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Ji N, Eckel SP, Foley H, Yang T, Lurmann F, Grubbs BH, Habre R, Bastain TM, Farzan SF, Breton CV. Prenatal air pollution exposure is associated with inflammatory, cardiovascular, and metabolic biomarkers in mothers and newborns. ENVIRONMENTAL RESEARCH 2024; 252:118797. [PMID: 38555084 PMCID: PMC11156540 DOI: 10.1016/j.envres.2024.118797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/20/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Prenatal air pollution exposure has been associated with individual inflammatory, cardiovascular, and metabolic biomarkers in mothers and neonates. However, studies of air pollution and a comprehensive panel of biomarkers across maternal and cord blood samples remain limited. Few studies used data-driven methods to identify biomarker groupings that converge biomarkers from multiple biological pathways. This study aims to investigate the impacts of prenatal air pollution on groups of biomarkers in maternal and cord blood samples. METHODS In the Maternal And Developmental Risks from Environmental and Social Stressors (MADRES) cohort, 87 biomarkers were quantified from 45 trimester 1 maternal blood and 55 cord blood samples. Pregnancy and trimester 1-averaged concentrations of particulate matter ≤2.5 μm and ≤10 μm in diameter (PM2.5 and PM10), nitrogen dioxide (NO2), and ozone (O3) were estimated, using inverse distance squared weighted spatial interpolation from regulatory air monitoring stations. Traffic-related NOx was assessed using California Line Source Dispersion Model: freeway/highway roads, non-freeway major roads, non-freeway minor roads, and their sum as total NOx. Elastic Net (EN) regression within the rexposome R package was used to group biomarkers and assess their associations with air pollution. RESULTS In maternal samples, trimester 1-averaged PM10 was associated with elevated inflammation biomarkers and lowered cardiovascular biomarkers. NO2 exhibited positive associations with cardiovascular and inflammation markers. O3 was inversely associated with inflammation, metabolic, and cardiovascular biomarkers. In cord blood, pregnancy-averaged PM2.5 was associated with higher cardiovascular biomarkers and lower metabolic biomarkers. PM10 was associated with lower inflammation and higher cardiovascular biomarkers. Total and major road NOx was associated with lower cardiovascular biomarkers. CONCLUSION Prenatal air pollution exposure was associated with changes in biomarkers related to inflammation, cardiovascular, metabolic, cancer, and neurological function in both mothers and neonates. This study shed light on mechanisms by which air pollution can influence biological function during pregnancy.
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Affiliation(s)
- Nan Ji
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, United States
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, United States
| | - Helen Foley
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, United States
| | - Tingyu Yang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, United States
| | - Fred Lurmann
- Sonoma Technology Inc., Petaluma, CA, 94954, United States
| | - Brendan H Grubbs
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, United States
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, United States
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, United States
| | - Shohreh F Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, United States
| | - Carrie V Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, United States.
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Vivod G, Merlo S, Kovacevic N. High-Grade Serous Ovarian Cancer during Pregnancy: From Diagnosis to Treatment. Curr Oncol 2024; 31:1920-1935. [PMID: 38668047 PMCID: PMC11048790 DOI: 10.3390/curroncol31040144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/10/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Due to the rarity of ovarian cancer diagnosed during pregnancy, the literature on the treatment of subtypes of epithelial ovarian cancer in pregnancy is sparse. The aim of our review was to analyze cases of high-grade serous ovarian cancer in pregnancy. METHODS The PubMed and Scopus databases were searched for relevant articles published in English between January 2000 and December 2023. The references of all the relevant reviews found were also checked to avoid omitting eligible studies. Information on the all retrieved cases was extracted and reviewed in detail. The most important detail was the subtype of high-grade serous ovarian cancer, which was referred to as serous adenocarcinoma (grade 2 or grade 3) in older cases. RESULTS We found eleven cases with relevant details of high-grade serous ovarian cancer diagnosed in pregnancy. Despite the small number of cases we found, our study demonstrated the importance of an accurate initial vaginal ultrasound at the first examination in pregnancy and the safety of diagnostic surgery and chemotherapy in pregnancy. CONCLUSIONS There have not been long-term follow-ups of patients' oncologic and obstetric outcomes. As patients should be comprehensively informed, more detailed case reports or series with longer follow-up periods are needed.
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Affiliation(s)
- Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (G.V.); (S.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (G.V.); (S.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boskin, 4270 Jesenice, Slovenia
| | - Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (G.V.); (S.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boskin, 4270 Jesenice, Slovenia
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Huang Y, Su X, Chen K, Zhang L, Xu W, Pu Y, Xu F, Gong R, Zhang J, Nie Y, Shi Q. Epidemiological characteristics of suspected adenomyosis in the Chinese physical examination population: a nested case-control study. BMJ Open 2024; 14:e074488. [PMID: 38216177 PMCID: PMC10806687 DOI: 10.1136/bmjopen-2023-074488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/27/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES We aimed to explore the epidemiological characteristics of suspected adenomyosis within a physical examination population in China. DESIGN A retrospective, nested case-control study; we matched healthy people and those with potential adenomyosis on a 1:2 ratio by age. SETTING A tertiary hospital health management centre. PARTICIPANTS We included 15-60 years old women who underwent at least one uterine examination from October 2017 to December 2020, excluding those who had undergone hysterectomy and menopause. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the incidence and prevalence rate of suspected adenomyosis. Conditional logistic regression was used to estimate associations between serum biomarkers and potential adenomyosis. Areas under the receiver-operating characteristic curves (AUC) were used to determine the cut-off point of the cancer antigen 125 (CA125) level for suspected adenomyosis. RESULTS A total of 30 629 women had uterus-related imaging examinations; 877 had suspected adenomyosis. The standardised incidence and prevalence of suspected adenomyosis was 1.32% and 2.35%, respectively, for all age groups. The conditional logistic regression analysis results showed that total bilirubin≥18.81 µmol/L (HR: 2.129; 95% CI 1.067 to 4.249; p<0.0321) and CA125 levels (HR: 1.014; 95% CI 1.002 to 4.731; p<0.0273) were positively correlated with onset of suspected adenomyosis; body mass index>24 kg/m2 (HR: 1.262; 95% CI 1.055 to 1.511; p<0.0109), CA125 levels (HR: 1.007; 95% CI 1.006 to 1.009; p<0.0001), and blood platelet levels (HR: 1.002; 95% CI 1 to 1.003; p<0.0141) were positively correlated with potential adenomyosis. The optimal cut-off of CA125 for new suspected adenomyosis was 10.714 U/mL, with a sensitivity of 77.42%, specificity of 53.76%, and AUC of 0.7841 (95% CI 0.7276 to 0.8407). CONCLUSIONS The disease burden of suspected adenomyosis remains huge and can be informed by biomarkers. The disease-specific threshold of CA125 will support further preventive strategy development in population. TRIAL REGISTRATION NUMBER ChiCTR2100049520, 2021/8/2.
