标记物及联合检测诊断的灵敏度、特异度和正确率进行评估。结果30例AFP阴性组血清CA19-9、CA125和CEA水平分别为138.8（85.7~185.1）U/ml、109.6（48.4~201.8）U/ml、11.2（17.5~21.9）ng/ml,均显著高于AFP阳性组的【（38.0（16.9~75.5）U/ml、18.1（9.3~48.1）U/ml、5.5（3.1~8.5）ng/ml）,P<0.01】;两组血清肿瘤标志物诊断ICC的ROC曲线下面积均呈现出CA19-9>CA125>CEA的趋势,在AFP阴性组,各单项诊断的ROC曲线下面积分别为0.85、0.83和0.81,显著高于AFP阳性组的【（0.55、0.45和0.42）,P<0.05】;在单项诊断ICC时,血清CA19-9、CA125和CEA的最佳临床诊断截断点分别为124.89 U/ml、96.04 U/ml和11.97 ng/ml;血清CA19-9、CA125和CEA诊断ICC的灵敏度、特异度和正确率分别为（73.33%、76.67%和71.67%）、（66.67%、70.00%和68.33%）和（60.00%、70.00%和65.00%）,以CA19-9检测诊断的效能最高;两组联合检测诊断的ROC曲线下面积均高于单项指标检测的ROC曲线下面积,且都表现为（CA19-9/CA125/CEA）>（CA19-9/CA125）>（CA19-9/CEA）>（CA125/CEA）,在AFP阴性组,各联合检测诊断的ROC曲线下面积分别为0.94、0.88、0.86和0.85 ,显著高于在AFP阳性组的【（0.74、0.62、0.58和0.52）,P<0.05】;（CA19-9/CA125/CEA）、（CA19-9/CA125）、（CA19-9/CEA）和（CA125/CEA）四种联合检测诊断的灵敏度、特异度和正确率均提高,分别为（90.00%、90.00%和90.00%）、（83.33%、83.33%和81.67%）、（76.67%、83.33%和80.00%）和（70.00%、76.67%和73.33%）,以CA19-9/CA125/CEA联合检测诊断效能最高。结论我们认为,血清CA19-9、CA125和CEA联合检测可提高对AFP阴性ICC患者诊断的正确率,需要临床扩大验证。     

Intra-abdominal sequestration of the lung and elevated serum levels of CA 19-9: a diagnostic pitfall

Background

Extralobar pulmonary sequestration is an uncommon congenital abnormality that is rarely diagnosed after the age of 40 years. We describe a 64-year-old woman with an intra-abdominal sequestration of the lung and elevated carbohydrate antigen (CA) 19-9 serum levels.

Case outline

On abdominal ultrasound a semi-solid cystic tumour was demonstrated that showed tight connection to the tail of the pancreas according to computed tomography. Cytological examination of the percutaneous biopsy did not lead to a definitive diagnosis. CA 19-9 serum levels were repeatedly elevated >250 IU/ml. With a tentative diagnosis of a tumour of the tail of pancreas the semi-solid cystic mass was resected. Frozen section histology suggested the diagnosis of pulmonary sequestration, which was confirmed by definitive histological examination. Immunohistochemical staining of the specimen with a specific monoclonal antibody against CA 19-9 showed strong immunoreactivity. Three months later the elevated CA 19-9 serum levels returned to normal.

Discussion

Elevated CA 19-9 serum levels have been described in benign pulmonary and mediastinal cystic lesions and in one case of extralobar intrathoracic lung sequestration. Although there is evidence that malignancies may arise in congenital lung cysts, CA 19-9 serum levels have not been investigated in such cases. Based on our results elevated serum values of CA 19-9 in combination with a cystic semi-solid mass in the left subphrenic space should include the differential diagnosis of extralobar pulmonary sequestration.     

