1296 Elevated CA 19-9 Associated With Heavy Black Tea Consumption

This is the authors' abstract. We don't add key points for this paper.

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 × 16.1 × 9.5 cm 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.