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Bhadra M, Sachan M, Nara S. Current strategies for early epithelial ovarian cancer detection using miRNA as a potential tool. Front Mol Biosci 2024; 11:1361601. [PMID: 38690293 PMCID: PMC11058280 DOI: 10.3389/fmolb.2024.1361601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
Ovarian cancer is one of the most aggressive and significant malignant tumor forms in the female reproductive system. It is the leading cause of death among gynecological cancers owing to its metastasis. Since its preliminary disease symptoms are lacking, it is imperative to develop early diagnostic biomarkers to aid in treatment optimization and personalization. In this vein, microRNAs, which are short sequence non-coding molecules, displayed great potential as highly specific and sensitive biomarker. miRNAs have been extensively advocated and proven to serve an instrumental part in the clinical management of cancer, especially ovarian cancer, by promoting the cancer cell progression, invasion, delayed apoptosis, epithelial-mesenchymal transition, metastasis of cancer cells, chemosensitivity and resistance and disease therapy. Here, we cover our present comprehension of the most up-to-date microRNA-based approaches to detect ovarian cancer, as well as current diagnostic and treatment strategies, the role of microRNAs as oncogenes or tumor suppressor genes, and their significance in ovarian cancer progression, prognosis, and therapy.
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Zhang J, Ding H, Zhang F, Xu Y, Liang W, Huang L. New trends in diagnosing and treating ovarian cancer using nanotechnology. Front Bioeng Biotechnol 2023; 11:1160985. [PMID: 37082219 PMCID: PMC10110946 DOI: 10.3389/fbioe.2023.1160985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
Ovarian cancer stands as the fifth most prevalent cancer among women, causing more mortalities than any other disease of the female reproductive system. There are numerous histological subtypes of ovarian cancer, each of which has distinct clinical characteristics, risk factors, cell origins, molecular compositions, and therapeutic options. Typically, it is identified at a late stage, and there is no efficient screening method. Standard therapies for newly diagnosed cancer are cytoreductive surgery and platinum-based chemotherapy. The difficulties of traditional therapeutic procedures encourage researchers to search for other approaches, such as nanotechnology. Due to the unique characteristics of matter at the nanoscale, nanomedicine has emerged as a potent tool for creating novel drug carriers that are more effective and have fewer adverse effects than traditional treatments. Nanocarriers including liposomes, dendrimers, polymer nanoparticles, and polymer micelles have unique properties in surface chemistry, morphology, and mechanism of action that can distinguish between malignant and normal cells, paving the way for targeted drug delivery. In contrast to their non-functionalized counterparts, the development of functionalized nano-formulations with specific ligands permits selective targeting of ovarian cancers and ultimately increases the therapeutic potential. This review focuses on the application of various nanomaterials to the treatment and diagnosis of ovarian cancer, their advantages over conventional treatment methods, and the effective role of controlled drug delivery systems in the therapy of ovarian cancer.
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Affiliation(s)
- Juan Zhang
- Department of Gynecology, Shaoxing Maternity and Child Healthcare Hospital, Shaoxing, China
- Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Haigang Ding
- Department of Gynecology, Shaoxing Maternity and Child Healthcare Hospital, Shaoxing, China
- Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Feng Zhang
- Department of Gynecology, Shaoxing Maternity and Child Healthcare Hospital, Shaoxing, China
- Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Yan Xu
- Intensive Care Unit, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Wenqing Liang
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
- *Correspondence: Liping Huang, ; Wenqing Liang,
| | - Liping Huang
- Department of Medical Oncology, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
- *Correspondence: Liping Huang, ; Wenqing Liang,
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3
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Protein Glycosylation as Biomarkers in Gynecologic Cancers. Diagnostics (Basel) 2022; 12:diagnostics12123177. [PMID: 36553184 PMCID: PMC9777642 DOI: 10.3390/diagnostics12123177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Gynecologic cancers are the leading cause of death in women. Endometrial, ovarian, and cervical cancer are the three main types of gynecologic cancers. Poor prognoses and high mortality rates of advanced-stage cancer are still challenges of all three types. Diagnostic tools for early cancer detection could be the cornerstone for further cancer treatment and prevention. Glycosylation plays a vital role in cell proliferation, adhesion, motility, and angiogenesis, and is aberrantly expressed in cancer cells. Alterations of glycosylation may represent promising biomarkers with potential diagnostic and monitoring applications, as well as disease prognosis. Many glycosylated biomarkers, including glycoprotein, glycan, and enzyme, were discovered and well-studied for application in gynecologic cancers. Some of them have been developed as targets for cancer treatment. The use of certain biomarkers for diagnostics and monitoring of gynecologic cancers has clinical advantages, as it is quantitative, comparable, convenient, and inexpensive. However, one of the single markers have sufficient sensitivity for the screening of gynecologic cancers. In this review, we introduced the details of glycosylation and the current application of glycosylated biomarkers in these three cancers. Moreover, we also reviewed the different roles of each biomarker in other cancers and aimed to understand these glycosylated biomarkers comprehensively.
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Kurnit KC, Frumovitz M. Primary mucinous ovarian cancer: options for surgery and chemotherapy. Int J Gynecol Cancer 2022; 32:ijgc-2022-003806. [PMID: 36229081 DOI: 10.1136/ijgc-2022-003806] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary mucinous ovarian cancer is a rare type of epithelial ovarian cancer. In this comprehensive review we discuss management recommendations for the treatment of mucinous ovarian cancer. Although most tumors are stage I at diagnosis, 15-20% are advanced stage at diagnosis. Traditionally, patients with primary mucinous ovarian cancer have been treated similarly to those with the more common serous ovarian cancer. However, recent studies have shown that mucinous ovarian cancer is very different from other types of epithelial ovarian cancer. Primary mucinous ovarian cancer is less likely to spread to lymph nodes or the upper abdomen and more likely to affect younger women, who may desire fertility-sparing therapies. Surgical management of mucinous ovarian cancer mirrors surgical management of other types of epithelial ovarian cancer and includes a bilateral salpingo-oophorectomy and total hysterectomy. When staging is indicated, it should include pelvic washing, omentectomy, and peritoneal biopsies; lymph node evaluation should be considered in patients with infiltrative tumors. The appendix should be routinely evaluated intra-operatively, but an appendectomy may be omitted if the appendix appears grossly normal. Fertility preservation can be considered in patients with gross disease confined to one ovary and a normal-appearing contralateral ovary. Patients with recurrent platinum-sensitive disease whose disease distribution suggests a high likelihood of complete gross resection may be candidates for secondary debulking. Primary mucinous ovarian cancer seems to be resistant to standard platinum-and-taxane regimens used frequently for other types of ovarian cancer. Gastrointestinal cancer regimens are another option; these include 5-fluorouracil and oxaliplatin, or capecitabine and oxaliplatin. Data on heated intra-peritoneal chemotherapy (HIPEC) for mucinous ovarian cancer are scarce, but HIPEC may be worth considering. For patients with recurrence or progression on first-line chemotherapy, we advocate enrollment in a clinical trial if one is available. For this reason, it may be beneficial to perform molecular testing in all patients with recurrent or progressive mucinous ovarian cancer.
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Affiliation(s)
- Katherine C Kurnit
- Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Tsuboyama T, Sato K, Ota T, Fukui H, Onishi H, Nakamoto A, Tatsumi M, Tomiyama N. MRI of Borderline Epithelial Ovarian Tumors: Pathologic Correlation and Diagnostic Challenges. Radiographics 2022; 42:2095-2111. [PMID: 36083804 DOI: 10.1148/rg.220068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Borderline epithelial ovarian tumors are a distinct pathologic entity characterized by increased epithelial proliferation and nuclear atypia, but without frank stromal invasion. Borderline tumor (BT) is now considered to represent an intermediate phase in the stepwise progression from benign to malignant ovarian epithelial tumor. Since BTs commonly manifest at early stages in women of reproductive age and are associated with a good prognosis, making the correct diagnosis is important in determining whether a patient is a candidate for fertility-sparing surgery. There are six histologic BT subtypes (serous, mucinous, seromucinous, endometrioid, clear cell, and Brenner), and each has different MRI features, reflecting their unique histologic architectures. Radiologists should be aware of the MRI features that can suggest BTs. These features include a hyperintense papillary architecture with hypointense internal branching, which can be observed with serous and seromucinous BTs on T2-weighted images; aggregates of microcysts that have hypointensity on T2-weighted images and reticular enhancement on contrast-enhanced T2-weighted images, which can be seen with mucinous BTs; and moderately high signal intensity on diffusion-weighted images along with relatively high apparent diffusion coefficient values, which can be observed regardless of the histologic subtype. Nevertheless, because the imaging features of BTs overlap with those of many benign lesions (eg, cystadenoma and cystadenofibroma, decidualized endometriosis, and polypoid endometriosis) and malignant tumors (ovarian cancers and metastases), histologic confirmation is required for the final diagnosis. Special emphasis is placed on the MRI features of BTs, pathologic correlation, and the challenges related to diagnosis. ©RSNA, 2022.
