A Case With Longitudinal Changes in Apolipoprotein A2 Isoform Indices Associated With CA19-9 and MRI Findings Until Pancreatic Cancer Development.

Authors

Masaki Kuwatani, Ryo Sugiura, Katsuma Nakajima, Kazumichi Kawakubo, Ayumi Kashiro, Kazufumi Honda, Naoya Sakamoto

Published in

Journal of gastroenterology and hepatology. Oct 26, 2026. Epub Oct 26, 2026.

Abstract

An 80-year-old female was referred to our hospital 6 years earlier with an abnormal plasma apolipoprotein A2 isoform (ApoA2-i) index, which is a promising biomarker for pancreatic cancer. Endoscopic ultrasonography (EUS) revealed a single small cystic lesion in the pancreatic head. Subsequently, the patient was followed up regularly. Two years after the initial visit, her ApoA2-i index was 50.2 μg/mL, and her plasma CA19-9 level was 42.5 U/mL. Magnetic resonance cholangiopancreatography (MRCP) performed 3 years after the initial visit also demonstrated small cystic lesions in the pancreatic head, consistent with the findings of the initial EUS, and a signal defect in the main pancreatic duct (MPD) in the pancreatic body, with a normal upstream MPD diameter. Her ApoA2-i index was 52.4 μg/mL, and her plasma CA19-9 level was 42.0 U/mL. Follow-up MRCP indicated similar cystic lesions in the pancreatic head and a signal defect in the MPD in the pancreatic body, with a normal upstream MPD diameter. However, her serial ApoA2-i indices gradually decreased from 52.1 to 35.7 μg/mL, correlated with an increase in plasma CA19-9. The latest MRCP demonstrated a similar signal defect and dilatation of the upstream MPD diameter compared with the previous MPD diameters. Her ApoA2-i index slightly decreased to 35.2 μg/mL, whereas her CA19-9 level remarkably increased to 1320 U/mL. Endoscopic retrograde pancreatography with cytology demonstrated adenocarcinoma cells. In the present case, we observed longitudinal changes in ApoA2-i indices correlated with CA19-9 and MRCP findings.

PMID:
42935000
Bibliographic data and abstract were imported from PubMed on 27 Oct 2026.

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