Alice C. Jiang, MD, Edie Y. Chan, MD, Shriram Jakate, MD, FRCPath, Nikunj Shah, MD
Rush University Medical Center, Chicago, IL
Introduction: CA 19-9 is an important tumor marker for pancreatic cancer, but is also seen in non-malignant conditions such as cholelithiasis, cholangitis, pancreatitis, and other non-pancreaticobiliary conditions such as interstitial lung disease. This is a case of markedly elevated CA 19-9 found in the setting of a simple biliary cyst in the liver and heavy black tea consumption.
Case Description/Methods: A 34 year old woman with no significant past medical history presented to the ER for acute onset RUQ pain and nausea with vomiting. She had an ultrasound showing a 10.8 x 16.1 x 9.5cm cystic lesion. Follow-up CT described the lesion as a large non-enhancing, hypoattenuating mass within the medial segment of the left lobe, most likely representing a cyst. AST, ALT, alkaline phosphatase, total bilirubin, albumin, INR and CBC were normal. AFP was < 2.0 and CA 19-9 was 45,266 U/mL. On further interview, she reported drinking large amounts of black tea daily. She underwent a left lobectomy, with pathology showing simple biliary cyst. After surgery, her symptoms resolved and she reduced tea consumption to once weekly. Her CA 19-9 level decreased to 29 U/mL by 1 month post-resection, and remains normal 1 year later.
Discussion: The first case report of an association between heavy black tea consumption and elevated CA 19-9 hypothesized that the high gallated flavenoid content in black tea can impact a range of molecular targets influencing cell growth through the angiogenesis pathway (1, 2). In a study of 270 healthy individuals with heavy black tea consumption, 43.3% had elevated levels of CA 19-9 between 69-105 U/mL. The remainder of individuals had levels of 40 U/mL or lower. The proposed mechanism was stimulated production of CA 19-9 in epithelial tissues. While the exact mechanisms remain unknown, the presence of heavy black tea consumption should be considered in patients with elevated CA 19-9 in the absence of pancreaticobiliary disease because it is an easily modifiable factor.
Citation: Alice C. Jiang, MD, Edie Y. Chan, MD, Shriram Jakate, MD, FRCPath, Nikunj Shah, MD. P0082 - ELEVATED CA 19-9 ASSOCIATED WITH HEAVY BLACK TEA CONSUMPTION. Program No. P0082. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.