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Affiliation(s)
- Takahiro Tsuboyama
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazuaki Sato
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takashi Ota
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hideyuki Fukui
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hiromitsu Onishi
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Atsushi Nakamoto
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Mitsuaki Tatsumi
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Noriyuki Tomiyama
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Liberto JM, Chen SY, Shih IM, Wang TH, Wang TL, Pisanic TR. Current and Emerging Methods for Ovarian Cancer Screening and Diagnostics: A Comprehensive Review. Cancers (Basel) 2022; 14:2885. [PMID: 35740550 PMCID: PMC9221480 DOI: 10.3390/cancers14122885] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
With a 5-year survival rate of less than 50%, ovarian high-grade serous carcinoma (HGSC) is one of the most highly aggressive gynecological malignancies affecting women today. The high mortality rate of HGSC is largely attributable to delays in diagnosis, as most patients remain undiagnosed until the late stages of -disease. There are currently no recommended screening tests for ovarian cancer and there thus remains an urgent need for new diagnostic methods, particularly those that can detect the disease at early stages when clinical intervention remains effective. While diagnostics for ovarian cancer share many of the same technical hurdles as for other cancer types, the low prevalence of the disease in the general population, coupled with a notable lack of sensitive and specific biomarkers, have made the development of a clinically useful screening strategy particularly challenging. Here, we present a detailed review of the overall landscape of ovarian cancer diagnostics, with emphasis on emerging methods that employ novel protein, genetic, epigenetic and imaging-based biomarkers and/or advanced diagnostic technologies for the noninvasive detection of HGSC, particularly in women at high risk due to germline mutations such as BRCA1/2. Lastly, we discuss the translational potential of these approaches for achieving a clinically implementable solution for screening and diagnostics of early-stage ovarian cancer as a means of ultimately improving patient outcomes in both the general and high-risk populations.
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Affiliation(s)
- Juliane M. Liberto
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; (J.M.L.); (I.-M.S.); (T.-L.W.)
| | - Sheng-Yin Chen
- School of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan;
| | - Ie-Ming Shih
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; (J.M.L.); (I.-M.S.); (T.-L.W.)
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
| | - Tza-Huei Wang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Tian-Li Wang
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; (J.M.L.); (I.-M.S.); (T.-L.W.)
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA;
| | - Thomas R. Pisanic
- Johns Hopkins Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD 21218, USA
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Cho A, Kim BR, Lim SH, Park CM. Extreme elevation of CA 19-9 levels in mature cystic teratoma without any complications: A case report. Ann Med Surg (Lond) 2022; 78:103803. [PMID: 35734746 PMCID: PMC9207001 DOI: 10.1016/j.amsu.2022.103803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Carbohydrate antigen 19–9 (CA 19–9) can be increased in benign ovarian cysts, but extreme elevation is rare. Case presentation We present a case of a mature cystic teratoma with extremely elevated CA 19-9 levels. After ovarian cystectomy, the level of CA 19–9 was decreased. Clinical discussion Abnormal levels of CA 19–9 can lead to unnecessary medical interventions and patient anxiety. Conclusion CA 19–9 can be extremely increased in mature cystic teratoma without any complications. CA 19–9 can be increased in benign ovarian cysts, but extreme elevation was rare. We presented the case of mature cystic teratoma with extremely elevated CA 19–9. Abnormal levels of CA 19–9 can lead to unnecessary medical intervention and patient anxiety.
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Rao S, Smith DA, Guler E, Kikano EG, Rajdev MA, Yoest JM, Ramaiya NH, Tirumani SH. Past, Present, and Future of Serum Tumor Markers in Management of Ovarian Cancer: A Guide for the Radiologist. Radiographics 2021; 41:1839-1856. [PMID: 34597221 DOI: 10.1148/rg.2021210005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The ability to accurately detect early ovarian cancer and subsequently monitor treatment response is essential to improving survival for patients with ovarian malignancies. Several serum tumor markers (STMs)-including cancer antigen 125 (CA-125), human epididymis protein 4 (HE4), cancer antigen 19-9 (CA 19-9), and carcinoembryonic antigen (CEA)-have been used as a noninvasive method of identifying ovarian cancer in conjunction with imaging. Although current guidelines do not recommend use of STMs as screening tools for ovarian cancer, these markers have clinical utility in both diagnosis and surveillance for women with ovarian cancer. CA-125 is the most commonly used STM; its level may be elevated in several types of ovarian cancer, including epithelial cell tumors, carcinosarcoma, teratomas, and secondary ovarian malignancies. An elevated level of CA 19-9 is associated with clear cell tumors, teratomas, and secondary malignancies. CEA is most commonly associated with mucinous ovarian cancers. Finally, HE4 is being increasingly used to identify certain subtypes of epithelial ovarian cancers, particularly serous and endometrioid tumors. Diagnosis of ovarian cancers relies on a combination of CA-125 levels and US findings, which include a large adnexal mass or high-risk features, including septa and increased vascularity. CT is preferred for staging and is used along with PET and STM monitoring for surveillance. Increasingly, MRI is being used to characterize ovarian lesions that are indeterminate at US or CT. The future of STM testing involves development of "liquid biopsies," in which plasma samples are analyzed for evidence of tumors, including circulating tumor DNA or tumor cells and tumor micro-RNA. When combined with traditional imaging techniques, liquid biopsies may lead to earlier diagnosis and improved survival. An invited commentary by Shinagare is available online. ©RSNA, 2021.
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Affiliation(s)
- Sanjay Rao
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Daniel A Smith
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Ezgi Guler
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Elias G Kikano
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Maharshi A Rajdev
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Jennifer M Yoest
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Nikhil H Ramaiya
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
| | - Sree Harsha Tirumani
- From the Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, B114, Cleveland, OH 44106-4915 (S.R., D.A.S., E.G., E.G.K., M.A.R., N.H.R., S.H.T.); and Department of Pathology, Case Western Reserve University, Cleveland, Ohio (J.M.Y.)
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Rajendran S, McCluggage WG. Tubo-Ovarian High-Grade Serous Carcinomas Commonly Express CA19.9. Histopathology 2021; 80:449-450. [PMID: 34268810 DOI: 10.1111/his.14453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
Tubo-ovarian high-grade serous carcinoma (HGSC) is one of the leading causes of cancer death in women worldwide and frequently presents at advanced stage (1). Many cases are unresectable at diagnosis due to extensive disease affecting multiple sites and in such cases when a disseminated tubo-ovarian HGSC is suspected, a percutaneous core biopsy is often undertaken prior to neoadjuvant chemotherapy being administered (2).
