Image in surgery| Volume 139, ISSUE 3, P448-450, March 2006

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Biliary cystadenocarcinoma presenting as recurrent cholangitis

      An 80-year-old woman presented with abdominal pain and fever of 3 weeks’ duration. She had experienced several similar episodes during the previous 20 years. Physical examination revealed tenderness in the epigastrium. Blood tests showed leukocytosis (12.5 × 103/μL) and increases in alkaline phosphatase (2097 IU/L), γ-glutamyl transpeptidase (820 IU/L), aspartate aminotransferase (152 IU/L), alanine aminotransferase (141 IU/L), and total bilirubin (3.0 mg/dL). The serum CA19-9 level was elevated to 471.4 U/mL; carcinoembryonic antigen and α-fetoprotein levels were normal.
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