Elevated CEA and Medullary Cell Carcinoma

Case Report

Austin J Clin Case Rep. 2014;1(5): 1023.

Elevated CEA and Medullary Cell Carcinoma

Azhar Ali Malik1*, Ali Elhouni2, Bachar Afandi3 and Rya Almazroei4

Department of internal medicine, Tawam Hospital, UAE, (1-4)

*Corresponding author: Azhar Ali Malik, Department of internal medicine Division of Endocrinology, Tawam Hospital Al ain UAE

Received: May 23, 2014; Accepted: June 30, 2014; Published: July 01, 2014


CEA; Medullary cell carcinoma; CT

25 years old female was investigated for a nonspecific abdominal pain history and was found to have elevated CEA (carcinogenic embryonic antigen). The work up for gastrointestinal malignancy included upper and lower gastrointestinal endoscopy and a contrast enhanced CT abdomen. The endoscopy findings were inconclusive while the CT abdomen revealed a 1cm nodule in left adrenal gland, which was of doubtful clinical significance, and not likely cause of elevated CEA Figure 1.

On clinical examination she is a lady of average build and height. Her systemic examination including neck and abdominal examination were unremarkable.

Prompted by concerns of rising CEA whole body PET scan was requested, which showed a small thyroid nodule in right side of neck Figure 2, which was confirmed on subsequent ultrasound of thyroid. Her thyroid nodule biopsy showed medullary cell carcinoma. This was not surprising in setting of elevated CEA, and positive uptake on PET scan, hence, explaining the elevated CEA .Because of positive thyroid biopsy, RETS gene testing and serum calcitonin, level was requested. The genetic testing was negative for MEN 2 (Medullary endocrine neoplasia), but calcitonin level was significantly elevated (>20ng/ ml). She has total thyroidectomy on 12/9/2012. Post operatively she had transient hypoparathyroidism and her serum calcitonin and CEA fall to zero level. She is on replacement therapy for post surgical hypothyroidism. Her follow up calcitonin CEA, level and urine metanephrine levels are within normal limits (Table1). CT abdomen, at 6 months follow up, showed a small increase in left adrenal nodule and it remained non functional.

Citation: Malik AA, Elhouni A, Afandi B and Almazroei R. Elevated CEA and Medullary Cell Carcinoma. Austin J Clin Case Rep. 2014;1(5): 1023. ISSN 2381-912X