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Affiliation(s)
| | - Xueyao Su
- Chongqing Medical University, Chongqing, China
| | - Ke Chen
- Nanchong Central Hospital, North Sichuan Medical University, Nanchong, China
| | - Lijun Zhang
- Chongqing Medical University, Chongqing, China
| | - Wei Xu
- Chongqing Medical University, Chongqing, China
| | - Yang Pu
- Chongqing Medical University, Chongqing, China
| | - Fan Xu
- Nanchong Central Hospital, North Sichuan Medical University, Nanchong, China
| | - Ruoyan Gong
- Chongqing Medical University, Chongqing, China
| | | | - Yuxian Nie
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
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Trapé J, Fernández-Galán E, Auge JM, Carbonell-Prat M, Filella X, Miró-Cañís S, González-Fernández C. Factors influencing blood tumor marker concentrations in the absence of neoplasia. Tumour Biol 2024; 46:S35-S63. [PMID: 38517826 DOI: 10.3233/tub-220023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Tumor markers (TMs) are a heterogeneous group of molecules used in the diagnosis, prognosis and follow-up of cancer patients. During neoplastic differentiation, cells can either directly synthesize or induce the synthesis of TMs, and the release of these molecules into the bloodstream allows their quantification in biological fluids. Although very small concentrations of TMs are usually present in the serum or plasma of healthy subjects, increased concentrations may also be found in the presence of benign diseases or due to technical interference, producing false positive results. MATERIAL AND METHODS AND RESULTS Our review analyses the causes of false positives described between January 1970 to February 2023 for the TMs most frequently used in clinical practice: α-fetoprotein (AFP), β2-microglobulin (β2-M), cancer antigen 15-3 (CA 15-3), cancer antigen CA 19-9 (CA 19-9), cancer antigen CA 72-4 (CA 72-4), cancer antigen 125 (CA 125), carcinoembryonic antigen (CEA), chromogranin A (CgA), choriogonadotropin (hCG), cytokeratin 19 fragment (CYFRA 21-1), neuron-specific enolase (NSE), human epididymis protein 4 (HE4), serum HER2 (sHER2), squamous cell carcinoma antigen (SCCA), protein induced by vitamin K absence-II (PIVKA-II), Pro-gastrin-releasing peptide (Pro-GRP), prostate-specific antigen (PSA), Protein S-100 (S-100) and thyroglobulin (Tg). A total of 247 references were included. CONCLUSIONS A better understanding of pathophysiological processes and other conditions that affect the concentration of TMs might improve the interpretation of results and their clinical application.
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Affiliation(s)
- Jaume Trapé
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Tissue Repair and Regeneration Laboratory, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central, Barcelona, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
| | - Esther Fernández-Galán
- Department of Biochemistry and Molecular Genetics - Hospital Clinic de Barcelona, Barcelona, Spain
| | - Josep Maria Auge
- Department of Biochemistry and Molecular Genetics - Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Xavier Filella
- Department of Biochemistry and Molecular Genetics - Hospital Clinic de Barcelona, Barcelona, Spain
| | - Sílvia Miró-Cañís
- Laboratori d'Anàlisis Clíniques, CLILAB Diagnòstics, Vilafranca del Penedès, Spain
| | - Carolina González-Fernández
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
- Gastrointestinal Oncology, Endoscopy and Surgery Research Group, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central, Barcelona, Spain
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Arup G, Shravan N. Cancer and Pregnancy in the Post-Roe v. Wade Era: A Comprehensive Review. Curr Oncol 2023; 30:9448-9457. [PMID: 37999104 PMCID: PMC10669942 DOI: 10.3390/curroncol30110684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Cancer during pregnancy, affecting 1 in 1000 pregnancies, is rising in incidence due to delayed childbearing and improved detection. Common types include breast cancer, melanoma and cervical cancer and Hodgkin's Lymphoma. There are several physiological changes that occur during pregnancy that make its management a challenge to clinicians. Managing it requires multidisciplinary approaches and cautious test interpretation due to overlapping symptoms. To minimize fetal radiation exposure, non-ionizing imaging is preferred, and the interpretation of tumor markers is challenging due to inflammation and pregnancy effects. In terms of treatment, chemotherapy is avoided in the first trimester but may be considered later. Immunotherapy's safety is under investigation, and surgery depends on gestational age and cancer type. Ethical and legal concerns are growing, especially with changes in U.S. abortion laws. Access to abortion for medical reasons is vital for pregnant cancer patients needing urgent treatment. Maternal outcomes may depend on the type of cancer as well as chemotherapy received but, in general, they are similar to the non-pregnant population. Fetal outcomes are usually the same as the general population with treatment exposure from the second trimester onwards. Fertility preservation may be an important component of the treatment discussion depending on the patient's wishes, age and type of treatment. This article addresses the complicated nature of a diagnosis of cancer in pregnancy, touching upon the known medical literature as well as the ethical-legal implications of such a diagnosis, whose importance has increased in the light of recent judicial developments.
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Affiliation(s)
- Ganguly Arup
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Narmala Shravan
- Department of Hematology and Oncology, DHR Health Oncology Institute, Edinburg, TX 78539, USA;
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Eckel F, Carlin G, Mayer S, Polterauer S, Chalubinski K. Krukenberg Progression of Gastric Carcinoma in Pregnancy: Is Early Diagnosis Possible? Case Report and Review of the Literature. J Clin Med 2023; 12:5397. [PMID: 37629439 PMCID: PMC10455580 DOI: 10.3390/jcm12165397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Krukenberg tumors are metastatic tumors of the ovaries, associated with poor outcomes. Most commonly, these tumors are of gastric origin. The diagnosis of Krukenberg tumors in pregnant patients is extremely rare and poses specific difficulties for clinicians. We report a case of a pregnant woman presenting with an unknown abdominal tumor. Through the use of magnetic resonance imaging, multiple differential diagnoses were proposed, including a malignant ovarian tumor. A cesarean section and explorative laparotomy were conducted, revealing Krukenberg metastases of a gastric tumor, discovered during intraoperative gastroscopy. Tumor resection with concomitant chemotherapy was conducted. The main aim of this paper was to evaluate whether earlier diagnosis seems possible in such cases. A thorough literature review was conducted, unfortunately revealing no reliable method for early detection. Furthermore, no consensus regarding diagnostics or therapy exists to date. Thus, more research should be conducted regarding this rare condition to offer recommendations regarding early detection, diagnostics, and therapeutic approaches.