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Affiliation(s)
- Simon Rajendran
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, Cibula D, Concin N, Fischerova D, Froyman W, Gallardo G, Lemley B, Loft A, Mereu L, Morice P, Querleu D, Testa AC, Vergote I, Vandecaveye V, Scambia G, Fotopoulou C. ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:148-168. [PMID: 33794043 DOI: 10.1002/uog.23635] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the preoperative diagnosis of ovarian tumors, including imaging techniques, biomarkers and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the preoperative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the preoperative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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Affiliation(s)
- D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Planchamp
- Clinical Research Unit, Institut Bergonie, Bordeaux, France
| | - T Bourne
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Metabolism, Digestion and Reproduction, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - C Landolfo
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A du Bois
- Department of Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - L Chiva
- Department of Gynaecology and Obstetrics, University Clinic of Navarra, Madrid, Spain
| | - D Cibula
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - N Concin
- Department of Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - D Fischerova
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - W Froyman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - G Gallardo
- Department of Radiology, University Clinic of Navarra, Madrid, Spain
| | - B Lemley
- Patient Representative, President of Kraefti Underlivet (KIU), Denmark
- Chair Clinical Trial Project of the European Network of Gynaecological Cancer Advocacy Groups, ENGAGe
| | - A Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Mereu
- Department of Gynecology and Obstetrics, Gynecologic Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - P Morice
- Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
| | - D Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - A C Testa
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Vergote
- Department of Obstetrics and Gynaecology and Gynaecologic Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - V Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Division of Translational MRI, Department of Imaging & Pathology KU Leuven, Leuven, Belgium
| | - G Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Fotopoulou
- Department of Gynecologic Oncology, Hammersmith Hospital, Imperial College, London, UK
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Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, Cibula D, Concin N, Fischerova D, Froyman W, Gallardo Madueño G, Lemley B, Loft A, Mereu L, Morice P, Querleu D, Testa AC, Vergote I, Vandecaveye V, Scambia G, Fotopoulou C. ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors. Int J Gynecol Cancer 2021; 31:961-982. [PMID: 34112736 PMCID: PMC8273689 DOI: 10.1136/ijgc-2021-002565] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group, and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the pre-operative diagnosis of ovarian tumors, including imaging techniques, biomarkers, and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the pre-operative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the pre-operative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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Affiliation(s)
- Dirk Timmerman
- Gynecology and Obstetrics, University Hospitals KU Leuven, Leuven, Belgium .,Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Tom Bourne
- Gynecology and Obstetrics, University Hospitals KU Leuven, Leuven, Belgium.,Development and Regeneration, KU Leuven, Leuven, Belgium.,Metabolism Digestion and Reproduction, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - Chiara Landolfo
- Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Andreas du Bois
- Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Luis Chiva
- Gynaecology and Obstetrics, University Clinic of Navarra, Madrid, Spain
| | - David Cibula
- Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Nicole Concin
- Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Fischerova
- Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Wouter Froyman
- Gynecology and Obstetrics, University Hospitals KU Leuven, Leuven, Belgium
| | | | - Birthe Lemley
- European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,KIU - Patient Organisation for Women with Gynaecological Cancer, Copenhagen, Denmark
| | - Annika Loft
- Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Liliana Mereu
- Gynecology and Obstetrics, Gynecologic Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Philippe Morice
- Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Antonia Carla Testa
- Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ignace Vergote
- Obstetrics and Gynaecology and Gynaecologic Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Vincent Vandecaveye
- Radiology, University Hospitals Leuven, Leuven, Belgium.,Division of Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Giovanni Scambia
- Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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12
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Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, Cibula D, Concin N, Fischerova D, Froyman W, Gallardo G, Lemley B, Loft A, Mereu L, Morice P, Querleu D, Testa C, Vergote I, Vandecaveye V, Scambia G, Fotopoulou C. ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumours. Facts Views Vis Obgyn 2021; 13:107-130. [PMID: 34107646 PMCID: PMC8291986 DOI: 10.52054/fvvo.13.2.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the preoperative diagnosis of ovarian tumours, including imaging techniques, biomarkers and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the preoperative diagnosis of ovarian tumours and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the preoperative diagnosis of ovarian tumours and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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13
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Talia KL, Parra-Herran C, McCluggage WG. Ovarian mucinous and seromucinous neoplasms: problematic aspects and modern diagnostic approach. Histopathology 2021; 80:255-278. [PMID: 33963606 DOI: 10.1111/his.14399] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The morphological spectrum of primary ovarian mucinous and seromucinous tumours is broad and presents an array of diagnostic challenges, many unique to these tumour types. This reflects the heterogeneous nature of these lesions, their varied histogenesis and evolving classification systems over recent decades, with further modification to the seromucinous category incorporated in the recently published 5th edition of the WHO Classification of Female Genital Tumours. In this review we provide an update on the classification of these neoplasms and discuss their histogenesis and diverse morphology, focusing on areas which are diagnostically problematic. We also cover tumour grading, differential diagnosis, immunohistochemistry, the recent elucidation of the molecular underpinnings of ovarian mucinous neoplasia and discuss the gross and intraoperative handling of these tumours. A number of diagnostic issues remain unresolved highlighting the importance of further research on this front, as well as a multidisciplinary approach in the care of patients with ovarian mucinous and seromucinous neoplasia.
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Affiliation(s)
- Karen L Talia
- Department of Pathology, Royal Women's Hospital and VCS Foundation, Melbourne, Australia
| | | | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
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14
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Glycomic-Based Biomarkers for Ovarian Cancer: Advances and Challenges. Diagnostics (Basel) 2021; 11:diagnostics11040643. [PMID: 33916250 PMCID: PMC8065431 DOI: 10.3390/diagnostics11040643] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 01/10/2023] Open
Abstract
Ovarian cancer remains one of the most common causes of death among gynecological malignancies afflicting women worldwide. Among the gynecological cancers, cervical and endometrial cancers confer the greatest burden to the developing and the developed world, respectively; however, the overall survival rates for patients with ovarian cancer are worse than the two aforementioned. The majority of patients with ovarian cancer are diagnosed at an advanced stage when cancer has metastasized to different body sites and the cure rates, including the five-year survival, are significantly diminished. The delay in diagnosis is due to the absence of or unspecific symptoms at the initial stages of cancer as well as a lack of effective screening and diagnostic biomarkers that can detect cancer at the early stages. This, therefore, provides an imperative to prospect for new biomarkers that will provide early diagnostic strategies allowing timely mitigative interventions. Glycosylation is a protein post-translational modification that is modified in cancer patients. In the current review, we document the state-of-the-art of blood-based glycomic biomarkers for early diagnosis of ovarian cancer and the technologies currently used in this endeavor.
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15
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Lertkhachonsuk AA, Buranawongtrakoon S, Lekskul N, Rermluk N, Wee-Stekly WW, Charakorn C. Serum CA19-9, CA-125 and CEA as tumor markers for mucinous ovarian tumors. J Obstet Gynaecol Res 2020; 46:2287-2291. [PMID: 32830422 PMCID: PMC7693209 DOI: 10.1111/jog.14427] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/03/2020] [Accepted: 07/25/2020] [Indexed: 01/19/2023]
Abstract
Abstract Aim To analyze the use of serum cancer antigen 19‐9 (CA19‐9), cancer antigen 125 (CA‐125) and carcinoembryogenic antigen (CEA) in predicting the malignant potential of mucinous ovarian tumor, and to assess the clinical factors associated with these tumors. Methods This retrospective study collected the data from 314 patients who were diagnosed with mucinous ovarian tumor. These patients had preoperative serum CA19‐9, CA‐125, CEA available and underwent surgery at Ramathibodi Hospital between January 2010 and December 2016. The diagnostic performance of CA19‐9, CA‐125 and CEA was analyzed using the receiver operator characteristic curve. The associations between clinicopathological factors and serum CA19‐9, CA‐125 and CEA level were also analyzed. Results A total of 314 patients were recruited in this study. They consisted of 221 patients with benign mucinous ovarian tumor (70.38%), 65 patients with borderline mucinous ovarian tumor (20.70%) and 28 patients with mucinous ovarian carcinoma (8.92%). Multivariate analysis revealed that the tumor size, elevated serum CA19‐9, CA‐125 and CEA influenced the tumor pathology. The mucinous ovarian tumor with large tumor size, elevated serum CA19‐9, CA‐125 and CEA more than the cut off values showed a positive correlation with the risk ratio of 1.60 (95% CI = 1.13–2.28; P = 0.005), 1.74 (95% CI = 1.22–2.47; P = 0.002), 1.90 (95% CI = 1.34–2.70; P < 0.001), 1.58 (95% CI = 1.10–2.29; P = 0.020), respectively. CA‐125 provided the highest diagnostic performance, with an area under receiver operator characteristic curve of 0.745, to differentiate between borderline, malignant or benign mucinous ovarian tumor. Conclusion Preoperative elevation of the serum CA19‐9, CA‐125, CEA and tumor size are useful predictors to differentiate between benign, borderline and malignant mucinous ovarian tumor. The best predictor is CA‐125, followed by CA19‐9 and CEA.
