Abstract
Simple hepatic cysts are very common, but may be difficult to differentiate from a biliary cystadenoma or cystadenocarcinoma. Because the surgical treatment if needed, such as a hepatic fenestration or resection, depends on the diagnosis, the assay of intracystic tumor markers is useful.
We report the case of a 67-year-old woman with a large hepatic cyst responsible of pain and inflammation. The combination of imaging findings, serum, and intracystic fluid tumor markers [CA72.4 (carbohydrate hydrogen)] permitted to diagnose a simple hepatic cyst despite an unusual persistent elevated serum CA19.9 level. A laparoscopic cyst fenestration was proposed with an uneventful postoperative course. The pathological findings showed a simple hepatic cyst.
In case of hepatic cysts, radiological findings can discriminate between benign and (pre)malignant lesions, but in case of doubtful diagnosis, the serum and intracystic tumor markers can be helpful.
The use of serum or intracystic tumor marker allows to choose the correct therapeutic strategy and to use mini-invasive approach when feasible.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Precetti S, Gandon Y, Vilgrain V. Imagerie des lésions kystiques du foie. J Radiol. 2007;88:1061–72.
Pavai S, Yap S. The clinical significance of elevated levels of serum CA 19–9. Med J Malaysia. 2003;58:667–72.
Seo JK, Kim SH, Lee SH, et al. Appropriate diagnosis of biliary cystic tumors: comparison with atypical hepatic simple cysts. Euro J Gastroenterol Hepatol. 2010;22:989–96.
Fuks D, Voitot H, Paradis V, et al. Intracystic concentrations of tumour markers for the diagnosis of cystic liver lesions: tumour markers for diagnosing cystic liver lesions. Br J Surg. 2014;101:408–16.
Teoh AYB, Ng SSM, Lee KF, et al. Biliary cystadenoma and other complicated cystic lesions of the liver: diagnostic and therapeutic challenges. World J Surg. 2006;30:1560–6.
Fiamingo P, Tedeschi U, Veroux M, et al. Laparoscopic treatment of simple hepatic cysts and polycystic liver disease. Surg Endosc Other Interv Tech. 2003;17:623–6.
Thomas KT, Welch D, Trueblood A, et al. effective treatment of biliary cystadenoma. Ann Surg. 2006;241:769–75.
Scoggins CR, Moore D, Washington K, et al. Supra-elevated CA 19–9 in a benign hepatic cystadenoma. HPB. 2004;6:43–4.
Yanai H, Tada N. A simple hepatic cyst with elevated serum and cyst fluid CA19-9 levels: a case report. J Med Case Rep. 2008;2:329.
Choi HK, Lee JK, Lee KH, et al. Differential diagnosis for intrahepatic biliary cystadenoma and hepatic simple cyst: significance of cystic fluid analysis and radiologic findings. J Clin Gastroenterol. 2010;44:289–93.
Kitajima Y, Okayama Y, Hirai M, et al. Intracystic hemorrhage of a simple liver cyst mimicking a biliary cystadenocarcinoma. J Gastroenterol. 2003;38:190–3.
Kovacs MD, Sheafor DH, Burchett PF, et al. Differentiating biliary cystadenomas from benign hepatic cysts: preliminary analysis of new predictive imaging features. Clin Imaging. 2018;49:44–7.
Tan GJS, Berlangieri SU, Lee ST, et al. FDG PET/CT in the liver: lesions mimicking malignancies. Abdom Imaging. 2014;39:187–95.
Waanders E, van Keimpema L, Brouwer JT, et al. Carbohydrate antigen 19–9 is extremely elevated in polycystic liver disease. Liver International. 2009;29:1389–95.
Horsmans Y, Laka A, Gigot J-F, et al. Serum and cystic fluid CA 19–9 determinations as a diagnostic help in liver cysts of uncertain nature. Liver. 2008;16:255–7.
Mariampillai AI, Josepine PDC, Suh J, et al. Cancer antigen 72–4 for the monitoring of advanced tumors of the gastrointestinal tract, lung, breast and ovaries. Anticancer Res. 2017;37:3649–56.
Hu P-J, Chen M-Y, Wu M-S, et al. Clinical evaluation of CA72-4 for screening gastric cancer in a healthy population: a multicenter retrospective study. Cancers. 2019;11:733.
Negishi Y, Iwabuchi H, Sakunaga H, et al. Serum and tissue measurements of CA72-4 in ovarian cancer patients. Gynecol Oncol. 1993;48:148–54.
Hollingsworth MA, Swanson BJ. Mucins in cancer: protection and control of the cell surface. Nat Rev Cancer. 2004;4:45–60.
Ouyang M, Wu W, Zou Y, et al. Immunoreactivity and prognostic value of tumor-associated glycoprotein 72 in primary gallbladder carcinoma. Surg Oncol. 2010;19:82–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Letizia Zurli, Jeanne Dembinski, Brice Robert and Jean-Marc Regimbeau declare that they have no conflict of interest.
Human and animal rights
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent
Informed consent was obtained from all patients for being included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Zurli, L., Dembinski, J., Robert, B. et al. Atypic large hepatic cyst with persistent elevated CA19.9 serum value: utility of intracystic CA72.4 dosage for a mini-invasive management. Clin J Gastroenterol 14, 258–262 (2021). https://doi.org/10.1007/s12328-020-01292-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-020-01292-4