Ascites and a raised serum Ca 125--confusing combination

MicroRNAs as Potential Biomarkers in Gynecological Cancers

MicroRNAs are non-coding transcripts that, thanks to the ability to regulate the mRNA of target genes, can affect the expression of genes encoding tumor suppressors and oncogenes. They can control many important cellular processes, including apoptosis, differentiation, growth, division, and metabolism. Therefore, miRNAs play an important role in the development of many cancers, including gynecological cancers. Ovarian cancer, endometrial cancer, cervical cancer, and vulvar cancer are the most common cancers in women and are a frequent cause of death. The heterogeneity of the pathogenesis of these gynecological diseases makes the diagnostic process a significant obstacle for modern medicine. To date, many studies have been carried out, in which particular attention has been paid to the molecular pathomechanism of these diseases, with particular emphasis on miRNAs. To date, the changed profile of many miRNAs, which influenced the promotion of proliferation, migration, invasion processes and the simultaneous inhibition of programmed cell death, has been proven many times. Detailed understanding of the molecular effects of miRNAs in the above-mentioned gynecological cancers will enable the development of potential predictive and prognostic biomarkers, as well as the optimization of the diagnostic process.

Primary Malignant Mesothelioma of the Peritoneum Mistaken for Peritoneal Tuberculosis due to Elevated Cancer Antigen 125

Adifferential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.

CA-125 Significance in Cirrhosis and Correlation with Disease Severity and Portal Hypertension: A Retrospective Study

Background and Aims: To evaluate the prevalence and significance of elevated cancer antigen-125 (CA-125) levels in patients with cirrhosis being treated in a tertiary care liver center and its correlation with objective markers of disease severity. Methods: We retrospectively reviewed medical records of 172 adult patients with cirrhosis (due to any etiology) after obtaining CA-125 serum analysis. Demographics, etiology of cirrhosis, model of end-stage liver disease (MELD) score, Child's Turcotte-Pugh classification, albumin bilirubin (ALBI) score, degree of ascites, presence of esophageal varices, serum CA-125 level and various other parameters were collected. Statistical analysis was performed using SPSS software and descriptive statistics. Results: Elevated CA-125 levels were noted in 147 patients (85%) of the study population. Higher MELD score was associated with higher CA-125 levels (p = 0.001). Statistically significant correlation was observed between elevated CA-125 levels and degree of ascites (p < 0.001), ALBI score (p < 0.001) and Child's Turcotte-Pugh class (p < 0.001). No correlation was observed with presence or absence of esophageal varices. Near-normal CA-125 levels were noted in patients with cirrhosis but undetectable ascites on ultrasound imaging. No differences were observed in mean values between male and female patients (p = 0.207). Regression analysis confirmed that CA-125 levels had a better correlation with degree of ascites than MELD score or ALBI score. Conclusions: Elevated CA-125 levels were noted in 85% of patients with cirrhosis at our center. Our study establishes that the more advanced the degree of decompensation based on MELD score, Child's Turcotte-Pugh classification and ALBI score, the higher the elevation in CA-125. Absence of ascites was associated with normal CA-125 level, with a direct correlation between high levels and worsening ascites, but there was no statistically significant correlation with esophageal varices, indicating that elevated CA-125 levels could be related to mechanical stretch of the peritoneum rather than portal hypertension itself. Further multi-centered studies are required to confirm and validate these findings.

Elevated CA-125 in IgG4 mesenteritis: a red herring or a disease biomarker? Case report and literature review

Mesenteric panniculitis (MP) is a rare chronic disease characterized by inflammation and subsequently fibrosis of adipose tissue of the omentum. Only recently it has been associated with IgG4-related disease. Cancer antigen 125 (CA-125) is a high-molecular mass glycoprotein, traditionally associated with ovarian cancer, although it can be elevated in other conditions. Herein we describe a case of a 56-year-old man with IgG4 related mesenteric panniculitis associated with very high levels of CA-125 at the onset of disease. The CA-125 levels corresponded to clinical disease activity and improved with steroid therapy and rituximab. A literature review was performed concerning possible association of MP, IgG4-related disease and CA-125. The review of literature suggests that high levels of CA-125 can be raised in non-malignant, inflammatory conditions including IgG4-related mesenteritis and can improve with treatment.