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Affiliation(s)
- Arb-Aroon Lertkhachonsuk
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supree Buranawongtrakoon
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Navamol Lekskul
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Naparat Rermluk
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wei-Wei Wee-Stekly
- Minimally Invasive Surgery Unit, Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore
| | - Chuenkamon Charakorn
- Division of Gynaecologic Oncology, Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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16
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Mulita F, Oikonomou N, Tchabashvili L, Liolis E, Kehagias I. A giant ovarian mucinous tumor in a 58-year-old postmenopausal patient with persistent abdominal pain and high serum levels of CA 19-9. Pan Afr Med J 2020; 37:76. [PMID: 33244339 PMCID: PMC7680227 DOI: 10.11604/pamj.2020.37.76.25932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 02/05/2023] Open
Abstract
Ovarian cancer is the seventh most commonly diagnosed cancer among women in the world and epithelial ovarian cancer is the most predominant pathologic subtype. Tumor markers are widely used in clinical practice to determine therapeutic efficacy, to detect recurrence and to predict prognosis in known cancers. CA-19-9 antigen is mainly elevated in cases of gastrointestinal tract malignancy, including of the pancreas, colorectum, and biliary tract. However, CA 19-9 antigen can also be elevated in ovarian mucinous neoplasms. We report herein the case of a 58-year-old woman who presented with an abnormally high level of CA 19-9 antigen associated with ovarian mucinous borderline tumor.
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Affiliation(s)
- Francesk Mulita
- Department of General Surgery, General University Hospital of Patras, Patras, Greece
- Corresponding author: Francesk Mulita, Department of General Surgery, General University Hospital of Patras, Patras, Greece.
| | - Nikoleta Oikonomou
- Department of Pediatrics, Neonatal Intensive Care Unit, General University Hospital of Patras, Patras, Greece
| | - Levan Tchabashvili
- Department of General Surgery, General University Hospital of Patras, Patras, Greece
| | - Elias Liolis
- Department of Internal Medicine, Division of Oncology, General University Hospital of Patras, Patras, Greece
| | - Ioannis Kehagias
- Department of General Surgery, General University Hospital of Patras, Patras, Greece
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17
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Lawrence AE, Fallat ME, Hewitt G, Hertweck P, Onwuka A, Afrazi A, Bence C, Burns RC, Corkum KS, Dillon PA, Ehrlich PF, Fraser JD, Gonzalez DO, Grabowski JE, Kabre R, Lal DR, Landman MP, Leys CM, Mak GZ, Overman RE, Rademacher BL, Raiji MT, Sato TT, Scannell M, Sujka JA, Wright T, Minneci PC, Deans KJ, Aldrink JH. Understanding the Value of Tumor Markers in Pediatric Ovarian Neoplasms. J Pediatr Surg 2020; 55:122-125. [PMID: 31677824 PMCID: PMC7181461 DOI: 10.1016/j.jpedsurg.2019.09.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/29/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to determine the diagnostic accuracy of tumor markers for malignancy in girls with ovarian neoplasms. METHODS A retrospective review of girls 2-21 years who presented for surgical management of an ovarian neoplasm across 10 children's hospitals between 2010 and 2016 was performed. Patients who had at least one concerning feature on imaging and had tumor marker testing were included in the study. Sensitivity, specificity, and negative and positive predictive values (PPV) of tumor markers were calculated. RESULTS Our cohort included 401 patients; 22.4% had a malignancy. Testing for tumor markers was inconsistent. AFP had high specificity (98%) and low sensitivity (42%) with a PPV of 86%. The sensitivity, specificity, and PPV of beta-hCG was 44%, 76%, and 32%, respectively. LDH had high sensitivity (95%) and Inhibin A and Inhibin B had high specificity (97% and 92%, respectively). CONCLUSIONS Tumor marker testing is helpful in preoperative risk stratification of ovarian neoplasms for malignancy. Given the variety of potential tumor types, no single marker provides enough reliability, and therefore a panel of tumor marker testing is recommended if there is concern for malignancy. Prospective studies may help further elucidate the predictive value of tumor markers in a pediatric ovarian neoplasm population. TYPE OF STUDY Retrospective Cohort Review. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amy E. Lawrence
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Mary E. Fallat
- Hiram C. Polk, Jr; M.D. Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Geri Hewitt
- Department of Surgery, Division of Pediatric and Adolescent Gynecology, The Ohio State University, Nationwide Children’s Hospital, Columbus, OH
| | - Paige Hertweck
- Hiram C. Polk, Jr; M.D. Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY,Department of Obstetrics and Gynecology, Louisville University School of Medicine, Louisville, KY
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH
| | - Amin Afrazi
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christina Bence
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Robert C. Burns
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Kristine S. Corkum
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Patrick A. Dillon
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jason D. Fraser
- Division of Pediatric Surgery, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO
| | - Dani O. Gonzalez
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Julia E. Grabowski
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rashmi Kabre
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dave R. Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Matthew P. Landman
- Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Charles M. Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Grace Z. Mak
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL
| | - R. Elliott Overman
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Brooks L. Rademacher
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Manish T. Raiji
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine and Biologic Sciences, Chicago, IL
| | - Thomas T. Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Madeline Scannell
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Joseph A. Sujka
- Division of Pediatric Surgery, Department of Surgery, Children’s Mercy Hospital, Kansas City, MO
| | - Tiffany Wright
- Hiram C. Polk, Jr; M.D. Department of Surgery, Division of Pediatric Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Peter C. Minneci
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Katherine J. Deans
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH,Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
| | - Jennifer H. Aldrink
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH
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18
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Prodromidou A, Pandraklakis A, Loutradis D, Haidopoulos D. Is There a Role of Elevated CA 19-9 Levels in the Evaluation of Clinical Characteristics of Mature Cystic Ovarian Teratomas? A Systematic Review and Meta-analysis. Cureus 2019; 11:e6342. [PMID: 31938630 PMCID: PMC6952044 DOI: 10.7759/cureus.6342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The role of preoperative CA 19-9 levels in patients with ovarian mature cystic teratoma (MCT) and the association of elevated levels of the biomarker with patients’ and tumor characteristics were evaluated. Four electronic databases were searched for articles published up to September 2019. Trials that evaluated the significance of elevated CA 19-9 in patients with ovarian MCTs and publications with > 20 patients were considered eligible for inclusion. Seven studies that included 995 patients with an ovarian MCT who were evaluated with elevated (n = 364) or normal (n = 631) CA 19-9 levels were included. Mean tumor size was significantly increased in patients with elevated CA 19-9 levels (p = 0.038). The rate of ovarian torsion was significantly increased in the elevated CA 19-9 group (p = 0.04). The present study highlights the importance of CA 19-9 as a marker in the diagnosis of MCT, and a meta-analysis supports that it could raise a high degree of clinical suspicion of early recognition of torsion and early surgical management due to complications related to increased size. Nonetheless, the diagnostic value of CA 19-9 is still limited and CA 19-9 can still serve only as a supplementary diagnostic tool in patients with MCTs.
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Affiliation(s)
- Anastasia Prodromidou
- Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Anastasios Pandraklakis
- Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Loutradis
- Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Haidopoulos
- Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, GRC
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19
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Watanabe S, Nagashima S, Onagi C, Yamazaki N, Shimada S, Sakai M, Yanai S, Haga Y, Ohara A, Kuroiwa M. Treatment strategy for pediatric giant mucinous cystadenoma: A case report. Pediatr Rep 2019; 11:8190. [PMID: 31579185 PMCID: PMC6769354 DOI: 10.4081/pr.2019.8190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/05/2019] [Indexed: 11/23/2022] Open
Abstract
Because of their rarity, the treatment strategy for pediatric ovarian epithelial tumors is controversial, especially for a giant cystadenoma. We report the largest mucinous cystadenoma (MCA) case in the pediatric literature thus far. A 12-year-old girl had abdominal distention and visited our hospital. She had a multilocular cyst with some protuberance on the inside and high values of CA 19-9 and CA-125. We diagnosed her with a left MCA and performed a left oophorectomy. The tumor was the stage IA borderline malignant MCA and weighed 11.8 kg. Five years have passed, the patient has not experienced recurrence or metastasis. The resection of giant tumors can affect respiration and circulation. However, pre- or intra-operative drainage may lead to dissemination and adhesion. When we treat pediatric giant ovarian epithelial tumors, we must understand the findings that suggest the possibility of malignancy to decide appropriately as to whether drainage should be performed.