Hairy cell leukaemia presenting with ascites, pleural effusion and increased CA 125 serum level

The body cavities are rarely involved in hairy cell leukaemia. Here we report a patient who had pancytopenia, hepatosplenomegaly, massive haemorrhagic ascites, pleural effusion at the left hemithorax and increased CA 125 serum level at the time of initial diagnosis. Laparoscopy showed multiple nodular white, opaque lesions on the omentum and on the parietal peritoneum. Laparoscopic biopsy of these lesions, and a bone marrow biopsy revealed a diffuse cellular infiltrate of tartrate-resistant acid phosphatase staining mononuclear cells. These mononuclear cells with irregular cytoplasmic protrusions were also found in the peripheral blood, in the ascites fluid and in the pleural effusion. The patient was treated with cladribine 0.1 mg/kg/day with continuous infusion for seven days. Three months after the treatment, the patient achieved a complete remission with normalisation of the peripheral blood count, bone marrow findings, CA 125 serum level, with no detectable ascites and/or pleural effusion.     

Elevated serum CA 19-9 in hepatic actinomycosis

Abstract

Objective. It is controversial whether endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is beneficial in all patients with suspected pancreatic cancer. The aim of this study was to assess diagnostic yield, safety and impact of EUS-FNA on management of patients with solid pancreatic mass. Material and methods. Consecutive patients undergoing EUS-FNA of solid pancreatic mass were enrolled. Gold standard for final diagnosis included histology from surgical resection. In patients without surgery, clinical evaluation methods and repeated imaging studies were used for the comparison of initial cytology and final diagnosis. Patients were followed-up prospectively focusing on subsequent treatment. Results. Among 207 enrolled patients, final diagnosis was malignant in 163 (78.6%) and benign in 44 (21.4%). The sensitivity, specificity and accuracy of EUS-FNA in diagnosing pancreatic cancer were 92.6% (95% CI: 87.20–95.96), 88.6% (95% CI: 74.64–95.64) and 91.8% (95% CI: 87.24–94.81), respectively. No major and five (2.4%) minor complications occurred. Of 151 true-positive patients by EUS-FNA, 57 (37.7%) were surgically explored, of whom 28 (49.1%) underwent resection. Ten of 12 patients with false-negative cytology were explored based on detection of mass on EUS, of whom two had a delay due to false-negative cytology without curative treatment. From the whole study cohort, EUS-FNA had positive and negative impacts on subsequent management in 136 (65.7%) and 2 (0.9%) patients, respectively. Conclusions. EUS-FNA provides accurate diagnosis in 92% and has positive therapeutic impact in two-thirds of patients with solid pancreatic mass. Despite negative cytology, surgical exploration is recommended in clinical suspicion for pancreatic cancer and solid mass on EUS.     

Diagnostic value of serum CA242, CA 19-9, CA 15-3 and CA 125 in patients with carcinoma of the gallbladder.

BACKGROUND: Tumor markers have an increasing significance in the diagnosis and evaluation of tumor, but their role in gallbladder cancer has not been established. The present study was undertaken to determine the utility of serological markers in carcinoma of the gallbladder (CaGB). METHODS: This study was carried out in 55 cases and 8 healthy controls presenting to a single surgical unit of the University Hospital, Varanasi, India. CA242, CA19-9, CA15-3 and CA125 were assayed preoperatively in serum of patients with carcinoma of the gallbladder (39), cholelithiasis (16) and healthy controls (8) using ELISA technique. RESULTS: Mean concentration of all tumor markers was significantly raised in carcinoma of the gallbladder when compared with cholelithiasis. CA 242 was 12.10 vs 42.19 u/ ml, CA19-9 was 211.27 vs 86.06 uml, CA 15-3 was 71.42 vs 1.93u/ml and CA125 was 253.61 vs 65.5 u/ml <0.05). Sensitivity and specificity were calculated at various cut off points. Significant changes in CAl9-9 and CA242 occurred with advanced stage (p <0.05) and grade of tumor (p<0.00 1). When two tumor markers were combined, like CA242 and CA125, sensitivity and specificity improved to 87.5% and 85.7% respectively. Diagnostic accuracy is highest with a combination of CA 19-9 and CA 125 (80.65%). However, combination of tumor markers did not improve any further sensitivity or specificity of markers. CONCLUSION: Assay of CA242, CA15-3, CA19-9 and CA 125 are fairly good markers for discriminating patients of carcinoma of the gallbladder from cholelithiasis. CA242 and CA125 when used together achieved best sensitivity and specificity. Serum markers seem to be less sensitive when used individually in carcinoma of the gallbladder but may prove useful in combination.     

