{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T16:12:38Z","timestamp":1757779958628,"version":"3.41.2"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T00:00:00Z","timestamp":1644969600000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Carbohydrate antigen 19\u20139 (CA 19\u20139) is a specific tumour marker for pancreato-biliary malignancy. Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated condition in which IgG4 deposits infiltrate various organs, including the biliary tract manifesting IgG4 sclerosing cholangitis and pseudotumours. An 83-year-old woman presented with severe obstructive jaundice, weight loss and an extreme elevation of CA 19\u20139 level of 3295 kU\/L. Magnetic resonance cholangiopancreatography (MRCP) revealed a pancreatic mass amputating the biliary tree. Liver function tests revealed a cholestatic pattern and severe hyperbilirubinaemia (289umol\/L). IgG4 level was found to be high at 7.97\u00a0g\/L. After treatment with high-dose corticosteroids, repeat MRCP 2 months later revealed disappearance of the pancreatic mass. There was also normalization of the bilirubin and a dramatic decrease of CA 19\u20139. This case reports the highest published benign elevation of Ca19.9 level in the setting of IgG4 disease. Differentiation between cholangiocarcinoma and IgG4-RD is important, as the treatment is vastly different.<\/jats:p>","DOI":"10.1093\/jscr\/rjac018","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T12:08:13Z","timestamp":1641902893000},"source":"Crossref","is-referenced-by-count":2,"title":["A pancreatic mass and extreme elevation of CA 19\u20139: a benign masquerade of cholangiocarcinoma"],"prefix":"10.1093","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4188-8072","authenticated-orcid":false,"given":"Catherine","family":"Hall","sequence":"first","affiliation":[{"name":"Division of Surgery, The Canberra Hospital, Garran, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mairi","family":"McLaren","sequence":"additional","affiliation":[{"name":"Division of Surgery, The Canberra Hospital, Garran, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Mosse","sequence":"additional","affiliation":[{"name":"Division of Surgery, The Canberra Hospital, Garran, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,2,16]]},"reference":[{"key":"2022021621133034300_ref1","article-title":"The clinical utility of the CA 19-9 tumor-associated antigen","volume":"85","author":"Steinberg","year":"1990","journal-title":"Am J Gastroenterol (Springer Nature)"},{"key":"2022021621133034300_ref2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/978-94-017-7215-0_15","article-title":"CA 19-9: biochemical and clinical aspects","author":"Scar\u00e0","year":"2015","journal-title":"Advances in Cancer Biomarkers"},{"key":"2022021621133034300_ref3","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1080\/13651820802014585","article-title":"Is preoperative histological diagnosis necessary before referral to major surgery for cholangiocarcinoma?","volume":"10","author":"Buc","year":"2008","journal-title":"HPB"},{"key":"2022021621133034300_ref4","doi-asserted-by":"crossref","first-page":"75","DOI":"10.14740\/jocmr4428","article-title":"Isolated type immunoglobulin G4 sclerosing cholangitis: the misdiagnosed cholangiocarcinoma","volume":"13","author":"Nasser","year":"2021","journal-title":"J Clin Med Res"},{"key":"2022021621133034300_ref5","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1136\/annrheumdis-2018-214603","article-title":"Clinical phenotypes of IgG4-related disease: an analysis of two international cross-sectional cohorts","volume":"78","author":"Wallace","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"2022021621133034300_ref6","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1097\/PAS.0b013e3181a5a207","article-title":"Inflammatory myofibroblastic tumor versus IgG4-related sclerosing disease and inflammatory pseudotumor: a comparative clinicopathologic study","volume":"33","author":"Yamamoto","year":"2009","journal-title":"Am J Surg Pathol"},{"key":"2022021621133034300_ref7","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1080\/13651820801992633","article-title":"Is preoperative histological diagnosis necessary for cholangiocarcinoma?","volume":"10","author":"Davidson","year":"2008","journal-title":"HPB"},{"key":"2022021621133034300_ref8","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jamcollsurg.2005.07.011","article-title":"Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma","volume":"201","author":"Corvera","year":"2005","journal-title":"J Am Coll Surg"},{"key":"2022021621133034300_ref9","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1002\/bjs.6057","article-title":"Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures","volume":"95","author":"Erdogan","year":"2008","journal-title":"Br J Surg"},{"key":"2022021621133034300_ref10","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1007\/s00268-004-7034-z","article-title":"Differential diagnosis of stenosing lesions at the hepatic hilus","volume":"28","author":"Koea","year":"2004","journal-title":"World J Surg"},{"key":"2022021621133034300_ref11","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.pan.2014.07.010","article-title":"Increase diagnostic accuracy in differentiating focal type autoimmune pancreatitis from pancreatic cancer with combined serum IgG4 and CA19-9 levels","volume":"14","author":"Chang","year":"2014","journal-title":"Pancreatology"},{"key":"2022021621133034300_ref12","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1159\/000455963","article-title":"Risk of cancer in patients with autoimmune pancreatitis: a single-center experience from Germany","volume":"95","author":"Schneider","year":"2017","journal-title":"Digestion"},{"key":"2022021621133034300_ref13","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1038\/ajg.2012.465","article-title":"Risk of cancer in patients with autoimmune pancreatitis","volume":"108","author":"Shiokawa","year":"2013","journal-title":"Am J Gastroenterol"},{"key":"2022021621133034300_ref14","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1016\/j.humpath.2008.01.021","article-title":"Synchronous autoimmune pancreatitis and infiltrating pancreatic ductal adenocarcinoma: case report and review of the literature","volume":"39","author":"Witkiewicz","year":"2008","journal-title":"Hum Pathol"},{"key":"2022021621133034300_ref15","doi-asserted-by":"crossref","first-page":"414","DOI":"10.3109\/s10165-011-0520-x","article-title":"Risk of malignancies in IgG4-related disease","volume":"22","author":"Yamamoto","year":"2012","journal-title":"Mod Rheumatol"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2022\/2\/rjac018\/42539333\/rjac018.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2022\/2\/rjac018\/42539333\/rjac018.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T21:13:50Z","timestamp":1645046030000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjac018\/6529284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,1]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjac018","relation":{},"ISSN":["2042-8812"],"issn-type":[{"type":"electronic","value":"2042-8812"}],"subject":[],"published-other":{"date-parts":[[2022,2]]},"published":{"date-parts":[[2022,2,1]]},"article-number":"rjac018"}}