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Affiliation(s)
- Fanny Eckel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Greta Carlin
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Stefanie Mayer
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, 1090 Vienna, Austria
| | - Kinga Chalubinski
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
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7
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Xing N, Wang L, Sui X, Zhao C, Huang Y, Peng J. The Safety of Chemotherapy for Ovarian Malignancy during Pregnancy. J Clin Med 2022; 11:jcm11247520. [PMID: 36556136 PMCID: PMC9784446 DOI: 10.3390/jcm11247520] [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: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Data on epidemiologic features, treatments and outcomes in women diagnosed with ovarian malignancy during pregnancy are very sparse due to its low incidence. The goal of our study was to summarize the epidemiologic characteristics of pregnant women complicated with ovarian malignancy and investigate the safety and efficacy of chemotherapy during pregnancy. METHODS We retrospectively analyzed the clinicopathological data of eight patients suffering from ovarian malignancy during pregnancy in our institution from June 2011 to July 2021. Furthermore, a systematic literature search was conducted in PubMed up to 1 September 2021, which identified 92 cases with ovarian malignancy during pregnancy eligible for the analysis. Therefore, we collected the data of 100 pregnant patients complicated with ovarian malignancy, including clinical demographics, tumor characteristics, treatment interventions and outcomes. RESULTS In total, 100 pregnant patients complicated with ovarian malignancy were investigated and classified into three groups: 34 cases in the epithelial ovarian cancer (EOC) group, 38 cases in the germ cell tumors (GCTs) group and 28 cases in the sex cord-stromal tumors (SCSTs) group. The onset age of pregnant patients with epithelial ovarian cancer was significantly higher than that of other patients. Pelvic mass and abdominal pain were the common clinical presentations of pregnant patients with ovarian malignancy. For distinguishing epithelial ovarian cancer during pregnancy, the area under the curve (AUC) of CA-125 was 0.718 with an optimal cutoff value of 58.2 U/mL. Moreover, 53 patients underwent surgery during pregnancy, the majority of whom underwent unilateral adnexectomy in the second trimester. Furthermore, 43 patients received chemotherapy during pregnancy, and 28 delivered completely healthy newborns at birth; 13 neonates showed transient abnormalities without further complications; and 2 died during the neonatal period. CONCLUSIONS Our study reveals the safety of chemotherapy for ovarian malignancy during pregnancy. However, large-sample prospective studies are still needed to further explore the safety of chemotherapy in pregnant patients with malignancy to choose the appropriate chemotherapy regimen and achieve the maximum benefit for patients.
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Affiliation(s)
- Naidong Xing
- Department of Urology, Qilu Hospital of Shandong University, Jinan 250001, China
| | - Lihui Wang
- Gynecology Center, Qingdao Women and Children’s Hospital, Qingdao 266034, China
| | - Xinlei Sui
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250001, China
| | - Chunru Zhao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250001, China
| | - Yan Huang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250001, China
| | - Jin Peng
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250001, China
- Correspondence:
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Cathcart AM, Nezhat FR, Emerson J, Pejovic T, Nezhat CH, Nezhat CR. Adnexal masses during pregnancy: diagnosis, treatment, and prognosis. Am J Obstet Gynecol 2022:S0002-9378(22)02179-2. [PMID: 36410423 DOI: 10.1016/j.ajog.2022.11.1291] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
Adnexal masses are identified in pregnant patients at a rate of 2 to 20 in 1000, approximately 2 to 20 times more frequently than in the age-matched general population. The most common types of adnexal masses in pregnancy requiring surgical management are dermoid cysts (32%), endometriomas (15%), functional cysts (12%), serous cystadenomas (11%), and mucinous cystadenomas (8%). Approximately 2% of adnexal masses in pregnancy are malignant. Although most adnexal masses in pregnancy can be safely observed and approximately 70% spontaneously resolve, a minority of cases warrant surgical intervention because of symptoms, risk of torsion, or suspicion of malignancy. Ultrasound is the mainstay of evaluation of adnexal masses in pregnancy because of accuracy, safety, and availability. Several ultrasound mass scoring systems, including the Sassone, Lerner, International Ovarian Tumor Analysis Simple Rules, and International Ovarian Tumor Analysis Assessment of Different NEoplasias in the adneXa scoring systems have been validated specifically in pregnant populations. Decisions regarding expectant vs surgical management of adnexal masses in pregnancy must balance the risks of torsion or malignancy with the likelihood of spontaneous resolution and the risks of surgery. Laparoscopic surgery is preferred over open surgery when possible because of consistently demonstrated shorter hospital length of stay and less postoperative pain and some data demonstrating shorter operative time, lower blood loss, and lower risks of fetal loss, preterm birth, and low birthweight. The best practices for laparoscopic surgery during pregnancy include left lateral decubitus positioning after the first trimester of pregnancy, port placement with respect to uterine size and pathology location, insufflation pressure of less than 12 to 15 mm Hg, intraoperative maternal capnography, pre- and postoperative fetal heart rate and contraction monitoring, and appropriate mechanical and chemical thromboprophylaxes. Although planning surgery for the second trimester of pregnancy generally affords time for mass resolution while optimizing visualization with regards to uterine size and pathology location, necessary surgery should not be delayed because of gestational age. When performed at a facility with appropriate obstetrical, anesthetic, and neonatal support, adnexal surgery in pregnancy generally results in excellent outcomes for pregnant patients and fetuses.
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Affiliation(s)
- Ann M Cathcart
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Farr R Nezhat
- Weill Cornell Medical College, Cornell University, New York, NY; New York University Long Island School of Medicine, Mineola, NY.
| | - Jenna Emerson
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Gynecologic Oncology, Oregon Health & Science University, Portland, OR
| | - Tanja Pejovic
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Gynecologic Oncology, Oregon Health & Science University, Portland, OR
| | - Ceana H Nezhat
- Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA
| | - Camran R Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, CA; University of California San Francisco, San Francisco, CA; Stanford University Medical Center, Palo Alto, CA
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Gerasimova AA, Shevchenko Y, Klimenko PA, Asyrafyan LA. Comparative assessment of RMI-IV and RMI-V in preoperative prediction of ovarian tumor type in pregnant women. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2022. [DOI: 10.24075/brsmu.2022.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Prediction of ovarian tumor type in pregnant women is of great clinical significance, however, it is vastly difficult. In the last 5–10 years gynecologists were suggested to use RMI (Risk of Malignancy Index) in non-pregnant women, however the value of the test for obstetric practice has yet to be established. The study was aimed to determine RMI-IV and RMI-V during preoperative non-invasive prediction of ovarian tumor type in pregnant women. Retrospective and prospective clinical and laboratory data of 114 pregnant women aged 20–38 were collected. Among them 15 patients had malignant ovarian tumors (MOTs), 28 had borderline ovarian tumors (BOTs), and 71 had benign ovarian tumors. Color Doppler and pulsed wave Doppler ultrasound was performed. The levels of СА-125 were defined by enzyme immunoassay. Models IV, V were used to assess the risk of ovarian cancer. A moderate non-significant increase in blood levels of СА-125 compared to patients with benign ovarian tumors and BOTs was found in pregnant women with MOTs. Patients with BOTs and MOTs showed higher RMI-IV and RMI-V values compared to the group of pregnant women with benign ovarian tumors. Extreme values are required to guarantee the differences in the diagnosis of tumors (RMI-IV > 3500 indicate the presence of MOTs, the values below 100 indicate no malignancy). Similar RMI-V values are 1500 and 60. However, in most cases, availability of RMI-IV and RMI-V is insufficient for decision making, and a comprehensive approach has to be used. Thus, it is difficult to define ovarian mass type in pregnant women using RMI only. Comprehensive clinical assessment with the use of imaging methods is required for preoperative prediction of ovarian mass type in pregnant women, along with the use of prognostic models taking into account the majority of descriptive “morphological” tumor characteristics.
