The Journal of the Arkansas Medical Society Med Journal Jan 2019 Final 2 | Page 10

CASE STUDY
Elevated Carcinoembryonic Antigen (CEA) Levels
in Colorectal Cancer From Ischemic Colitis
Sai Prasad Desikan 1 ; Anthony Kunnumpurath, MD 2 ; Raman Desikan, MD 3
Ross University School of Medicine, Dominica
2,3
White River Health System, Batesville, Ark.
1
Abstract
EA is widely used as a tumor
marker in colorectal cancer. CEA
is of limited use in detection of
colorectal cancer; however serial CEA
measurements are very useful in de-
tecting recurrence of colorectal cancer. 1
C
This may result in early detection and resection of
metastatic disease, which can result in extended
survival, [five-year survival (26-40%)] and cure of
patients. 2-4 Elevated CEA levels observed during se-
rial CEA determinations prompted imaging studies,
which did not reveal any evidence of local recur-
rence or metastatic disease in our patient. Colo-
noscopic evaluation done 12 months from surgery
revealed ischemic colitis. CEA levels normalized 18
months from surgery. Patient had no symptoms
from ischemic colitis other than increased bleeding
after colonoscopy.
Case Report
A 72-year-old Caucasian male with history of
colonic polyposis underwent colonoscopy after an
episode of rectal bleeding. This revealed malignant-
appearing mass in the rectum 7 cms from anal
verge. Biopsy revealed tubulo-villous polyp with
high-grade dysplasia. Trans anal excision of the
mass revealed adenocarcinoma invasive focally
into muscularis propria in addition to polyp (Fig 1).
Prior radiation to pelvis precluded consolidative
radiation. Laparoscopic anoperineal resection was
complicated on account of adhesions from pelvic
radiation. He had significant blood loss requiring
eight units of packed red cells, FFP, and platelets.
His evaluation in the office five months from sur-
gery revealed well-healed perineal wound and ter-
minal colostomy. Exam did not reveal hepatomeg-
aly or masses. CT scan did not reveal any pelvic
mass or metastatic disease. CEA level was elevated
at 85ng/ml. He was evaluated 11 months after sur-
gery; on this occasion, he had further elevation of
CEA to 312ng/ml. Physical evaluation and CT scans
showed no evidence of local recurrence or metas-
tasis. PET/CT and MRI of pelvis done one month
later showed no evidence of disease. Colonoscopy
was performed through the stoma 12 months
from surgery revealed ischemic colitis, confirmed
by pathologic evaluation (Fig 2.) extending from
transverse colon to descending colon. Patient did
Figure 1. Invasive adenocarcinoma, well to moderately
differentiated. Neoplastic glands infiltrating into submucosal
fibroconnective tissue. x40, original magnification.
154 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
not have any symptoms from ischemic colitis other
than excessive bleeding after colonoscopy. Further
evaluations have not revealed any evidence of dis-
ease and CEA level was normal 18 months from
surgery (Fig 3).
Discussion
Ischemic colitis is the most common form
of ischemic injury to the gastrointestinal tract.
A plethora of conditions predispose to colonic
ischemia. Clinically, ischemic colitis can be clas-
sified into gangrenous variety, more often associ-
ated with vascular occlusion and non-gangrenous
form. Non-gangrenous colitis could be transient
and reversible, or chronic. Chronic forms can
present as ischemic strictures or chronic seg-
mental colitis. This is the first report of ischemic
colitis causing elevated CEA level in colorectal
cancer. 5 Elevated CEA levels have been reported
in four patients with ischemic colitis in Japan; two
patients with acute gangrenous colitis and two
patients with chronic colitis. Of the two patients
with chronic form, one patient had chronic seg-
mental colitis and the other had ischemic stric-
ture. CEA levels normalized six days and 16 days
Figure 2. Ischemic colitis. Necrotic mucosa with withered/
degenerate glands, surface acute inflammatory exudate, and
hyalinized lamina propria stroma. x40, original magnification.
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