Editorial

Tumor Markers: An Important Adjunct to Clinical Practice

Authors: Mankanwal S. Sachdev, MD, Claudio R. Tombazzi, MD

Abstract

The authors of the article, “Elevated CA 19-9 Levels in a Patient with Mirizzi Syndrome: Case Report”1 provide a unique scenario in which a person presents with an elevated serum carbohydrate antigen 19-9 (CA 19-9). The initial workup involved looking for typical causes such as biliary and ampullary carcinoma, but ultimately revealed a case of Mirizzi syndrome. While this is not the first report,2,3 this case reminds us that often in medicine one needs to think outside of the box. Occasionally, we forget that diagnoses do not always have to be defined by lab tests, and this case report shows us that although they are helpful, tumor markers are not always accurate. Also, it highlights the potential benefit of newer imaging modalities.

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References

1. Sanchez M, Gomes H, Marcus EN. Elevated CA 19-9 Levels in a Patient with Mirizzi's Syndrome: Case Report. South Med J 2006;99:160–163.
 
2. Lee KC, Yamazaki O, Horii K, et al. Mirizzi syndrome caused by xanthogranulomatous cholecystitis: report of a case. Surg Today 1997;27:757–761.
 
3. Principe A, Del Gaudio M, Grazi GL, et al. Mirizzi syndrome with cholecysto-choledocal fistula with a high CA19-9 level mimicking biliary malignancies: a case report. Hepatogastroenterology 2003;50:1259–1262.
 
4. Duffy MJ. Evidence for the clinical use of tumour markers. Ann Clin Biochem 2004;41(Pt 5):370–377.
 
5. Pleskow DK, Berger HJ, Gyves J, et al. Evaluation of a serologic marker, CA19-9, in the diagnosis of pancreatic cancer [see comment]. Ann Intern Med 1989;110:704–709.
 
6. Pavai S, Yap SF. The clinical significance of elevated levels of serum CA 19-9. Med J Malaysia2003;58:667–672.
 
7. Moon JH, Cho YD, Cheon YK, et al. Wire-guided intraductal US in the assessment of bile duct strictures with Mirizzi syndrome-like features at ERCP. Gastrointest Endosc 2002;56:873–879.