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Affiliation(s)
- AA Gerasimova
- Center of Family Planning and Reproduction of the Moscow Healthcare Department, Moscow, Russia
| | - YuV Shevchenko
- Center of Family Planning and Reproduction of the Moscow Healthcare Department, Moscow, Russia
| | - PA Klimenko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - LA Asyrafyan
- Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
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van Velsen EFS, Leung AM, Korevaar TIM. Diagnostic and Treatment Considerations for Thyroid Cancer in Women of Reproductive Age and the Perinatal Period. Endocrinol Metab Clin North Am 2022; 51:403-416. [PMID: 35662449 DOI: 10.1016/j.ecl.2021.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Thyroid cancer is one of the most common cancers diagnosed in women of reproductive age and during pregnancy. This leads to important questions about thyroid cancer prognosis and treatment, but also fertility and risk for adverse obstetric and/or fetal and neonatal outcomes. The benefits of thyroid cancer treatment should be weighed against its harms, as various options may adversely impact maternal and fetal health. In the current review, the authors focus on perinatal-specific clinical considerations related to the care of patients with thyroid cancer.
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Affiliation(s)
- Evert F S van Velsen
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Dr Molewaterplein 40, 3015 CE, Rotterdam, The Netherlands.
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, 100 Medical Plaza, Suite 310, Los Angeles, CA 90095, USA; Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (111D), Los Angeles, CA 90073, USA
| | - Tim I M Korevaar
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Dr Molewaterplein 40, 3015 CE, Rotterdam, The Netherlands
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Lee YS, Javan H, Reems JA, Li L, Lusty Beech J, Schaaf CI, Pierce J, Phillips JD, Selzman CH. Acellular human amniotic fluid protects the ischemic/reperfused rat myocardium. Am J Physiol Heart Circ Physiol 2022; 322:H406-H416. [DOI: 10.1152/ajpheart.00331.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Amniotic products are potent immunomodulators utilized clinically to repair tissue injury. Little information exists regarding the potential of cell-free human amniotic fluid (hAF) to treat cardiovascular disease. Herein, we sought to determine the influence and efficacy of acellular hAF on myocardial ischemia/reperfusion injury. Processed hAF was obtained from volunteer donors at the time of elective caesarean section and manufactured using proprietary methods. Left anterior descending coronary artery ligation was performed on rats for 60 minutes. Thirty minutes after release and reperfusion, either saline or hAF was injected intramyocardially. Serial echocardiography revealed that compared to saline injected rats, hAF animals maintained their ejection fraction and did not adversely remodel through the 4-week period. This preserved ventricular function correlated with decreased infarct size, less fibrosis, and reduced expression of cytokines and infiltrating inflammatory cells. Comparative arrays of different donor hAF lots confirmed the presence of a wide array of immunomodulatory and host-defense proteins. The observed functional cardioprotection was furthermore evident when given intravenously and across multiple hAF donors. In conclusion, our data demonstrate, for the first time, the cardioprotective effect of acellular hAF on myocardial injury. These observations spanned across diverse donors and likely result from the mixture of a plethora of naturally produced cytokines, chemokines, and immune-modulating proteins rather than a single, defined mechanistic culprit. The ubiquitous availability of hAF as a cell-free solution further suggests its potential for widespread adoption as a therapy for myocardial ischemia/reperfusion injury.
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Affiliation(s)
- Young Sook Lee
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Hadi Javan
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jo-Anna Reems
- Cell Therapy and Regenerative Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Ling Li
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jessica Lusty Beech
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Christine I. Schaaf
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jan Pierce
- Cell Therapy and Regenerative Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - John D. Phillips
- Cell Therapy and Regenerative Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Craig H. Selzman
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
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12
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Dow E, Freimund A, Smith K, Hicks RJ, Jurcevic P, Shackleton M, James PA, Fellowes A, Delatycki MB, Fawcett S, Flowers N, Pertile MD, McGillivray G, Mileshkin L. Cancer Diagnoses Following Abnormal Noninvasive Prenatal Testing: A Case Series, Literature Review, and Proposed Management Model. JCO Precis Oncol 2022; 5:1001-1012. [PMID: 34994626 DOI: 10.1200/po.20.00429] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Noninvasive prenatal testing (NIPT) is a screening test for fetal chromosomal aneuploidy using cell-free DNA derived from maternal blood. It has been rapidly accepted into obstetric practice because of its application from 10-weeks' gestation, and its high sensitivity and specificity. NIPT results can be influenced by several factors including placental or maternal mosaicism and co-twin demise; cell-free DNA from a maternal origin can also complicate interpretation, with evidence that NIPT can detect previously unsuspected malignancies. This study aimed to develop management guidelines for women with NIPT results suspicious of maternal malignancy. The Peter MacCallum Cancer Center's experience of seven cases where abnormal NIPT results led to investigation for maternal malignancy between 2016 and 2019 were reviewed, along with the published literature. Six of the seven women (86%) referred for investigation were diagnosed with advanced malignancies, including colorectal cancer, breast cancer, melanoma, and Hodgkin lymphoma. Based on our single-center experience, as well as the available literature, guidelines for the investigation of women with NIPT results suspicious of malignancy are proposed, including utilization of fluorodeoxyglucose positron emission tomography-computed tomography, which had a high concordance with other investigations and diagnoses. These guidelines include maternal and fetal investigations, as well as consideration of the complex medical, psychologic, social, and ethical needs of these patients and their families.
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Affiliation(s)
- Eryn Dow
- Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alison Freimund
- Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Kortnye Smith
- Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rodney J Hicks
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Jurcevic
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | - Mark Shackleton
- Department of Oncology, Alfred Health, Melbourne, Australia.,Department of Medicine, Monash University, Clayton, Australia
| | - Paul A James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Andrew Fellowes
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Service, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Susan Fawcett
- Clinical Genetics Service, Royal Women's Hospital, Parkville, Australia
| | - Nicola Flowers
- Victorian Clinical Genetics Service, Murdoch Children's Research Institute, Parkville, Australia
| | - Mark D Pertile
- Victorian Clinical Genetics Service, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - George McGillivray
- Victorian Clinical Genetics Service, Murdoch Children's Research Institute, Parkville, Australia.,Clinical Genetics Service, Royal Women's Hospital, Parkville, Australia
| | - Linda Mileshkin
- Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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13
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Zhou H, Alhaskawi A, Sun Q, Dong Y, Kota VG, Hasan Abdulla MHA, Ezzi SHA, Wang Z, Lu H. Desmoplastic Small Round Cell Tumor in a Pregnant Woman: A Case Report and Literature Review. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:613-622. [PMID: 34970100 PMCID: PMC8686780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Desmoplastic small round cell tumor (DSRCT) is an aggressive malignant tumor commonly found in young men; most occurs in the abdominal cavity. Here we conducted an in-depth analysis of a pregnant patient in our hospital and explored all the case information in the literature on small round cell carcinoma of women. Case presentation: A 27-year-old pregnant woman underwent tumor resection in our hospital at 29 weeks gestational age for a large progressive shoulder lump. The postoperative pathology showed that the mass was a DSRCT. Genetic testing found no fusion gene. At 36 weeks gestation, a painful mass was found in the breast and proved to be a metastatic focus of the desmoplastic small round cell tumor. Twenty days after a successful cesarean section at 40 weeks gestation, she received the VAC-IE chemotherapy regimen, successfully completed the first course, but when awaiting the next chemotherapy, unfortunately, the patient died during follow-up due to tumor recurrence and metastasis. Conclusion: The treatment of DSRCT in pregnant women requires a multidisciplinary consultation, and the treatment and examination during pregnancy are subject to many constraints, which may have a negative impact on the patient's prognosis. Also, a review of the literature found that there is still no standard treatment protocol for DSRCT, and its prognosis in female patients is independent of age and tissue origin.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, The First Affiliated
Hospital, Zhejiang University, Hangzhou, P. R. China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated
Hospital, Zhejiang University, Hangzhou, P. R. China
| | - Qingrong Sun
- Department of Basic Medicine, School of Basic Medicine
and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P. R.
