Extraordinarily high serum CA 19-9 in setting of pancreatic necrosis and underlying pancreatic adenocarcinoma: a case report.

Carbohydrate antigen (CA 19-9) is the most validated marker for both sensitivity and specificity of pancreatic adenocarcinoma used to aid diagnosis of symptomatic patients as well as to evaluate the progression or treatment of disease. Though higher levels of CA 19-9 tend to correlate with neoplastic disease, elevated levels are also often seen in patients with benign gastrointestinal diseases, such as obstructive jaundice and pancreatitis. We present a case of a 74-year-old male who was admitted for abdominal pain and worsening jaundice who was diagnosed with extensive pancreatic necrosis and an underlying invasive pancreatic adenocarcinoma whose serum level of CA 19-9 was found to be extraordinarily high.

Adventitial cystic disease of the axillary artery.

Adventitial cystic disease (ACD) is an extremely rare cause of arterial and venous insufficiency, with only 317 reported cases in the world literature. These lesions have been previously described in the popliteal fossa, external iliac artery, and distal brachial, radial, and ulnar arteries as well as in the proximal saphenous vein at the ankle. We describe here the first reported case of this disease in a proximal vessel, the axillary artery. A 33-year-old man was evaluated for upper extremity arterial insufficiency and was diagnosed with ACD on the basis of physical examination and radiographic findings, which was confirmed by pathological assessment. The patient was treated by excision of the lesion and interposition vein bypass. As this represents the first case of ACD in the proximal vasculature, it demonstrates that these lesions can occur in axial blood vessels.