TY - JOUR AU - Villani, R. AU - Gargano, R. AU - Rovai, C. AU - Milillo, P. AU - Macarini, L. AU - Serviddio, G. PY - 2016/09/15 Y2 - 2024/03/28 TI - To be or not to be: a two years surveillance for a CA 19-9 persistent elevation before cancer diagnosis and bone metastases JF - JOURNAL OF GERONTOLOGY AND GERIATRICS JA - Gerontology and Geriatrics VL - 64 IS - 3 SE - Clinical Observations in Geriatrics - Clinical Experiences and Case Reports DO - UR - https://www.jgerontology-geriatrics.com/article/view/174 SP - 112-115 AB - Background. CA 19-9 is an antigen expressed by several epithelial cells and currently used for the diagnosisand follow-up of gastrointestinal cancers. Even if a serum level > 1000 UI/ml has a specificity for pancreaticcancer of 99.8% its elevation is also reported in benign diseases. The pancreatic ductal adenocarcinoma istipically aggressive and therefore shorter follow-up are expected to be found before diagnosis.Case presentation. A 75-years-old female referred to us for evaluation of high level of serum CA 19-9 (558 UI/ml) observed for the first time one year before when she had also been undergone colonoscopy that haveexcluded neoplasms.At the adimission she complained fatigue, weight loss, hyporexia, nausea, low-grade fever and intermittentself-limiting skin lesions of the lower limbs. Serum CA 19-9 level was > 1000 UI/ml.Her past medical history was significant for chronic HCV hepatitis, essential hypertension and hysterectomyfor leiomyofibroma of the uterus thirty years before.We did not found any neoplasm and scheduled a close follow-up with colonoscopy, CT and PET for one additionalyear. At the end of December 2015 we observed the appearance of small painful nodules in the subcutaneousperiumbilical region and a CT showed a pancreatic tail malignancy and bone metastases. Periumbilicalbiopsy was performed and the diagnosis of pancreatic ductal adenocarcinoma was proven.Conclusion. A long time observation of a persistent and progressive CA 19-9 increase should never excludethe malignant origin. The trend, more than the duration of this finding may guide clinical decision.AbbreviationsCarbohydrate Antigen 19-9 – CA 19-9Computerized Tomography – CTF-18-fluorodeoxyglucose positron emission tomography – 18F-FDG PETCarcinoembryonic Antigen – CEACancer antigen 125 – CA 125 ER -