2017 Volume 60 Issue 10 Pages 719-725
A 72-year-old female had been diagnosed with diabetes 3 years previously and had since been receiving medical treatment; however, her glycemic control was observed to have worsened about 4 months prior to this presentation. She was admitted to the hospital due to acute bronchitis and high HbA1c levels (11.7 %). Abnormally high tumor marker levels of CA19-9 3226.0 U/mL and CEA 41.3 ng/mL were also observed, and abdominal ultrasonography, CT, MRCP, gastroscopy and colonoscopy were performed; however, the primary disease could not be identified. Regarding the patient's diabetes, her blood glucose levels improved after administering intensive insulin therapy, and a further improvement was obtained after administering insulin degludec/aspart and vildagliptin. An increased fluorodeoxyglucose (18F-FDG) accumulation was identified in the ileocecum on 18F-FDG-positron emission tomography/computed tomography, and surgery was performed. As a result, mucinous appendiceal adenocarcinoma with metastasis to the lymph nodes was diagnosed. The tumor cells were densely stained by CA19-9 immunostaining, with serum CA19-9 normalizing after carrying out postoperative chemotherapy. Fat cells in the cancer nest showed positive staining for IL-6 and TNFα. A tendency for the blood glucose levels to decrease was observed after carcinectomy, resulting in a reduction in the insulin dose. Subsequently, the patient showed a good recovery, and her HbA1c levels returned to the upper 6 % range.