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Affiliation(s)
- Shun Watanabe
- Department of Surgery, Toho University School of Medicine, Tokyo.,First Department of Surgery, Dokkyo Medical University, Tochigi
| | | | - Chihiro Onagi
- Department of Surgery, Toho University School of Medicine, Tokyo
| | - Nobuto Yamazaki
- Department of Surgery, Toho University School of Medicine, Tokyo
| | - Shuhei Shimada
- Department of Surgery, Toho University School of Medicine, Tokyo
| | - Masato Sakai
- Department of Surgery, Toho University School of Medicine, Tokyo
| | - Shun Yanai
- Department of Pediatrics, Toho University School of Medicine, Tokyo, Japan
| | - Yoichi Haga
- Department of Pediatrics, Toho University School of Medicine, Tokyo, Japan
| | - Akira Ohara
- Department of Pediatrics, Toho University School of Medicine, Tokyo, Japan
| | - Minoru Kuroiwa
- Department of Surgery, Toho University School of Medicine, Tokyo
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20
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Kang SK, Reinhold C, Atri M, Benson CB, Bhosale PR, Jhingran A, Lakhman Y, Maturen KE, Nicola R, Pandharipande PV, Salazar GM, Shipp TD, Simpson L, Small W, Sussman BL, Uyeda JW, Wall DJ, Whitcomb BP, Zelop CM, Glanc P. ACR Appropriateness Criteria ® Staging and Follow-Up of Ovarian Cancer. J Am Coll Radiol 2019; 15:S198-S207. [PMID: 29724422 DOI: 10.1016/j.jacr.2018.03.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/12/2022]
Abstract
In the management of epithelial ovarian cancers, imaging is used for cancer detection and staging, both before and after initial treatment. The decision of whether to pursue initial cytoreductive surgery for ovarian cancer depends in part on accurate staging. Contrast-enhanced CT of the abdomen and pelvis (and chest where indicated) is the current imaging modality of choice for the initial staging evaluation of ovarian cancer. Fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT and MRI may be appropriate for problem-solving purposes, particularly when lesions are present on CT but considered indeterminate. In patients who achieve remission, clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. Contrast-enhanced CT is the modality of choice to assess the extent of recurrent disease, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT is also usually appropriate, as small metastatic foci may be identified. If imaging or clinical examination confirms a recurrence, the extent of disease and timing of disease recurrence then determines the choice of treatments, including surgery, chemotherapy, and radiation therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Stella K Kang
- Principal Author, New York University Medical Center, New York, New York.
| | | | - Mostafa Atri
- Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Refky Nicola
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American Congress of Obstetricians and Gynecologists
| | - Lynn Simpson
- Columbia University, New York, New York; American Congress of Obstetricians and Gynecologists
| | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | | | | | - Bradford P Whitcomb
- Tripler Army Medical Center, Honolulu, Hawaii; Society of Gynecologic Oncology
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey, and NYU School of Medicine, New York, New York; American Congress of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, Sunnybrook Health Sciences Centre Bayview Campus, Toronto, Ontario, Canada
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Zhang W, Jia S, Xiang Y, Yang J, Jia C, Leng J. Factors associated with misdiagnosis of frozen section of mucinous borderline ovarian tumor. J Int Med Res 2018; 47:96-104. [PMID: 30198356 PMCID: PMC6384450 DOI: 10.1177/0300060518795582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective This study was performed to investigate the diagnostic accuracy of frozen section (FS) of mucinous borderline ovarian tumors (mBOTs) and the diagnostic value of various risk factors for misdiagnosis. Methods Patients with either an FS or permanent pathologic diagnosis of mBOT were included. Optimum cut-off values for serum tumor markers and maximal tumor diameter were determined, and risk factors for underdiagnosis of mucinous malignant ovarian tumors (mMOTs) were evaluated. The sensitivity, specificity, Youden’s index, and diagnostic odds ratio of the risk factors were assessed to determine their diagnostic value for mMOTs. Results Of 121 included patients, 97 were diagnosed with mBOTs by FS. Relatively abnormal cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) levels; bilateral tumors; and specific pathological features showed significant associations with underdiagnosis of mMOTs in the univariate analysis. The presence of specific pathological features was the only significant risk factor in the multivariate analysis. The CA125, CA19-9, and CEA levels and specific pathological features demonstrated certain diagnostic value in detecting malignant cases among FS-diagnosed mBOTs. Conclusions In patients with FS-diagnosed mBOT, significant predictors of malignancy were relatively higher CA125, CA19-9, and CEA levels; bilateral tumors; and tumors with specific pathological features.
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Affiliation(s)
- Wen Zhang
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Shuangzheng Jia
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Yang Xiang
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Junjun Yang
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Congwei Jia
- 2 Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Jinhua Leng
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China
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Pandey D, Sharma R, Sharma S, Salhan S. Unusually High Serum Levels of CA 19-9 in an Ovarian Tumour: Malignant or Benign? J Clin Diagn Res 2017; 11:QD08-QD10. [PMID: 28511463 DOI: 10.7860/jcdr/2017/21017.9506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022]
Abstract
Carbohydrate antigen 19-9 (CA 19-9) is a tumour marker found to be elevated in some ovarian tumours. We share our experience with a 55-year-old postmenopausal lady with unusually high CA19-9 levels arising from a benign mucinous cystadenoma of the ovary. The levels returned to normal eight weeks following staging laparotomy and a total abdominal hysterectomy with bilateral salpingo-oopherectomy. This report shows rare and significant elevation of CA 19-9 levels with benign mucinous cystadenomas of the ovary thus showing that women with unusually elevated tumour markers may actually harbour benign disease. The tumour markers should not be used to predict the malignant status of a tumour.
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Affiliation(s)
- Divya Pandey
- Assistant Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, Delhi, India
| | - Ritu Sharma
- Assistant Professor, Department of Obstetrics and Gynaecology, NDMC Medical College and Hindu Rao Hospital, Delhi, India
| | - Shakti Sharma
- Senior Resident, Department of Obstetrics and Gynaecology, NDMC Medical College and Hindu Rao Hospital, Delhi, India
| | - Sudha Salhan
- Professor and Unit Head, Department of Obstetrics and Gynaecology, NDMC Medical College and Hindu Rao Hospital, Delhi, India
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Chang C, Chen J, Chen WA, Ho SP, Liou WS, Chiang AJ. Assessing the risk of clinical and pathologic factors for relapse of borderline ovarian tumours. J OBSTET GYNAECOL 2016; 37:233-237. [PMID: 27922289 DOI: 10.1080/01443615.2016.1244810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this study was to identify clinical and pathologic factors that are significant to relapse in borderline ovarian tumours (BOT). All patients with BOTs from 1997 to 2012 in our institute were identified. 115 patients were included in the study. The Cox proportional hazards model was used to identify significant factors. The median age was 42 years (range 14-85 years). The majority of the patients were at FIGO stage I (88.7%), and most of the patients had mucinous histology (66.1%), reflecting the predominant distribution of mucinous BOTs in East Asia. The median follow-up was 3.3 years (range 0-4.1 years). Twelve patients (10.4%) relapsed and two died consequently. Advanced stage, invasive implants and restaging surgery were significant factors of recurrence. Serous tumours had slightly higher risk than mucinous tumours, but the difference was not significant. As the study was performed in an area where mucinous BOTs are predominant, the results may complement current literature on BOT management.
