Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2020; 12(12): 549-554
Published online Dec 27, 2020. doi: 10.4240/wjgs.v12.i12.549
Giant simple hepatic cyst with multiple elevated serum tumor markers: A case report
Jia-Wei Zhang, Cheng Peng, Yan-Shuo Ye, Wei Li
Jia-Wei Zhang, Cheng Peng, Yan-Shuo Ye, Wei Li, Department of Hepatobiliary-Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Jia-Wei Zhang, Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Cheng Peng, Department of Hepatobiliary-Pancreatic Surgery, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Author contributions: Zhang JW initially identified the case, collected and organized the medical records, and performed an intensive revision of the manuscript; Peng C primarily drafted the article, accomplished the actual writing, selected the references, and drafted the discussion; Ye YS also performed the revision of the manuscript; Li W contributed to the conceptual design, and carried out critical revision and finalization of the manuscript.
Supported by Nature Science Foundation of The Science and Technology Bureau of Jilin Province, No. Li 20190201227JC; and The Innovation Capacity Building Fund of The Development and Reform Commission of Jilin Province, No. Li 2019C015.
Informed consent statement: The patient provided informed written consent for the publication of this case report.
Conflict-of-interest statement: None.
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: Wei Li, MD, PhD, Professor, Surgeon, Department of Hepatobiliary-Pancreatic Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun 130033, Jilin Province, China. weili888@jlu.edu.cn
Received: July 23, 2020
Peer-review started: July 23, 2020
First decision: October 6, 2020
Revised: October 16, 2020
Accepted: November 12, 2020
Article in press: November 12, 2020
Published online: December 27, 2020
Processing time: 151 Days and 11.5 Hours
Abstract
BACKGROUND

Simple hepatic cysts are relatively common in adults, and mostly appear as asymptomatic incidental radiologic findings. Occasionally, a large cyst will cause symptoms. Elevations in the serum biomarkers protein induced by vitamin K absence (PIVKA)-II, cancer antigen (CA) 12-5, and CA19-9 are often associated with malignant tumors in the liver or bile ducts. This is the first report to describe a case of hepatic cyst with elevated levels of PIVKA-II and CA12-5. 

CASE SUMMARY

An 84-year-old Chinese woman was admitted with gradual abdominal distension. Her symptoms started 1 year ago, and she had poor appetite and a weight loss of 5 kg within the past 2 wk. She denied any symptoms associated with abdominal pain, fever and chills, nausea and vomiting, etc. The abdomen was enlarged, more in the right upper quadrant, without tenderness. Laboratory examination showed significantly increased serum levels of PIVKA-II, CA12-5, and CA19-9. A computed tomography scan revealed multiple round cysts in the liver with clear boundaries. The largest cyst was 20.1 cm × 12.2 cm × 19.6 cm in size, located in the right lobe of the liver with mild dilatation of the intrahepatic bile duct, but there was no contrast enhancement. Percutaneous drainage on the largest hepatic cyst and polycinnamol sclerosing agent injection into the cyst cavity were performed. After treatment, the patient’s symptoms relieved and the elevated serum tumor makers reduced to the normal levels dramatically. 

CONCLUSION

The present report identifies an unusual case of a giant hepatic cyst with marked elevation of serum tumor marker levels of PIVKA-II, CA12-5, and CA19-9. After treatment, these three serum markers dramatically decreased to normal levels. The mechanisms for the elevation of these tumor markers may be as follows: (1) A giant hepatic cyst compresses the liver, causing injury to the hepatocytes, which may lead to secretion of a large amount of PIVKA-II; and (2) Some tumor-associated antigens, such as carcinoembryonic antigen, CA19-9, CA12-5, and CA15-3, are expressed on inflammatory cells.

Keywords: Hepatic cyst; Tumor markers; Protein induced by vitamin K absence-II; Cancer antigen 12-5; Cancer antigen 19-9; Case report

Core Tip: Simple hepatic cysts typically appear as asymptomatic benign tumors of the liver without elevation of any diagnostic serum biomarkers. However, over the years, a few cases of simple hepatic cysts with elevated tumor markers have been reported in the world. Here, we report a case of giant simple hepatic cyst with elevation of multiple serum cancer biomarkers, including protein induced by vitamin K absence-II, cancer antigen (CA) 12-5, and CA19-9.