Elevated tumor markers in a young patient undergoing lung transplantation evaluation

SESSION TITLE: Cases in Lung Transplantation SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Cancer screening is a vital aspect of pre-transplantation evaluation, as diagnosis of cancer can impact transplant candidacy. Consensus guidelines recommend age-appropriate and disease-specific screening, though testing varies by center and little evidence exists to guide optimal screening methods. Use of serum tumor markers has been studied in de-novo cancer screening post-transplantation, yet use in pre-transplant evaluation is rarely described. CASE PRESENTATION: A 33 year-old female with history of undifferentiated interstitial lung disease (ILD) presented with dyspnea. Given severity and rapid progression of her lung disease, she initiated an expedited lung transplantation evaluation. During testing, she was found to have markedly elevated carcinoembryonic antigen (CEA) of 56.6 ng/mL and cancer antigen 125 (CA-125) of 287.5 U/mL. Chest and abdominal imaging, breast mammography, virtual colonoscopy, transvaginal ultrasound (US), and pap smear were unrevealing of malignancy. A PET-CT scan demonstrated FDG-avid interstitial pulmonary opacities with minimally-avid mediastinal lymphadenopathy, with no definite malignancy. Bronchoscopy with endobronchial US and biopsy was performed, revealing benign pathology. As no malignancy was identified, she was listed for and underwent bilateral transplantation. Pathology of her explanted lung was negative for malignancy, and showed bronchiolocentric fibrosis, inflammation and diffuse alveolar damage. She has had an uncomplicated post-transplantation course with no further evidence of malignancy. Her CEA and CA-125 levels decreased to 4.1 ng/mL and 55.2 U/mL, respectively. DISCUSSION: CEA and CA-125 are non-specific and can be elevated in both malignant and benign conditions, including advanced lung disease. This patient's negative malignancy work-up as well as dramatic improvement in both tumor markers after explantation of her lungs, suggests the elevation may have been related to her ILD. CONCLUSIONS: While approach to cancer screening should remain individualized, this case advises cautious interpretation of CEA and CA-125 in patients with advanced lung disease undergoing transplant evaluation and underscores the need for further research into optimal evaluation methods. REFERENCE #1: Rusanov V, Kramer MR, Raviv Y, Medalion B, Guber A, Shitrit D. The significance of elevated tumor markers among patients with idiopathic pulmonary fibrosis before and after lung transplantation. Chest. 2012 Apr;141(4):1047-1054. REFERENCE #2: Kwon, B.S., Kim, E.S., Lim, S.Y. et al. The significance of elevated tumor markers among patients with interstitial lung diseases. Sci Rep 12, 16702 (2022). DISCLOSURES: No relevant relationships by Luis Angel No relevant relationships by Justin Chan No relevant relationships by Stephanie Chang No relevant relationships by Travis Geraci No relevant relationships by Melissa Lesko No relevant relationships by Ian Mahoney No relevant relationships by Jake Natalini No relevant relationships by Darya Rudym