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Affiliation(s)
- Chung Chang
- a Department of Applied Mathematics , National Sun Yat-sen University , Taiwan , ROC
| | - Jiabin Chen
- b Multidisciplinary Science Research Center , National Sun Yat-sen University , Taiwan , ROC
| | - Wei-An Chen
- a Department of Applied Mathematics , National Sun Yat-sen University , Taiwan , ROC
| | - Szu-Pei Ho
- c Department of Pathology and Laboratory Medicine , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan , ROC
| | - Wen Shiung Liou
- d Department of Obstetrics and Gynecology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan , ROC
| | - An Jen Chiang
- d Department of Obstetrics and Gynecology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan , ROC.,e Department of Biological Sciences , National Sun Yat-sen University , Kaohsiung , Taiwan , ROC.,f Department of Pharmacy and Graduate Institute of Pharmaceutical Technology , Ta-Jen University , Pingtung , Taiwan , ROC.,g Institute of Biomedical Sciences , National Sun Yat-Sen University , Kaohsiung , Taiwan , ROC
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Clinical Use of Cancer Biomarkers in Epithelial Ovarian Cancer: Updated Guidelines From the European Group on Tumor Markers. Int J Gynecol Cancer 2016; 26:43-51. [PMID: 26588231 PMCID: PMC4679342 DOI: 10.1097/igc.0000000000000586] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
To present an update of the European Group on Tumor Markers guidelines for serum markers in epithelial ovarian cancer.
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25
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Park SY, Oh YT, Jung DC. Differentiation between borderline and benign ovarian tumors: combined analysis of MRI with tumor markers for large cystic masses (≥5 cm). Acta Radiol 2016; 57:633-9. [PMID: 26231948 DOI: 10.1177/0284185115597266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is overlap in imaging features between borderline and benign ovarian tumors. PURPOSE To analyze diagnostic performance of magnetic resonance imaging (MRI) combined with tumor markers for differentiating borderline from benign ovarian tumor. MATERIAL AND METHODS Ninety-nine patient with MRI and surgically confirmed ovarian tumors 5 cm or larger (borderline, n = 37; benign, n = 62) were included. On MRI, tumor size, septal number (0; 1-4; 5 or more), and presence of solid portion such as papillary projection or septal thickening 0.5 cm or larger were investigated. Serum tumor markers (carbohydrate antigen 125 [CA 125] and CA 19-9) were recorded. Multivariate analysis was conducted for assessing whether combined MRI with tumor markers could differentiate borderline from benign tumor. The diagnostic performance was also analyzed. RESULTS Incidence of solid portion was 67.6% (25/37) in borderline and 3.2% (2/62) in benign tumors (P < 0.05). In all patients, without combined analysis of MRI with tumor markers, multivariate analysis revealed solid portion (P < 0.001) and CA 125 (P = 0.039) were significant for predicting borderline tumors. When combined analysis of MRI with CA 125 ((i) the presence of solid portion or (ii) CA 125 > 44.1 U/mL with septal number ≥5 for borderline tumor) is incorporated to multivariate analysis, it was only significant (P = 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of combined analysis of MRI with CA 125 were 89.1%, 91.9%, 86.8%, 93.4, and 90.9%, respectively. CONCLUSION Combined analysis of MRI with CA 125 may allow better differentiation between borderline and benign ovarian tumor compared with MRI alone.
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Affiliation(s)
- Sung Yoon Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Taik Oh
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Chul Jung
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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26
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Elevated serum progesterone levels in postmenopausal women with mucinous ovarian tumors. Menopause 2016; 23:544-9. [DOI: 10.1097/gme.0000000000000587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lehtinen L, Vesterkvist P, Roering P, Korpela T, Hattara L, Kaipio K, Mpindi JP, Hynninen J, Auranen A, Davidson B, Haglund C, Iljin K, Grenman S, Siitari H, Carpen O. REG4 Is Highly Expressed in Mucinous Ovarian Cancer: A Potential Novel Serum Biomarker. PLoS One 2016; 11:e0151590. [PMID: 26981633 PMCID: PMC4794165 DOI: 10.1371/journal.pone.0151590] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/01/2016] [Indexed: 11/26/2022] Open
Abstract
Preoperative diagnostics of ovarian neoplasms rely on ultrasound imaging and the serum biomarkers CA125 and HE4. However, these markers may be elevated in non-neoplastic conditions and may fail to identify most non-serous epithelial cancer subtypes. The objective of this study was to identify histotype-specific serum biomarkers for mucinous ovarian cancer. The candidate genes with mucinous histotype specific expression profile were identified from publicly available gene-expression databases and further in silico data mining was performed utilizing the MediSapiens database. Candidate biomarker validation was done using qRT-PCR, western blotting and immunohistochemical staining of tumor tissue microarrays. The expression level of the candidate gene in serum was compared to the serum CA125 and HE4 levels in a patient cohort of prospectively collected advanced ovarian cancer. Database searches identified REG4 as a potential biomarker with specificity for the mucinous ovarian cancer subtype. The specific expression within epithelial ovarian tumors was further confirmed by mRNA analysis. Immunohistochemical staining of ovarian tumor tissue arrays showed distinctive cytoplasmic expression pattern only in mucinous carcinomas and suggested differential expression between benign and malignant mucinous neoplasms. Finally, an ELISA based serum biomarker assay demonstrated increased expression only in patients with mucinous ovarian cancer. This study identifies REG4 as a potential serum biomarker for histotype-specific detection of mucinous ovarian cancer and suggests serum REG4 measurement as a non-invasive diagnostic tool for postoperative follow-up of patients with mucinous ovarian cancer.
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Affiliation(s)
- Laura Lehtinen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
- * E-mail:
| | - Pia Vesterkvist
- VTT Technical Research Centre of Finland, Espoo and Turku Centre for Biotechnology, University of Turku, Turku, Finland
| | - Pia Roering
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Taina Korpela
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Liisa Hattara
- VTT Technical Research Centre of Finland, Espoo and Turku Centre for Biotechnology, University of Turku, Turku, Finland
| | - Katja Kaipio
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - John-Patrick Mpindi
- FIMM, Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Annika Auranen
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Ben Davidson
- Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Kristiina Iljin
- VTT Technical Research Centre of Finland, Espoo and Turku Centre for Biotechnology, University of Turku, Turku, Finland
| | - Seija Grenman
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Harri Siitari
- VTT Technical Research Centre of Finland, Espoo and Turku Centre for Biotechnology, University of Turku, Turku, Finland
| | - Olli Carpen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
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Seckin KD, Karslı MF, Yucel B, Bestel M, Yıldırım D, Canaz E, Akbayır O. The utility of tumor markers and neutrophil lymphocyte ratio in patients with an intraoperative diagnosis of mucinous borderline ovarian tumor. Eur J Obstet Gynecol Reprod Biol 2015; 196:60-3. [PMID: 26683535 DOI: 10.1016/j.ejogrb.2015.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 10/12/2015] [Accepted: 10/28/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the utility of tumor markers and complete blood count to increase the diagnostic accuracy to detect malignant cases that are intraoperatively reported as mucinous borderline ovarian tumors (BOT). STUDY DESIGN Patients who underwent laparotomy at our gynecologic oncology clinic between 2007 and 2015 for evaluation of an adnexal mass with an intraoperative frozen section report of mucinous BOT were retrospectively analyzed. Patients were grouped according to the final pathological diagnoses (malignant, borderline and benign), and were compared in terms of tumor marker levels and complete blood count parameters. Significant parameters were evaluated together with frozen section results, and were assessed for diagnostic accuracy. RESULTS A total of 63 patients were included in the study. Of these, 41 patients had borderline, 11 patients had benign, and 11 patients had malignant mucinous ovarian tumors. Patient age, menopausal status, hemoglobin, platelet and lymphocyte counts were similar among the groups (p>0.05). On the other hand, white blood cell, neutrophil counts and neutrophil/lymphocyte ratio (NLR) were significantly higher in malignant cases (p<0.05). Similarly, CA125 and CA19-9 were significantly higher in malignant group (p<0.05). When evaluated with the frozen section results, CA19-9 and NLR had the highest sensitivity to detect mucinous cancers (81 and 78 percent, respectively). CONCLUSIONS In patients who have an intraoperative frozen section diagnosis of borderline mucinous ovarian tumors, CA19-9, NLR and CA125 were significant predictors of malignancy. In light of larger future studies, we believe that integrating these parameters into routine clinical practice may decrease the rate of under diagnosis.