Carbohydrate antigen 125 and carcinoembryonic antigen in the differentiation of tuberculous peritonitis and peritonitis carcinomatosa

Tumor markers could increase in both tuberculous peritonitis and peritonitis carcinomatosa, confusing the differentiation of these diseases. This study aimed to better understand the extent of elevation and diagnostic efficacies of carbohydrate antigen 125 (CA 125), carcinoembryonic antigen (CEA) and combinative use of them in tuberculous peritonitis and peritonitis carcinomatosa. Of 2998 patients reviewed, 101, 120 and 71 patients were assigned to TBP group (tuberculous peritonitis), non-OCA group (non-ovarian carcinoma-related peritonitis carcinomatosa) and OCA group (ovarian carcinoma-related peritonitis carcinomatosa), respectively. The composite index was calculated by CA 125 multiplying CEA. Receiver operator characteristic curves for CA 125, CEA and composite index were acquired. As a result, CA 125 value in OCA group was higher than other two groups (serum CA 125: P < 0.001; ascites CA 125: P < 0.001). On the other hand, non-OCA group had the highest CEA value among three groups (serum CEA: P < 0.001; ascites CEA: P < 0.001). Area under curves of serum/ascites composite index and serum/ascites CEA were larger than those of serum/ascites CA 125. Furthermore, ascites and serum composite index displayed the best sensitivity (0.907) and specificity (0.989), respectively. In conclusion, CA 125 increases in tuberculous peritonitis and non-ovarian carcinoma-related peritonitis carcinomatosa, but it elevates more in ovarian carcinoma-related peritonitis carcinomatosa. CEA is found to increase more significantly in non-ovarian carcinoma-related peritonitis carcinomatosa. CEA and composite index are helpful in distinguishing peritonitis carcinomatosa from tuberculous peritonitis, but composite index is slightly superior to CEA in the differential diagnosis.

Diagnostic Difficulties in Woman with Crohn's Disease, Ascites, and Elevated Value of Serum CA125 Antigen

Variety of symptoms and atypical clinical course of Crohn's disease (CD) often create the need for additional diagnostic procedures. In the described case of woman with CD, there was a suspicion of coexistence of ovarian cancer. This issue is particularly important in patients treated with immunosuppressants and biological agents. The discussion focused on the usefulness of CA125 (cancer antigen 125, mucin 16) serum level estimation in clinical practice and draws attention to the possible reasons for the increase of its value which is not associated to ovarian cancer.

Abnormal CA-125 levels in menopausal women without ovarian cancer

OBJECTIVE

To determine if an abnormal CA-125 level in a menopausal female without ovarian cancer is associated with an increase in mortality.

METHODS

The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Randomized Controlled (PLCO) Trial is a large multicenter prospective trial conducted by the National Cancer Institute (NCI). Over 78,000 healthy women aged 55-74 were randomized to a screening arm versus a usual medical care arm to evaluate the efficacy of screening in reducing mortality due to ovarian cancer. Women in the screening arm underwent annual screening for ovarian cancer with transvaginal ultrasound and CA-125 levels. There were 38,818 patients without ovarian cancer that had at least one CA-125 level drawn; 1201 (3.09%) had at least one abnormal level. The current study compares mortality in patients that had one or more abnormal CA-125 levels without ovarian cancer versus those with all normal levels.

RESULTS

Patients with one or more abnormal CA-125 levels, without ovarian cancer, had a significantly higher mortality than patients with all normal CA-125 levels in the PLCO screening trial (p<0.0001). This increased risk extended throughout the follow-up period. Analysis of cause of death listed on the death certificate showed an excess mortality attributable to lung cancer, digestive disease, and endocrine, nutritional, and metabolic disease.

