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A simple hepatic cyst with elevated serum and cyst fluid CA19-9 levels: a case report.

Yanai H, Tada N - J Med Case Rep (2008)

Bottom Line: Simple hepatic cysts rarely cause symptoms, however, occasionally they become symptomatic due to mass effect, rupture, hemorrhage, and infection.After the intracystic instillation of minocycline hydrochloride, necrotic cells in the cyst were drained, and it totally collapsed after 1 week.Cyst fluid CA19-9 levels increased remarkably after the intracystic instillation of minocycline hydrochloride, while serum CA19-9 levels decreased significantly.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Division of General Medicine, Kashiwa Hospital, The Jikei University School of Medicine, Kashiwashita, Kashiwa, Chiba, Japan. yanaih@jikei.ac.jp

ABSTRACT

Introduction: Simple hepatic cysts rarely cause symptoms, however, occasionally they become symptomatic due to mass effect, rupture, hemorrhage, and infection. We report a patient with a large hepatic cyst with elevated serum and cyst fluid CA19-9 levels. We studied serum and cyst fluid CA19-9 levels in this patient, before and after the intracystic instillation of minocycline hydrochloride.

Case presentation: A 76-year-old Japanese woman was diagnosed as having an infected hepatic cyst, by physical examination and enhanced abdominal computed tomography. Serum (170 U/ml; reference: < 37 U/ml) and hepatic cyst fluid (371 U/ml) CA19-9 levels were elevated. After the intracystic instillation of minocycline hydrochloride, necrotic cells in the cyst were drained, and it totally collapsed after 1 week. Cyst fluid CA19-9 levels increased remarkably after the intracystic instillation of minocycline hydrochloride, while serum CA19-9 levels decreased significantly.

Conclusion: Our study is the first report to reveal the influence of intracystic instillation of minocycline hydrochloride on serum and cyst fluid CA19-9 levels in a patient with a simple hepatic cyst.

No MeSH data available.


Related in: MedlinePlus

Changes in serum and cyst fluid CA19-9 levels before and after the intracystic instillation of minocycline hydrochloride.
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Figure 2: Changes in serum and cyst fluid CA19-9 levels before and after the intracystic instillation of minocycline hydrochloride.

Mentions: In addition, we performed percutaneous treatment of the hepatic cyst by drainage and sclerotherapy using minocycline hydrochloride. Briefly, after local anesthesia of the puncture site with 1% mepivacaine hydrochloride, a 20-cm long, 22-gauge needle was passed into the cyst under real-time ultrasonic guidance with a 3.5 MHz convex transducer. After a pig tail catheter had been inserted into the cyst, the cystic fluid was aspirated. Bacteria, neoplastic cells, and parasites were not detected in the cystic fluid, however, CA19-9 levels were elevated in hepatic cyst fluid (371 U/ml). At 3 days after drainage, her fever and serum CRP level (4.1 mg/dl) were remarkably decreased; this also supported the diagnosis of an infected hepatic cyst. 400 mg of minocycline hydrochloride was dissolved in 50 ml of saline, and this minocycline solution was injected into the cyst using the drainage catheter. The drain was closed, and was opened 24 hours after intracystic instillation of minocycline hydrochloride. To determine the contribution of the hepatic cyst to the CA19-9 levels, we measured serum and cyst fluid CA19-9 levels before, 1 day after and 1 week after intracystic instillation of minocycline hydrochloride. After intracystic instillation, necrotic cells in the cyst were drained, and the cyst totally collapsed after 1 week (Figure 1B). Cyst fluid CA19-9 levels increased remarkably after the minocycline instillation, while serum CA19-9 levels decreased (Figure 2).


A simple hepatic cyst with elevated serum and cyst fluid CA19-9 levels: a case report.

Yanai H, Tada N - J Med Case Rep (2008)

Changes in serum and cyst fluid CA19-9 levels before and after the intracystic instillation of minocycline hydrochloride.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572621&req=5

Figure 2: Changes in serum and cyst fluid CA19-9 levels before and after the intracystic instillation of minocycline hydrochloride.
Mentions: In addition, we performed percutaneous treatment of the hepatic cyst by drainage and sclerotherapy using minocycline hydrochloride. Briefly, after local anesthesia of the puncture site with 1% mepivacaine hydrochloride, a 20-cm long, 22-gauge needle was passed into the cyst under real-time ultrasonic guidance with a 3.5 MHz convex transducer. After a pig tail catheter had been inserted into the cyst, the cystic fluid was aspirated. Bacteria, neoplastic cells, and parasites were not detected in the cystic fluid, however, CA19-9 levels were elevated in hepatic cyst fluid (371 U/ml). At 3 days after drainage, her fever and serum CRP level (4.1 mg/dl) were remarkably decreased; this also supported the diagnosis of an infected hepatic cyst. 400 mg of minocycline hydrochloride was dissolved in 50 ml of saline, and this minocycline solution was injected into the cyst using the drainage catheter. The drain was closed, and was opened 24 hours after intracystic instillation of minocycline hydrochloride. To determine the contribution of the hepatic cyst to the CA19-9 levels, we measured serum and cyst fluid CA19-9 levels before, 1 day after and 1 week after intracystic instillation of minocycline hydrochloride. After intracystic instillation, necrotic cells in the cyst were drained, and the cyst totally collapsed after 1 week (Figure 1B). Cyst fluid CA19-9 levels increased remarkably after the minocycline instillation, while serum CA19-9 levels decreased (Figure 2).

Bottom Line: Simple hepatic cysts rarely cause symptoms, however, occasionally they become symptomatic due to mass effect, rupture, hemorrhage, and infection.After the intracystic instillation of minocycline hydrochloride, necrotic cells in the cyst were drained, and it totally collapsed after 1 week.Cyst fluid CA19-9 levels increased remarkably after the intracystic instillation of minocycline hydrochloride, while serum CA19-9 levels decreased significantly.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Division of General Medicine, Kashiwa Hospital, The Jikei University School of Medicine, Kashiwashita, Kashiwa, Chiba, Japan. yanaih@jikei.ac.jp

ABSTRACT

Introduction: Simple hepatic cysts rarely cause symptoms, however, occasionally they become symptomatic due to mass effect, rupture, hemorrhage, and infection. We report a patient with a large hepatic cyst with elevated serum and cyst fluid CA19-9 levels. We studied serum and cyst fluid CA19-9 levels in this patient, before and after the intracystic instillation of minocycline hydrochloride.

Case presentation: A 76-year-old Japanese woman was diagnosed as having an infected hepatic cyst, by physical examination and enhanced abdominal computed tomography. Serum (170 U/ml; reference: < 37 U/ml) and hepatic cyst fluid (371 U/ml) CA19-9 levels were elevated. After the intracystic instillation of minocycline hydrochloride, necrotic cells in the cyst were drained, and it totally collapsed after 1 week. Cyst fluid CA19-9 levels increased remarkably after the intracystic instillation of minocycline hydrochloride, while serum CA19-9 levels decreased significantly.

Conclusion: Our study is the first report to reveal the influence of intracystic instillation of minocycline hydrochloride on serum and cyst fluid CA19-9 levels in a patient with a simple hepatic cyst.

No MeSH data available.


Related in: MedlinePlus