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Affiliation(s)
- Kerem Doga Seckin
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Fatih Karslı
- Obstetrics and Gynecology Department, Sami Ulus Women and Children Health Training and Research Hospital, Ankara, Turkey
| | - Burak Yucel
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Melih Bestel
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Dogukan Yıldırım
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Emel Canaz
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ozgur Akbayır
- Gynecology and Oncology Department, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Clinical Use of Cancer Biomarkers in Epithelial Ovarian Cancer: Updated Guidelines From the European Group on Tumor Markers. Int J Gynecol Cancer 2015. [PMID: 26588231 DOI: 10.1097/igc.0000000000000586] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To present an update of the European Group on Tumor Markers guidelines for serum markers in epithelial ovarian cancer. METHODS Systematic literature survey from 2008 to 2013. The articles were evaluated by level of evidence and strength of recommendation. RESULTS Because of its low sensitivity (50-62% for early stage epithelial ovarian cancer) and limited specificity (94-98.5%), cancer antigen (CA) 125 (CA125) is not recommended as a screening test in asymptomatic women. The Risk of Malignancy Index, which includes CA125, transvaginal ultrasound, and menopausal status, is recommended for the differential diagnosis of a pelvic mass. Because human epididymis protein 4 has been reported to have superior specificity to CA125, especially in premenopausal women, it may be considered either alone or as part of the risk of ovarian malignancy algorithm, in the differential diagnosis of pelvic masses, especially in such women. CA125 should be used to monitor response to first-line chemotherapy using the previously published criteria of the Gynecological Cancer Intergroup, that is, at least a 50% reduction of a pretreatment sample of 70 kU/L or greater. The value of CA125 in posttherapy surveillance is less clear. Although a prospective randomized trial concluded that early administration of chemotherapy based on increasing CA125 levels had no effect on survival, European Group on Tumor Markers state that monitoring with CA125 in this situation should occur, especially if the patient is a candidate for secondary cytoreductive surgery. CONCLUSIONS At present, CA125 remains the most important biomarker for epithelial ovarian cancer, excluding tumors of mucinous origin.
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Abnormally high level of CA-19-9 in a benign ovarian cyst. Obstet Gynecol Sci 2015; 58:530-2. [PMID: 26623421 PMCID: PMC4663235 DOI: 10.5468/ogs.2015.58.6.530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/08/2022] Open
Abstract
CA-19-9 antigen is mainly elevated in cases of gastrointestinal tract malignancy, including of the pancreas, colorectum, and biliary tract. CA 19-9 antigen can also be elevated in ovarian mucinous neoplasms, however, as well as in many benign conditions. Markedly raised levels of more than 10,000 U/mL were almost observed in advanced stage of malignancy. We report herein the case of a 37-year-old woman who presented with an abnormally high level of CA 19-9 antigen associated with benign mucinous cystadenoma.
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CA 19-9 in evaluation of adnexal mass: retrospective cohort analysis and review of the literature. Int J Biol Markers 2015; 30:e333-40. [PMID: 25704505 DOI: 10.5301/jbm.5000139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the diagnostic accuracy of serum marker CA 19-9 levels in the triage of adnexal masses. METHODS This retrospective cohort study was carried out in patients referred to the Gynecology Department at Carmel Medical Center due to adnexal masses. All patients underwent preoperative measurements of serum CA 125 and CA 19-9 and surgery with histopathologically confirmed diagnosis. RESULTS Between January 2005 and December 2012, 503 patients with adnexal masses were evaluated with serum tumor markers. Combination of CA 19-9 with CA 125, compared with CA 125 levels alone, suggested a nonsignificant effect on sensitivity (86.9% vs. 88.9%, respectively, p = 0.54) or specificity (79.5% vs. 73.5%, p = 0.1) in differentiating malignant from benign adnexal masses. CA 19-9 was not helpful in detecting mucinous histological types or borderline tumors. Mean CA 19-9 levels were higher in metastatic cases compared with primary ovarian malignancy (488.7 ± 1,457 vs. 46.3 ± 149.8 U/mL, respectively, p = 0.001). In mature cystic teratomas, mean CA 19-9 levels were higher and CA 125 levels were lower than in ovarian carcinoma (p = 0.049 and p = 0.0012, respectively). CONCLUSIONS The combination of the tumor markers CA 19-9 and CA 125 did not contribute significantly to the detection of malignant adnexal masses compared with CA 125 alone. As our results suggest that higher CA 19-9 levels could be helpful in differentiating metastatic tumors from primary ovarian malignancy; this issue should be investigated in large well-designed prospective cohort trials.
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Ilker S, Nilufer C, Firat CZ, Bulent O, Hatice B, Tayfun G. Predicting lympho-vascular space invasion in endometrial cancers with mucinous carcinomatous components. Asian Pac J Cancer Prev 2015; 16:4247-50. [PMID: 26028080 DOI: 10.7314/apjcp.2015.16.10.4247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the predictors of lympho-vascular space invasion (LVSI) in endometrial cancers which contain mucinous carcinomatous histology. MATERIALS AND METHODS Clinical and histopathological data of endometrial carcinomas with a mucinous carcinomatous component diagnosed between January 2007 and January 2014 at the Gynecologic Oncology Department of Zekai Tahir Burak Women's Health Education and Research Hospital were reviewed retrospectively. RESULTS Twelve patients (25.5%) were positive for LVSI and 35 (74.5%) patients were negative. Patients with LVSI were mostly staged higher than 1A. Mean age, BMI and parity were not significantly different between patient groups. Larger tumor diameter (≥2 cm) (p=0.04) and elevated Ca125 and Ca-19.9 (p=0.01) levels were significant for predicting LVSI. We also found >1/2 myometrial invasion (p<0.001), cervical stromal involvement (p=0.002) and higher grade (2-3) (p=0.001) significant for predicting LVSI. In multivariate analysis we found only grade significant for predicting LVSI. CONCLUSIONS Especially grade of tumor is a crucial factor for determining LVSI in endometrial cancers with mucinous carcinomatous components.
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Affiliation(s)
- Selcuk Ilker
- Gynecologic Oncology Unit, Zekai Tahir Burak Women's Health, Education and Research Hospital, Ankara, Turkey E-mail :
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Gynecologic Cancer InterGroup (GCIG) consensus review for mucinous ovarian carcinoma. Int J Gynecol Cancer 2014; 24:S14-9. [PMID: 25341574 DOI: 10.1097/igc.0000000000000296] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mucinous carcinomas of the ovary can be primary or metastatic in origin. Improvements in the pathological diagnosis have increased the ability to distinguish between primary and metastatic ovarian cancers and shown that primary mucinous carcinomas are a rare subtype of ovarian cancer. Most tumors are diagnosed at an early stage, and the prognosis after surgery is good. Advanced or recurrent mucinous carcinoma of the ovary responds poorly to current cytotoxic treatments, and the prognosis is poor. Here, we review the guidelines for surgery and the results of treatment of advanced and recurrent disease. Chemotherapy with platinum and paclitaxel is currently used to treat advanced disease, but the effect of these drugs is modest, and new treatments are needed.
