Abstract
The case of a patient with an elevated preoperative serum CA19-9 level of 533.0 U/ml who was diagnosed with a CA19-9-producing gastric cancer and diffuse cystic malformation (DCM) is reported. A 57-year-old man with an abnormal screening upper GI series (fluoroscopy) was referred for further evaluation. Upper GI endoscopy showed a type 4 lesion, and adenocarcinoma was diagnosed by biopsy. Surgery, including a total gastrectomy, D2 lymph node dissection, splenectomy, and cholecystectomy, was performed. The histopathologic diagnosis was pT3(se)N3H0M0, pStage III with DCM.
Immunostaining of the resected specimen was positive for CA19-9 in the cancer cell cytoplasm, and, based on normalization of the serum CA19-9 level two months after surgery, a CA19-9-producing gastric cancer was diagnosed. Several lymph node metastases were found, so adjuvant chemotherapy was started 20 days after surgery. Currently, at 60 months postoperatively, the patient is alive without recurrence.
CA19-9-producing gastric cancer is rare, with only 39 cases, including the present patient, reported in Japan. The coexistence of DCM in such cases has not been previously reported. This case is presented along with a discussion of the relevant literature.