血清CA19—9、CEA、CA125联合检测诊断食管癌的价值

目的探讨多抗原联合检测诊断食管癌的价值。方法应用全自动化学免疫分析检测254例食管癌患者、40例食管炎患者和100例健康体检者血清CA19-9、CEA、CA125的表达。结果三项指标联合检测诊断食管癌的灵敏度和特异度均明显高于单独检测及任两项联合检测（P均〈0．01）。结论三项指标联合检测可提高诊断食管癌的灵敏度和特异度,有利于早期诊断食管癌。     

CA 19-9 in patients with benign pulmonary diseases

Although serum CA 19-9 is considered to be a useful and specific tumor marker for pancreatic cancer, some patients with benign pulmonary diseases show elevated serum CA 19-9 levels. We measured serum CA 19-9 levels of 156 patients with benign pulmonary diseases (55 with asbestosis, 11 with bronchial asthma, 32 with bronchiectasis, 16 with idiopathic pulmonary fibrosis (IPF), 13 with healed pulmonary tuberculosis (HPT) and 29 other benign diseases). The percentage of patients with positive serum CA 19-9 was 42.3% (14.5% in asbestosis, 27.3% in bronchial asthma, 59.4% in bronchiectasis, 81.3% in IPF, 61.5% in HPT and 51.7% in others). In some patients, serum CA 19-9 levels were as high as those found in malignant gastrointestinal diseases. Serum CA 19-9 levels correlated well with disease activity. Immunohistochemically, CA 19-9 was expressed in mucous cells of the bronchial gland and surface of the bronchiolar surface epithelium cells in benign pulmonary disease. Gel filtration study suggested some difference in molecular weight between the serum CA 19-9 antigen of lung cancer and that of benign pulmonary diseases. It is suggested that serum CA 19-9 increases in the case of hyperplasia of the bronchiolar epithelium cells or the mucous cells of the bronchial gland. We conclude that benign pulmonary disease is one of the factors that affect serum CA 19-9 levels.     

Intralobar pulmonary sequestration with aspergilloma in an adult

Intralobar pulmonary sequestration most often manifests with recurrent bacterial infections and fungal infections are rare. We report an unusual case of intralobar pulmonary sequestration with aspergilloma in a 49-year-old woman who presented with chronic cough and intermittent haemoptysis. The diagnosis of intralobar pulmonary sequestration was established by the multidetector computed tomographic angiography and the pathologic appearances of sequestrated lung tissue. The aspergilloma was detected postoperatively through histological examination of the resected lung tissue. Aspergilloma may occur as a superadded infection in any case of intralobar pulmonary sequestration presenting with chronic cough and recurrent bacterial infections.     

Comparison of serum CA72-4, CEA,TPA, CA19-9 and CA125 levels in gastric cancer patients and correlation with recurrence

BACKGROUND/AIMS: Serum tumor markers were investigated as prognostic factors for recurrence in patients with gastric cancers. METHODOLOGY: Preoperative serum levels of CEA, CA72-4, CA19-9, TPA and CA125 were sampled in 196 patients with gastric cancers undergoing curative surgery. The results were compared with the clinical recurrence and various clinicopathological factors. RESULTS: CA72-4, CEA, CA19-9, TPA and CA125 had sensitivities of 16.4%, 31.4%, 16.1%, 31.6%, and 6%, respectively. Sensitivity of two combinations was as high as 56.5%. Seventy-seven patients (39.9%) had clinical recurrence in the follow-up periods. For those with preoperatively elevated serum tumor markers, 38% (12/32) had CA72-4, 42% (13/31) had CA19-9, 48% (29/60) and had CEA, 54% (6/11) had CA125, and 62% (37/61) had TPA, and remained disease-free. Univariate analysis showed that TNM staging, Tumor size, Borrmann classification of tumor growth, and preoperative serum CA72-4 level were correlated with recurrence of disease. Multivariate analysis showed that independent prognostic factor of recurrence was TNM staging (P = 0.0007). CONCLUSIONS: Preoperative serum CA72-4 level is correlated with staging of disease, but is not an independent predictor for clinical recurrence of disease in patients with gastric cancers that undergo surgery.