China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated
Hospital, Zhejiang University, Hangzhou, P. R. China
| | | | | | | | - Zewei Wang
- Zhejiang University School of Medicine, Hangzhou, P. R.
China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated
Hospital, Zhejiang University, Hangzhou, P. R. China,To whom all correspondence should be addressed:
Hui Lu, MD, Department of Orthopedics, The First Affiliated Hospital, College of
Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P.R. China;
; ORCID iD:
https://orcid.org/0000-0002-2969-4400
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14
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Lee SJ, Kim YH, Lee MY, Ko HS, Oh SY, Seol HJ, Kim JW, Ahn KH, Na S, Seong WJ, Kim HS, Park CW, Park JS, Jun JK, Won HS, Kim MY, Hwang HS, Lee SM. Ultrasonographic evaluation of ovarian mass for predicting malignancy in pregnant women. Gynecol Oncol 2021; 163:385-391. [PMID: 34561098 DOI: 10.1016/j.ygyno.2021.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study is to compare ultrasonographic ovarian mass scoring systems in pregnant women. STUDY DESIGN This multicenter study included women with an ovarian mass during pregnancy who were evaluated using ultrasound and underwent surgery in 11 referral hospitals. The ovarian mass was evaluated and scored using three different scoring systems(International Ovarian Tumor Analysis Assessment of Different NEoplasias in the adnexa[IOTA ADNEX], Sassone, and Lerner). The final diagnosis was made histopathologically. Receiver operating characteristic(ROC) curves were generated for each scoring system. RESULTS During the study period, 236 pregnant women underwent surgery for an ovarian mass, including 223 women(94.5%) with a benign ovarian mass and 13 women(5.5%) with a malignant ovarian mass. Among 10 ultrasound image findings, six findings were different between benign and ovarian masses(maximal diameter of mass, maximal diameter of solid mass, wall thickness of mass, inner wall structure, thickness of septations, and papillarity). In all three scoring systems, the ovarian mass scores were significantly higher in malignant masses than in benign masses, with the highest area under the ROC curve(AUROC) in the Sassone scoring system(AUROC: 0.831 for Sassone, 0.710 for Lerner vs 0.709 for IOTA ADNEX; p < 0.05, between the Sassone and Lerner/ IOTA ADNEX). A combined model was developed with the six different ultrasound findings, and the AUROC of the combined model was 0.883(p = not significant between the combined model and Sassone). CONCLUSION In pregnant women, malignant ovarian tumors can be predicted with high accuracy using either the Sassone scoring system or the combined model.
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Affiliation(s)
- Se Jin Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Young-Han Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jong Woon Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sunghun Na
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Moon Young Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Han Sung Hwang
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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15
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Lannoo L, Lenaerts L, Van Den Bogaert K, Che H, Brison N, Devriendt K, Amant F, Vermeesch JR, Van Calsteren K. Non-invasive prenatal testing suggesting a maternal malignancy: What do we tell the prospective parents in Belgium? Prenat Diagn 2021; 41:1264-1272. [PMID: 34405430 DOI: 10.1002/pd.6031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 12/20/2022]
Abstract
Cancer is diagnosed in one in 1000 to 1500 pregnancies. Most frequently encountered malignancies during pregnancy are breast cancer, hematological cancer, cervical cancer and malignant melanoma. Maternal cancer is associated with an increased risk of IUGR and preterm labor, especially in patients with systemic disease or those receiving chemotherapy during pregnancy, requiring a high-risk obstetrical follow-up. Fetal aneuploidy screening by non-invasive prenatal testing (NIPT) can lead to the incidental identification of copy number alterations derived from non-fetal cell-free DNA (cfDNA), as seen in certain cases of maternal malignancy. The identification of tumor-derived cfDNA requires further clinical, biochemical, radiographic and histological investigations to confirm the diagnosis. In such cases, reliable risk estimation for fetal trisomy 21, 18 and 13 is impossible. Therefore, invasive testing should be offered when ultrasonographic screening reveals an increased risk for chromosomal anomalies, or when a more accurate test is desired. When the fetal karyotype is normal, long term implications for the fetus refer to the consequences of the maternal disease and treatment during pregnancy. This manuscript addresses parental questions when NIPT suggests a maternal malignancy. Based on current evidence and our own experience, a clinical management scheme in a multidisciplinary setting is proposed.
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Affiliation(s)
- Lore Lannoo
- Department of Development and Regeneration, Division Woman and Child, Clinical Department Obstetrics and Gynaecology, University Hospital Leuven, KULeuven, Leuven, Belgium
| | | | | | - Huiwen Che
- Department of Human Genetics, KULeuven, Leuven, Belgium
| | | | | | - Frédéric Amant
- Department of Gynaecological Oncology, KULeuven, Leuven, Belgium.,Center for Gynecological Oncology Amsterdam, Academic Medical Centre Amsterdam, University of Amsterdam, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | - Kristel Van Calsteren
- Department of Development and Regeneration, Division Woman and Child, Clinical Department Obstetrics and Gynaecology, University Hospital Leuven, KULeuven, Leuven, Belgium
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16
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Hakoun AM, AbouAl-Shaar I, Zaza KJ, Abou-Al-Shaar H, A Salloum MN. Adnexal masses in pregnancy: An updated review. Avicenna J Med 2021; 7:153-157. [PMID: 29119081 PMCID: PMC5655645 DOI: 10.4103/ajm.ajm_22_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Adnexal masses in pregnancy are not commonly encountered. The majority of these masses are discovered incidentally during routine follow-up. However, some of these masses become symptomatic due to their size, location, and impingement of adjacent structures. Several diagnostic modalities can be utilized for the detection of adnexal masses with different sensitivity and specificity rates. The differential diagnosis of adnexal masses discovered during pregnancy is broad and includes both benign and malignant lesions. The management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. Tumor size, site, and the trimester of mass detection are all crucial in management. In this account, we review adnexal masses discovered in pregnancy, the diagnostic modalities utilized for detecting these lesions, their differential diagnosis, and management strategies.
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Affiliation(s)
| | - Iyad AbouAl-Shaar
- School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled J Zaza
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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17
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Abstract
Importance Adnexal masses are identified in approximately 0.05% to 2.4% of pregnancies, and more recent data note a higher incidence due to widespread use of antenatal ultrasound. Whereas most adnexal masses are benign, approximately 1% to 6% are malignant. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians. Objective The aim of this study was to review imaging modalities for evaluating adnexal masses in pregnancy and imaging characteristics that differentiate benign and malignant masses, examine various types of adnexal masses, and understand complications of and explore management options for adnexal masses in pregnancy. Evidence Acquisition This was a literature review using primarily PubMed and Google Scholar. Results Ultrasound can distinguish between simple-appearing benign ovarian cysts and masses with more complex features that can be associated with malignancy. Radiologic information can help guide physicians toward recommending conservative management with observation or surgical removal during pregnancy to facilitate diagnosis and treatment. The risks of expectant management of an adnexal mass during pregnancy include rupture, torsion, need for emergent surgery, labor obstruction, and progression of malignancy. Historically, surgical removal was performed more routinely to avoid such complications in pregnancy; however, increasing knowledge has directed management toward conservative measures for benign masses. Surgical removal of adnexal masses is increasingly performed via minimally invasive techniques including laparoscopy and robotic surgery due to a decreased risk of surgical complications compared with laparotomy. Conclusions and Relevance Adnexal masses are increasingly identified in pregnancy because of the use of antenatal ultrasound. Clear and specific guidelines exist to help differentiate between benign and malignant masses. This is important for management as benign masses can usually be conservatively managed, whereas malignant masses require excision for diagnosis and treatment. A multidisciplinary approach, including referral to gynecologic oncology, should be used for masses with complex features associated with malignancy. Proper diagnosis and management of adnexal masses in pregnancy are an important skill for obstetricians.
