CA 19_9

CA 19.9

Immunohistochemical expression

This is a monosialoganglioside related to the Lewis A blood group antigen. It is positive in most gastrointestinal and pancreaticobiliary carcinomas and less frequently in adenocarcinomas of other sites¹. In the 10% of the population that is Lewis-A negative, Ca 19.9 is absent and therefore cannot be applied as a tumour marker.

Ca19.9 can be detected in fetal epithelia of the stomach, small intestine, colon, liver and pancreas. It is present in very low concentrations in adult gastrointestinal and lung tissues. It is present at high concentrations in mucin in saliva, seminal fluid, gastric and duodenal secretions, amniotic fluid, urine, bile, pancreatic secretions and ovarian cyst fluid.

It is expressed by adenocarcinomas at a wide range of sites:

Breast, ductal carcinoma

57/119¹⁰

Breast, lobular carcinoma

1/10¹⁰

Pulmonary adenocarcinomas

24/35¹⁰

Gastric carcinomas

22/39¹⁰

Colonic carcinoma

19/25¹⁰

Pancreatic carcinoma

22/26¹⁰

Ovarian carcinoma

12/29¹⁰

Renal carcinomas

12/45¹⁰

Diagnostic utility

Ca19.9 is used as a serum marker with a relative specificity for tumours of the pancreas and gastrointestinal tract. Differentiation of mesothelioma from adenocarcinoma. Low sensitivity for adenocarcinoma means that it is not of general use. However, its frequent positivity in serous carcinomas of the ovary and peritoneum makes it useful in differentiating these tumours from epithelioid mesotheliomas of the peritoneum^8,9.

adenocarcinoma

mesothelioma

Ordonez 1987⁹

45/78

not studied

Ordonez 1989⁴

9/23 (pulmonary adenocarcinomas)

0/19 (all epithelioid mesotheliomas)

Bateman 1997²

8/14

0/17

Chenard-Neu 1990³

13/20 (primary adenocarcinomas variously of lung, breast, ovary and stomach)

0/14

Ohshea 1995⁵

45/76 (all types - squamous, adenocarcinoma and small cell - showed positivity)

0/?

Chenard-Neu 1998⁶

16/30 (various sites of origin)

0/28

Fetsch 1998¹

24/49 (8/15 breast, 5/8 ovary, 0/5 prostate, 3/10 lung focally, 8/11 gastrointestinal tract)

1/37

Ordonez 1998⁸

31/45 (papillary serous carcinomas [20/30 ovarian (10 primary and 20 metastatic to the peritoneum) and 11/15 papillary serous carcinomas of the peritoneum])

0/35 (epithelioid peritoneal mesotheliomas)

Ordonez 2003⁷

24/50 (all primary lung adenocarcinomas: 2 case >75% of cells stained, 6 cases 50-75% of cells, 10 cases 25-50% of cells, 6 cases 1-25% of cells.)

0/60 (all epithelioid mesotheliomas)

Overall

56% (215/385)

0.5% (1/210)

References

¹PA Fetsch et al. Utility of the antibodies CA 19-9, HBME-1, and thrombomodulin in the diagnosis of malignant mesothelioma and adenocarcinoma in cytology. Cancer 1998;84:101-8.

²Bateman, A. C., R. K. al-Talib, et al. (1997). "Immunohistochemical phenotype of malignant mesothelioma: predictive value of CA125 and HBME-1 expression." Histopathology 30(1): 49-56.

³Chenard-Neu, M. P., J. P. Bellocq, et al. (1990). "[Malignant mesothelioma of the pleura. Analysis of its immunohistochemical aspects]." Ann Pathol 10(1): 20-7.

⁴Ordonez, N. G. (1989). "The immunohistochemical diagnosis of mesothelioma. Differentiation of mesothelioma and lung adenocarcinoma." Am J Surg Pathol 13(4): 276-91.

⁵Ohshio, G., K. Yamaki, et al. (1995). "Distribution of the carbohydrate antigens, DU-PAN-2 and CA19-9, in tumors of the lung." Tumori 81(1): 67-73.

⁶Chenard-Neu, M. P., A. Kabou, et al. (1998). "[Immunohistochemistry in the differential diagnosis of mesothelioma and adenocarcinoma. Evaluation of 5 new antibodies and 6 traditional antibodies]." Ann Pathol 18(6): 460-5.

⁷Ordonez, N. G. (2003). "The immunohistochemical diagnosis of mesothelioma: a comparative study of epithelioid mesothelioma and lung adenocarcinoma." Am J Surg Pathol 27(8): 1031-51.

⁸ Ordonez, N. G. (1998). "Role of immunohistochemistry in distinguishing epithelial peritoneal mesotheliomas from peritoneal and ovarian serous carcinomas." Am J Surg Pathol 22(10): 1203-14.

⁹ Ordonez, N. G., R. S. Freedman, et al. (1987). "Lewis and related tumor-associated determinants on ovarian carcinoma." Gynecol Oncol 26(1): 1-10.

¹⁰Kaufmann, O., T. Deidesheimer, et al. (1996). "Immunohistochemical differentiation of metastatic breast carcinomas from metastatic adenocarcinomas of other common primary sites." Histopathology 29(3): 233-40.

Encabo G,Ruibal A Seric CA 19.9 levels in patients with non tumoral pathologies. Our experience in 892 cases. Bull Cancer 1986; 73:256-9

Tabuchi Y, Deguchi H, Imanishi K, et al. Immunohistochemical studies on the main entrance-route of CA19-9 into the peripheral venous blood of gastric cancer patients. Correlation with CA19-9 levels in peripheral and portal blood. Cancer 1990; 66:1529-33

This page last revised 25.9.2004.

Breast, ductal carcinoma	57/119¹⁰
Breast, lobular carcinoma	1/10¹⁰
Pulmonary adenocarcinomas	24/35¹⁰
Gastric carcinomas	22/39¹⁰
Colonic carcinoma	19/25¹⁰
Pancreatic carcinoma	22/26¹⁰
Ovarian carcinoma	12/29¹⁰
Renal carcinomas	12/45¹⁰

	adenocarcinoma	mesothelioma
Ordonez 1987⁹	45/78	not studied
Ordonez 1989⁴	9/23 (pulmonary adenocarcinomas)	0/19 (all epithelioid mesotheliomas)
Bateman 1997²	8/14	0/17
Chenard-Neu 1990³	13/20 (primary adenocarcinomas variously of lung, breast, ovary and stomach)	0/14
Ohshea 1995⁵	45/76 (all types - squamous, adenocarcinoma and small cell - showed positivity)	0/?
Chenard-Neu 1998⁶	16/30 (various sites of origin)	0/28
Fetsch 1998¹	24/49 (8/15 breast, 5/8 ovary, 0/5 prostate, 3/10 lung focally, 8/11 gastrointestinal tract)	1/37
Ordonez 1998⁸	31/45 (papillary serous carcinomas [20/30 ovarian (10 primary and 20 metastatic to the peritoneum) and 11/15 papillary serous carcinomas of the peritoneum])	0/35 (epithelioid peritoneal mesotheliomas)
Ordonez 2003⁷	24/50 (all primary lung adenocarcinomas: 2 case >75% of cells stained, 6 cases 50-75% of cells, 10 cases 25-50% of cells, 6 cases 1-25% of cells.)	0/60 (all epithelioid mesotheliomas)
Overall	56% (215/385)	0.5% (1/210)