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35
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Cho HY, Kyung MS. Serum CA19-9 as a predictor of malignancy in primary ovarian mucinous tumors: a matched case-control study. Med Sci Monit 2014; 20:1334-9. [PMID: 25073801 PMCID: PMC4117678 DOI: 10.12659/msm.890954] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background This study was designed to investigate the clinical characteristics correlated with serum CA19-9 elevation in primary mucinous ovarian tumors and to evaluate the role of serum CA19-9 in predicting borderline or malignant tumors. Material/Methods We retrospectively identified 27 women with pathologically-confirmed primary ovarian mucinous neoplasms (16 borderline and 11 malignant), who had been preoperatively checked for serum CA19-9 and CA125 levels. The control group was established by 1:2 matching for age among all women with pathologically-confirmed benign mucinous tumors over the same time period. The associations of the serum CA19-9 elevation and clinical characteristics, including tumor pathology, were evaluated. Results Serum CA19-9 was more frequently elevated in borderline or malignant than benign tumors (57.9% vs. 16.7%, P=0.001), although the mean value of serum CA19-9 was not significantly different among histological subtypes. CA19-9 elevation was correlated with large tumor size (largest diameter ≥15 cm; p=0.028), serum CA125 elevation (p=0.006), and tumor pathology (borderline or malignant tumors; p=0.001). Other clinical characteristics, including parity, menopause, bilateral tumor involvement, and torsion were not correlated with CA19-9 elevation. Multivariate analysis revealed that tumor pathology was the only independent factor for CA19-9 elevation in primary ovarian mucinous tumors (odds ratio 3.842, 95% CI 1.277–11.558, p=0.017). Interestingly, subgroup analysis in women with normal serum CA 125 level revealed that CA19-9 was significantly correlated with borderline and malignant tumors but not with benign tumors (odds ratio 6.3, 95% CI 1.438–19.648, p=0.014). Conclusions Serum CA19-9 can be a useful complementary marker in differentiating benign from borderline or malignant mucinous tumors in the ovaries, particularly when serum CA125 level is not elevated.
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Affiliation(s)
- Hye-Yon Cho
- Department of Obstetrics and Gynecology, Hallym University, Dongtan Sacred Heart Hospital, Kyeonggido, Korea
| | - Min Sun Kyung
- Department of Obstetrics and Gynecology, Hallym University, Dongtan Sacred Heart Hospital, Kyeonggido, Korea
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36
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Iglesias Otero M, Formigo Couceiro FJ, de la Fuente Mariño R, Portela Romero M. [Woman with abdominal distention of 2 months duration]. Semergen 2014; 41:287-9. [PMID: 24880760 DOI: 10.1016/j.semerg.2014.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Affiliation(s)
- M Iglesias Otero
- Medicina Familiar y Comunitaria, Centro de Salud de Padrón, XAP Santiago, Padrón, A Coruña, España.
| | - F J Formigo Couceiro
- Medicina Familiar y Comunitaria, Centro de Salud Concepción Arenal, XAP Santiago, Santiago de Compostela, A Coruña, España
| | - R de la Fuente Mariño
- Medicina Familiar y Comunitaria, Centro de Salud de Padrón, XAP Santiago, Padrón, A Coruña, España
| | - M Portela Romero
- Medicina Familiar y Comunitaria, Centro de Salud de Padrón, XAP Santiago, Padrón, A Coruña, España
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Passerini R, Cassatella MC, Boveri S, Salvatici M, Radice D, Zorzino L, Galli C, Sandri MT. The pitfalls of CA19-9: routine testing and comparison of two automated immunoassays in a reference oncology center. Am J Clin Pathol 2012; 138:281-7. [PMID: 22904141 DOI: 10.1309/ajcpopnpllcyr07h] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
We evaluated CA19-9 as a marker of various malignancies and compared the results of 2 commercial immunoassays. The Abbott ARCHITECT i2000 and Roche cobas 410 immunoassays were used on 500 consecutive samples to evaluate the frequency of positive results by cancer type and the correlation between assays. The patients were tested before or after surgery and/or during chemotherapy. The rate of results exceeding conventional thresholds was 92.3% in pancreatic cancer, 36.8% in gastric cancer, and ranged from 3.0% to 35.9% in other tumors. Agreement (90.6%) and correlation (R(2) = 0.865) between the 2 assays were good and the frequency of highly discordant results was low (6/500). In some cases, interference by heterophilic antibodies was demonstrated. The 2 methods were comparable in diagnostic accuracy and had good correlation but are not interchangeable. Patients should always be monitored for CA19-9 with the same method and it should be indicated in the report.
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Affiliation(s)
- Rita Passerini
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Maria C. Cassatella
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Sara Boveri
- Preventive Gynecology Unit, European Institute of Oncology, Milan, Italy
| | - Michela Salvatici
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Laura Zorzino
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | | | - Maria T. Sandri
- Division of Laboratory Medicine, European Institute of Oncology, Milan, Italy
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Morotti M, Menada MV, Gillott DJ, Venturini PL, Ferrero S. The preoperative diagnosis of borderline ovarian tumors: a review of current literature. Arch Gynecol Obstet 2011; 285:1103-12. [DOI: 10.1007/s00404-011-2194-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 12/19/2011] [Indexed: 12/14/2022]
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Morphological subtypes of ovarian carcinoma: a review with emphasis on new developments and pathogenesis. Pathology 2011; 43:420-32. [PMID: 21716157 DOI: 10.1097/pat.0b013e328348a6e7] [Citation(s) in RCA: 326] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Ovarian carcinomas comprise a heterogeneous group of neoplasms, the four most common subtypes being serous, endometrioid, clear cell and mucinous. In recent years, our understanding of the underlying pathogenesis and initiating molecular events in the different tumour subtypes has greatly increased, and although ovarian carcinoma is often considered clinically as one disease, there is now a much greater realisation that the various subtypes have a different natural behaviour and prognosis. At present, adjuvant therapy is mainly dependent upon tumour stage and grade rather than type; however, this is likely to change in the future with the development of new chemotherapeutic agents and targeted therapies and clinical trials are necessary to evaluate the efficacy of different agents in clear cell, mucinous and low grade serous carcinomas, neoplasms which are considered relatively resistant to traditional chemotherapeutic regimes. In this review, the major subtypes of ovarian carcinoma are discussed. It is now firmly established that there are two distinct types of ovarian serous carcinoma, low grade and high grade, the former being much less common and arising in many cases from a serous borderline tumour. Low grade and high grade serous carcinoma represent two distinct tumour types with a different underlying pathogenesis rather than low grade and high grade variants of the same neoplasm. Both are usually advanced stage (stage III or IV) at diagnosis. B-raf and k-ras mutations are important molecular events in low grade serous carcinomas while high grade serous carcinomas are almost always associated with TP53 mutation. There is now emerging and compelling evidence that many high grade serous carcinomas (by far the most common subtype of ovarian carcinoma) actually arise from the epithelium of the distal fallopian tube. Future studies regarding the initiating molecular events in the development of this aggressive neoplasm should concentrate on this site. Primary ovarian mucinous carcinomas are uncommon, almost always unilateral and stage I, and largely of so-called intestinal or enteric type. Most arise in a stepwise manner from a pre-existing mucinous cystadenoma and mucinous borderline tumour. Endometrioid and clear cell carcinomas typically present as low stage neoplasms and in many, or most, cases arise from endometriosis; the former are usually well differentiated and there is now evidence that the majority of neoplasms reported in the past as high grade endometrioid carcinoma are of serous type. WT1 is useful in this regard since it is a relatively specific marker of a serous phenotype. It is recommended that different subtypes of ovarian carcinoma are graded using different systems rather than employing a universal grading system.
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McCluggage WG. Immunohistochemistry in the distinction between primary and metastatic ovarian mucinous neoplasms: Table 1. J Clin Pathol 2011; 65:596-600. [DOI: 10.1136/jcp.2010.085688] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The distinction between a primary and metastatic mucinous carcinoma within the ovary may be problematic. In most cases, the distinction can be made by careful pathological examination encompassing both the gross and microscopic findings and taking into account the distribution of the disease. However, immunohistochemistry may be of value in certain scenarios. In this review, I discuss the value of markers in the distinction between primary ovarian mucinous neoplasms and metastatic mucinous carcinomas from the colorectum, appendix, pancreas, biliary tract, stomach and cervix, the most common primary sites which give rise to metastatic mucinous carcinoma within the ovary. There is a significant degree of immunophenotypic overlap between primary ovarian mucinous neoplasms and metastatic mucinous carcinomas from the gastrointestinal tract, especially the upper gastrointestinal type; this is because most primary ovarian mucinous carcinomas and borderline tumours are of so-called intestinal or enteric type and exhibit some degree of positivity with enteric markers. Mullerian type primary ovarian mucinous neoplasms also exist and exhibit distinct immunohistochemical differences to the more common intestinal type.
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