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18
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Liu X, Wang K, Cao B, Shen L, Ke X, Cui D, Zhong C, Li W. Multifunctional Nano-Sunflowers with Color-Magnetic-Raman Properties for Multimodal Lateral Flow Immunoassay. Anal Chem 2021; 93:3626-3634. [DOI: 10.1021/acs.analchem.0c05354] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Xinyi Liu
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, People’s Republic of China
| | - Kan Wang
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Engineering Research Center for Intelligent Diagnosis and Treatment Instrument, Key Laboratory of Thin Film and Microfabrication (Ministry of Education), Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, People’s Republic of China
| | - Bo Cao
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Engineering Research Center for Intelligent Diagnosis and Treatment Instrument, Key Laboratory of Thin Film and Microfabrication (Ministry of Education), Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, People’s Republic of China
| | - Lisong Shen
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai 200092, People’s Republic of China
| | - Xing Ke
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai 200092, People’s Republic of China
| | - Daxiang Cui
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Engineering Research Center for Intelligent Diagnosis and Treatment Instrument, Key Laboratory of Thin Film and Microfabrication (Ministry of Education), Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, People’s Republic of China
| | - Chunmei Zhong
- Zhejiang Orient Gene Biotech Co., Ltd., 3787 East Yangguang Avenue, Anji 313300 Zhejiang, People’s Republic of China
| | - Wanwan Li
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, People’s Republic of China
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19
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Mor A, Gardezi M, Jubanyik K, Simsek B, Seifer DB, Patrizio P, Esencan E, Imamoglu G, Zhang M, Nichols-Burns SM, Taylor HS. Miscarriage determination in first trimester based on alpha-fetoprotein extracted from sanitary pads. Fertil Steril 2021; 116:462-469. [PMID: 33461753 DOI: 10.1016/j.fertnstert.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/21/2020] [Accepted: 10/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine if high alpha-fetoprotein (AFP) level in vaginal blood collected on a sanitary pad can assist with detecting an active miscarriage. DESIGN A prospective cohort study. SETTING Academic medical center. PATIENT(S) Five groups were evaluated: women with active miscarriage, pregnancy of unknown location, completed miscarriage or extrauterine pregnancy (EUP), ongoing pregnancy, and undergoing elective dilation and curettage (D&C). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) For each patient, AFP level in the vaginal blood collected on a sanitary pad was quantified. RESULT(S) The vaginal blood AFP median levels (and their ranges) were 3.7 IU/mL (0.5-739.2) and 4,542 IU/mL (15.6-100,000) in the active miscarriage (n = 16) and the elective D&C (n = 24) groups, respectively. Alpha-fetoprotein was detected in all elective D&C and active miscarriage cases except in 1 case. In the ongoing pregnancy group (n = 35), only 2 of 35 specimens showed detectable AFP levels. In the pregnancy of unknown location (n = 12) and the completed miscarriage or EUP (n = 10) groups, no AFP was detected. Receiver operating characteristic analysis demonstrated 93.7% sensitivity and 97.8% specificity for the detection of an active miscarriage (cutoff 0.61 IU/mL; area under the curve 0.96). CONCLUSION(S) Alpha-fetoprotein can be extracted from vaginal blood collected on sanitary pads. A high level of vaginal AFP can assist with the same-day detection of an active miscarriage. This novel test is useful in differentiating active miscarriages from ongoing pregnancies, completed miscarriages, and EUPs and, therefore, it reduces uncertainty, anxiety level, and number of repeat office visits.
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Affiliation(s)
- Amir Mor
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Mursal Gardezi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Karen Jubanyik
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Burcin Simsek
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David B Seifer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Pasquale Patrizio
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Ecem Esencan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Gizem Imamoglu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Man Zhang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Stephanie M Nichols-Burns
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Hugh S Taylor
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
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20
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Franciszek Dłuski D, Mierzyński R, Poniedziałek-Czajkowska E, Leszczyńska-Gorzelak B. Ovarian Cancer and Pregnancy-A Current Problem in Perinatal Medicine: A Comprehensive Review. Cancers (Basel) 2020; 12:E3795. [PMID: 33339178 PMCID: PMC7765590 DOI: 10.3390/cancers12123795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022] Open
Abstract
The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15-5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to discuss the problem of ovarian cancer complicating pregnancy and the current recommendations for diagnostics and treatment, with an emphasis on the risk to the fetus. A detailed analysis of the literature found in the PubMed and MEDLINE databases using the keywords "ovarian cancer", "ovarian malignancy", "adnexal masses", "ovarian tumor" and "pregnancy" was performed. There were no studies on a large series of pregnant women treated for ovarian malignancies and the management has not been well established. The diagnostics and therapeutic procedures need to be individualized with respect to the histopathology of the tumor, its progression, the gestational age at the time of diagnosis and the mother's decisions regarding pregnancy preservation. The multidisciplinary cooperation of specialists in perinatal medicine, gynecological oncology, chemotherapy, neonatology and psychology seems crucial in order to obtain the best possible maternal and neonatal outcomes.
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Affiliation(s)
- Dominik Franciszek Dłuski
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-954 Lublin, Lubelskie Region, Poland; (R.M.); (E.P.-C.); (B.L.-G.)
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21
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Liang X, Miao X, Xiao W, Ye Q, Wang S, Lin J, Li C, Huang Z. Filter-Membrane-Based Ultrafiltration Coupled with Surface-Enhanced Raman Spectroscopy for Potential Differentiation of Benign and Malignant Thyroid Tumors from Blood Plasma. Int J Nanomedicine 2020; 15:2303-2314. [PMID: 32280222 PMCID: PMC7132009 DOI: 10.2147/ijn.s233663] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/01/2020] [Indexed: 12/24/2022] Open
Abstract
Objective The objective of this study is to evaluate the performance and feasibility of surface-enhanced Raman spectroscopy coupled with a filter membrane and advanced multivariate data analysis on identifying and differentiating benign and malignant thyroid tumors from blood plasma. Patients and Methods We proposed a membrane filter SERS technology for the differentiation between benign thyroid tumor and thyroid cancer. That is to say, by using filter membranes with optimal pore size, the blood plasma samples from thyroid tumor patients were pretreated with the macromolecular proteins being filtered out prior to SERS measurement. The SERS spectra of blood plasma ultrafiltrate obtained using filter membranes from 102 patients with thyroid tumors (70 thyroid cancers and 32 benign thyroid tumors) were then analyzed and compared. Two multivariate statistical analyses, principal component analysis-linear discriminate analysis (PCA-LDA) and Lasso-partial least squares-discriminant analysis (Lasso-PLS-DA), were performed on the SERS spectral data after background subtraction and normalization, as well as the first derivative processing, to analyze and compare the differential diagnosis of benign thyroid tumors and thyroid cancer. Results SERS measurements were performed in blood plasma acquired from a total of 102 thyroid tumor patients (benign thyroid tumor N=32; thyroid cancer N=70). By using filter membranes, the macromolecular proteins in blood plasma were effectively filtered out to yield high-quality SERS spectra. 84.3% discrimination accuracy between benign and malignant thyroid tumor was achieved using PCA-LDA method, while Lasso-PLS-DA yields a discrimination accuracy of 90.2%. Conclusion Our results demonstrate that SERS spectroscopy, coupled with ultrafiltration and multivariate analysis has the potential of providing a non-invasive, rapid, and objective detection and differentiation of benign and malignant thyroid tumors.