CONCLUSION

Menopausal females with an elevated CA-125 and without ovarian cancer are exposed to an increased risk of premature mortality.

Myxedema ascites with high CA-125: Case and a review of literature

Ascites appearing in a previously healthy female patient is usually ascribed to a variety of causes, among which, is a cancerous process, especially if it comes with a raised CA-125 level. Although the CA-125 antigen is present on more than 80% of malignant epithelial ovarian tissue of non-mucinous type, it is also found on both healthy and malignant cells of mesothelial and non-mesothelial origin. Myxedema ascites which is caused by hypothyroidism is a rare entity, but on the other hand is easy to treat. It is one of the differential diagnoses when the ascites is refractory to treatment and no other obvious cause can be identified. If the diagnosis is delayed, patients will frequently receive unnecessary procedures, while treatment has very good response rates and ascites resolve with serum CA-125 normalization after adequate hormonal treatment.

A patient with tuberculous peritonitis with very high serum CA 125

An 88-year-old woman presented with abdominal pain and distension. Serum cancer antigen 125 (CA 125) level was very high; however, abdominal CT reveals ascites without definite mass. Ascites analysis revealed a lymphocytic exudate with high adenosine deaminase enzyme level, negative stains for bacteria and negative PCR for Mycobacterium tuberculosis. Presumptive diagnosis for tuberculous peritonitis was made and antituberculous therapy resulted in the resolution of ascites and normalisation of CA 125.

Struma ovarii associated with Pseudo-Meig's syndrome and high serum level of CA 125; a case report

Struma ovarii is a rare form of ovarian neoplasm in a form of mature teratoma and is composed predominantly of thyroid tissue. In the literature review, there has only been 10 cases of this tumor, associated with ascites and pleural effusion (Meig's Syndrome) and increased CA125 so far. In such cases, the tumor mimics malignant ovarian tumor. In this article, the case of a 72-year-old symptomatic woman with a pelvic mass, pleural and peritoneal effusion and high level of serum CA125 is presented. Cytological evaluation for the pleural fluid was performed. She underwent hysterectomy and bilateral salpingo-oophorectomy. The result of pathologic diagnosis is presented in this paper. The patient was well in postoperative period and paraclinical tests including CA 125 were normal as well.

CA125--a test with a change of heart

CA125 is well known as a tumour marker for ovarian cancer. Like all tumour markers it is not specific for a specific tumour and may be elevated in benign disease. Even in ovarian cancer it seems that CA125 is derived from mesothelial production rather than from the cancer cells. CA125 is a natural product of serosal epithelial cells and present in most serosal fluids whether malignant or benign. Benign causes of CA125 elevation include liver cirrhosis, peritoneal infection, abdominal surgery or the congestion of cardiac failure. Elevated CA125 levels are found in ascitic, pleural or pericardial fluid of patients with cardiac failure and the serum levels correlate with the clinical staging of cardiac failure. Whilst CA125 levels might be useful for diagnosis of cardiac failure, it has an equally impressive ability for defining prognosis in that condition, especially when combined with measuring natriuretic peptides. The CA125 assay is not standardised and different methods, such as new CA125II assays, often give differing results. Furthermore, as CA125 levels fall at the menopause, and may rise in the elderly, reference limits appropriate for age and gender need to be refined in order for CA125 to fulfil any of its potential as a marker of cardiac failure in these age groups.

Screening for Ovarian Cancer

The efficacy of ovarian cancer screening remains to be proven. Advances in ultrasound and tumor marker technology, combined with complex statistical analysis have facilitated 2 large ongoing randomized controlled trials of screening which are powered to determine the impact on mortality. Serum proteomics seems to be a promising area for biomarker discovery, but requires more rigorous validation before it can be used in clinical trials. Current screening tests, clinical trials in the general and high-risk populations, screening acceptability and costs are reviewed in this article.