Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2020; 8(6): 1108-1115
Published online Mar 26, 2020. doi: 10.12998/wjcc.v8.i6.1108
Abnormal serum carbohydrate antigen 19-9 levels in a patient with splenic retiform haemangioendothelioma concomitant with hepatic amyloidosis: A case report
Kai-Di Sun, Yu-Jie Zhang, Lan-Ping Zhu, Bo Yang, Sai-Yu Wang, Zi-Han Yu, Hai-Cheng Zhang, Xin Chen
Kai-Di Sun, Lan-Ping Zhu, Bo Yang, Sai-Yu Wang, Zi-Han Yu, Hai-Cheng Zhang, Xin Chen, Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
Yu-Jie Zhang, Department of Pathology, Tianjin Medical University General Hospital, Tianjin 300052, China
Author contributions: Sun KD collected and analyzed the data, and drafted the manuscript; Zhang YJ and Zhu LP provided clinical data and designed the outline of the manuscript; Yang B and Wang SY revised the manuscript for important intellectual content; Yu ZH and Zhang HC were responsible for informing, tracking, follow-up, and consultation of the patient; Chen X designed the overall concept and modified the manuscript; Sun KD, Zhang YJ, Zhu LP, and Yang B equally contributed to this work. All authors have read and approved the final version to be published.
Supported by Tianjin Research Innovation Project for Postgraduate Students, No. 2019YJSB108; and Science and Technology Program of Tianjin, No. 19PTZWHZ00090.
Informed consent statement: The therapy described was in accordance with the principles of medical ethics and good medical practice. The patient provided informed written consent prior to all medical procedures and for the publication of this report.
Conflict-of-interest statement: The authors declare no conflict of interest regarding this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xin Chen, MD, PhD, Associate Professor, Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Tianjin 300052, China. xchen03@tmu.edu.cn
Received: December 15, 2019
Peer-review started: December 15, 2019
First decision: January 7, 2020
Revised: March 4, 2020
Accepted: March 14, 2020
Article in press: March 14, 2020
Published online: March 26, 2020
Abstract
BACKGROUND

Carbohydrate antigen 19-9 (CA 19-9) is a glycoprotein that is used as a reliable tool for monitoring pancreatic cancer. Serum CA 19-9 levels are increased in patients suffering from liver, lung, and other non-malignant diseases. Haemangioendothelioma is a vascular neoplasm with a borderline biological behaviour. However, no case of haemangioendothelioma has yet been reported to be associated with CA 19-9.

CASE SUMMARY

A 54-year-old Chinese man was referred to our hospital for discontinuous fatigue and unintentional weight loss for over one year. Laboratory investigations revealed an elevated serum CA 19-9 concentration of 39 IU/mL (reference interval, 0–37 IU/mL) over one year before admission. Afterwards, coagulopathy appeared, and the patient’s serum CA 19-9 concentration increased continuously. At the time of admission, abdominal pain and haemorrhagic shock burst occurred, and emergency medical operation was performed. Laboratory investigations conducted upon admission showed a serum CA19-9 concentration of 392.56 IU/mL. Surgical resection of the spleen was undertaken, and pathological examination showed retiform haemangioendothelioma. The patient developed jaundice ten days after surgical excision of the spleen. Pathological examination of needle biopsy samples of the liver yielded a diagnosis of hepatic amyloidosis.

CONCLUSION

We describe a rare case of splenic retiform haemangioenthelioma concomitant with hepatic amyloidosis. Physicians should note abnormal serum CA 19-9 levels with early symptoms of fatigue and unintentional weight loss.

Keywords: Carbohydrate antigen 19-9, Haemangioendothelioma, Amyloidosis, Spleen, Liver, Case report

Core tip: We describe a rare case of splenic retiform haemangioenthelioma concomitant with hepatic amyloidosis. Although the specificity of carbohydrate antigen 19-9 is weak, sometimes the potential lesions may be ignored. Physicians should be aware of abnormal serum carbohydrate antigen 19-9 levels with early symptoms of fatigue and unintentional weight loss.