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Affiliation(s)
- Xiaozhou Liang
- Fujian Normal University, Ministry of Education, Key Laboratory of Optoelectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory for Photonics Technology, Fuzhou, People's Republic of China
| | - Xuchao Miao
- Fujian Normal University, Ministry of Education, Key Laboratory of Optoelectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory for Photonics Technology, Fuzhou, People's Republic of China
| | - Weijin Xiao
- Department of Pathology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, People's Republic of China
| | - Qin Ye
- Department of Head and Neck Surgery, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, People's Republic of China
| | - Sisi Wang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Juqiang Lin
- Fujian Normal University, Ministry of Education, Key Laboratory of Optoelectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory for Photonics Technology, Fuzhou, People's Republic of China
| | - Chao Li
- Department of Pathology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, People's Republic of China.,Department of Pathology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, People's Republic of China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, People's Republic of China
| | - Zufang Huang
- Fujian Normal University, Ministry of Education, Key Laboratory of Optoelectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory for Photonics Technology, Fuzhou, People's Republic of China
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Delić R, Štefanović M, Krivec Š, Weber V, Koren J. HE4 levels in uncomplicated pregnancies: are there any differences? J Matern Fetal Neonatal Med 2020; 35:610-612. [PMID: 32054362 DOI: 10.1080/14767058.2020.1727434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: The aim of our study was to evaluate HE4 serum concentrations throughout uncomplicated pregnancies in the absence of adnexal masses.Methods: In a retrospectively designed, monocentric study (Department of Gynecology and Obstetrics, General Hospital Celje, Celje, Slovenia, EU), 229 women with uncomplicated pregnancies were included. HE4 levels were obtained and analyzed with regard to gestational age of pregnancy.Results: While having all HE4 levels within reference range, differences in mean concentrations between study groups were found be statistically significant (Group I, n = 22, <20 weeks of pregnancy, mean = 42.2 pmol/L; Group II, n = 40, pregnancies between 20-34 weeks of pregnancy, mean = 43.6 pmol/L; Group III, n = 167, ≥34 weeks of pregnancy, mean = 57.5 pmol/L, p < .001).Conclusion: Our findings confirmed that HE4 levels in uncomplicated pregnancies are within reference range provided by manufacturer, however its serum concentration rises significantly in third trimester. The HE4 cutoff value (<140 pmol/L) used for nonpregnant women can be helpful in the evaluation of adnexal masses in pregnancy.
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Affiliation(s)
- Ratko Delić
- Department of Gynecology and Obstetrics, General Hospital Celje, Celje, Slovenia
| | - Mario Štefanović
- Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Štefka Krivec
- Department of Laboratory Medicine, General Hospital Celje, Celje, Slovenia
| | - Vladimir Weber
- Department of Gynecology and Obstetrics, General Hospital Celje, Celje, Slovenia
| | - Jakob Koren
- Department of Gynecology and Obstetrics, General Hospital Celje, Celje, Slovenia
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[Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Pregnancy]. ACTA ACUST UNITED AC 2020; 48:322-329. [PMID: 32004783 DOI: 10.1016/j.gofs.2020.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the place of imaging, tumour markers, type of treatment and surgical route, follow-up, delivery mode, and re-staging in case of BOT during pregnancy, in order to provide guidelines. METHOD A systematic bibliographical analysis on BOT during pregnancy was performed through a PUDMED search on articles published from 1990 to 2019 using keywords « borderline ovarian tumour and pregnancy ». RESULTS Pelvic ultrasound is the gold standard and first-line examination for the detection and characterization of adnexal masses during pregnancy (grade C). Pelvic MRI is recommended from 12 gestational weeks in case of indeterminate adnexal masses and should be concluded by a diagnostic score (grade C). Gadolinium injection should be minimized because of proven risk to the fetus and should be discussed on a case-by-case basis after patient information (grade C). In the absence of data in the literature, it is not possible to recommend the use of any tumour marker for the diagnosis of BOT during pregnancy. In case of a surgical treatment of BOT during pregnancy, there is insufficient evidence to recommend either a cystectomy or an oophorectomy. For BOT, the laparoscopic approach should be preferred during pregnancy if it is feasible (grade C). Surgical route and type of surgery should be chosen after taking into account the tumour size, the obstetrical term, and the subsequent desire for pregnancy, following discussion in a multidisciplinary meeting. In the absence of sufficient data in the literature, it is not possible to make any recommendation on the follow-up of a BOT suspected during pregnancy. There is not enough evidence in the literature to change obstetrical management for delivery in patients with BOT. In case of incomplete staging of a BOT treated during pregnancy, restaging can be discussed as for non-pregnant patients (grade C). CONCLUSION The diagnosis of BOT occurring during pregnancy remains rare despite systematic screening of adnexal masses in the first trimester of pregnancy and an increasing maternal age. There is limited data in the literature concerning the management of BOT during pregnancy. All decisions must be taken after discussion in a multidisciplinary meeting.
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Pregnancy-associated digestive cancer – diagnosis and management. GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.30.4.2020.3940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Akbaş M, Koyuncu FM, Artunç Ülkümen B, Taneli F, Özdemir H. Can maternal urinary and serum carbohydrate antigen 19-9 concentrations be utilized in the diagnosis of fetal hydronephrosis? J Turk Ger Gynecol Assoc 2019; 21:41-45. [PMID: 31564081 PMCID: PMC7075403 DOI: 10.4274/jtgga.galenos.2019.2019.0101] [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: 12/01/2022] Open
Abstract
Objective: Fetal hydronephrosis (FH) is the most common fetal renal pathology encountered in daily obstetric practice. Urinary and serum carbohydrate antigen 19-9 (CA 19-9) concentrations are elevated in obstructive renal pathologies. Our aim was to assess maternal urinary and serum CA 19-9 concentrations in pregnancies with FH and compare results with controls. Material and Methods: Twenty pregnancies with severe FH, 20 pregnancies with mild-moderate FH, and 20 healthy singleton pregnancies were included in this descriptive, case-control study. The diagnosis and classification of FH was based on the anterioposterior diameter of fetal renal pelvis. Maternal urinary and serum CA 19-9 concentrations were measured and compared between groups. Results: Severe FH cases had significantly higher maternal urinary CA 19-9 concentrations compared to controls (median: 75 vs 24 U/mL; respectively; p=0.014). Concentrations of CA 19-9 did not differ between the mild-moderate FH group and control group. No statistically significant difference was found between the groups with respect to maternal serum CA 19-9 concentrations. Conclusion: Our results show that maternal urinary CA 19-9 concentration is significantly higher in pregnancies with severe FH. However, no difference was detected in serum CA 19-9 concentrations between pregnancies with severe FH, mild-moderate FH and controls. If the mechanisms of transplacental passage and maternal urinary excretion are clarified, maternal urinary CA 19-9 may be a potential marker for indicating fetal kidney damage.
