Abstract
The patient was a 61-year-old female who was admitted to our hospital because of abdominal pain. Initial blood investigations revealed an increased white cell count of 16200 /μl and a C-reactive protein level of 31.8 mg/dl. Based on the findings of diagnostic imaging, we diagnosed the patient to have cholecystitis and thus started conservative therapy. Three days after admission, the fever and abdominal pain still remained, and serum CA19-9 level had also markedly increased (>12000 U/ml). Abdominal computed tomography showed the presence of ascites around the liver, and performing a needle biopsy, we confirmed the presence of biliary fluid. As a result, the patient was diagnosed to have a perforation of the gallbladder and immediately underwent emergency cholecystectomy and intraadbominal drainage. The pathologic examination revealed chronic cholecystitis, but no malignancy was identified. The mucosa and stroma of the gallbladder were both positive for the immunohistochemical staining of CA19-9, and the serum CA19-9 levels also normalized to 19 U/ml postoperatively. CA19-9 has been widely used as a useful marker for diagnosing malignant tumors, especially for biliary malignancies. However, the serum CA19-9 level also sometimes increases in benign diseases, such as cholecystitis.