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Affiliation(s)
- Murat Akbaş
- Department of Obstetrics and Gynecology, Division of Perinatology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Faik Mümtaz Koyuncu
- Department of Obstetrics and Gynecology, Division of Perinatology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Burcu Artunç Ülkümen
- Department of Obstetrics and Gynecology, Division of Perinatology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Fatma Taneli
- Department of Medical Biochemistry, Manisa Celal Bayar University, Manisa, Turkey
| | - Habib Özdemir
- Department of Medical Biochemistry, Manisa Celal Bayar University, Manisa, Turkey
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Adeku MA, Adegbola O, Ajayi GO. The predictive value of serum cancer antigen 125 (CA125) levels on pregnancy outcome in threatened miscarriages. J Perinat Med 2019; 47:704-709. [PMID: 31421046 DOI: 10.1515/jpm-2019-0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/21/2019] [Indexed: 11/15/2022]
Abstract
Background Spontaneous miscarriages are common pregnancy complications which result in psychological and emotional burden in the affected women. It is therefore necessary to identify biomarkers that can predict pregnancy outcome in women with threatened miscarriages so as to assist in their counselling and management. Methods The study compared levels of maternal serum CA125 in 65 pregnancies with threatened miscarriages (study group) with 65 normal intrauterine pregnancies (control group) between 6 weeks and 19 weeks + 6 days gestation using an enzyme linked immunosorbent assay (ELISA) technique. Results The mean age of the study and control groups were 29.5 ± 0.14 years and 30.1 ± 0.14 years, respectively. The mean serum CA125 in the study group was 30.1 ± 1.1 IU/mL while that of the control group was 22.9 ± 1.2 IU/mL and this was statistically significant (P = 0.0001). The mean serum CA125 level in the women whose pregnancies were aborted (aborters) was 34.8 ± 1.4 IU/mL while the mean value among those whose pregnancies continued till term (non-aborters) was 27.3 ± 1.2 IU/mL. This was statistically significant (P = 0.001). Further analysis using CA125 ≥36.2 IU/mL (mean value of serum CA125 among aborters + 1 standard deviation) as a threshold for intrauterine pregnancies that eventually got aborted showed a sensitivity of 66.7%, specificity of 83.3%, positive predictive value of 55.6%, negative predictive value of 88.9% and the diagnostic effectiveness (accuracy) was 79.4%. Conclusion The measurement of serum CA125 is a useful predictor of pregnancy outcome in threatened miscarriages.
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Affiliation(s)
- Mosunmola A Adeku
- Department of Obstetrics and Gynaecology, State Hospital, Ota, Ogun State, Nigeria
| | - Omololu Adegbola
- Department of Obstetrics and Gynaecology, State Hospital, Ota, Ogun State, Nigeria
| | - Godwin O Ajayi
- Prenatal Diagnosis and Therapy Centre, Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos State, Nigeria
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Ziruma A, Hukuimwe M, Nyakura M, Majangara R, Venge M. A rare case of Meigs syndrome in pregnancy. Pan Afr Med J 2019; 33:36. [PMID: 31384351 PMCID: PMC6658162 DOI: 10.11604/pamj.2019.33.36.18653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/30/2019] [Indexed: 11/11/2022] Open
Abstract
We present a case of Meigs syndrome in a 19 year old woman. We suspected metastatic ovarian cancer after she had presented in her first pregnancy at 12 weeks gestation. Ultrasound scan had confirmed a complex solid mass in the left adnexa, measuring 7cm x 8cm, a viable 12 weeks pregnancy and gross ascites. She had elevated Ca 125 and serum beta - HCG. She went on to have a spontaneous miscarriage while being worked up for exploratory laparotomy. At laparotomy, a left sided solid ovarian mass 8cm x 10cm with a smooth surface and intact capsule was found. This was later confirmed to be a fibrothecoma at histology. The patient went on to recover without any further reaccumulation of ascites.
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Affiliation(s)
- Asaph Ziruma
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Misai Hukuimwe
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Michael Nyakura
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Rumbidzai Majangara
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Mervyn Venge
- Department of Obstetrics and Gynaecology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
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Uslu B, Dogan S, Özdem S, Şimşek T. Serum concentrations of HE4 and Ca125 in uncomplicated pregnancies: a longitudinal study. J OBSTET GYNAECOL 2019; 40:70-76. [DOI: 10.1080/01443615.2019.1603212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Bilge Uslu
- Department of Obstetrics and Gynecology, Antalya Atatürk State Hospital, Antalya, Turkey
| | - Selen Dogan
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Sebahat Özdem
- Department of Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Tayup Şimşek
- Gynecologic Oncology, Akdeniz University, Antalya, Turkey
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Kocián P, de Haan J, Cardonick EH, Uzan C, Lok CAR, Fruscio R, Halaska MJ, Amant F. Management and outcome of colorectal cancer during pregnancy: report of 41 cases. Acta Chir Belg 2019; 119:166-175. [PMID: 30010511 DOI: 10.1080/00015458.2018.1493821] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer in pregnancy is rare, with an incidence of 0.8 per 100,000 pregnancies. Advanced disease (stage III or IV) is diagnosed more frequently in pregnant patients. We aimed to review all cases of colorectal cancer in pregnancy from the International Network on Cancer, Infertility and Pregnancy database in order to learn more about this rare disease and improve its management. METHODS Data on the demographic features, symptoms, histopathology, diagnostic and therapeutic interventions and outcomes (obstetric, neonatal and maternal) were analysed. RESULTS Twenty-seven colon and 14 rectal cancer cases were identified. Advanced disease was present in 30 patients (73.2%). During pregnancy, 21 patients (51.2%) received surgery and 12 patients (29.3%) received chemotherapy. Thirty-three patients (80.5%) delivered live babies: 21 by caesarean section and 12 vaginally. Prematurity rate was high (78.8%). Eight babies were small for gestational age (27.6%). Three patients (10.7%) developed recurrence of disease. Overall 2-year survival was 64.4%. CONCLUSION Despite a more frequent presentation with advanced disease, colorectal cancer has a similar prognosis in pregnancy when compared with the general population. Diagnostic interventions and treatment should not be delayed due to the pregnancy but a balance between maternal and foetal wellbeing must always be kept in mind.
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Affiliation(s)
- P. Kocián
- Department of Surgery, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - J. de Haan
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, Netherlands
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - E. H. Cardonick
- Department of Obstetrics and Gynaecology, Division Maternal Fetal Medicine, Cooper Medical School at Rowan University, Camden, United States of America
| | - C. Uzan
- Department of Gynaecological Surgery, Institute Gustave Roussy, Villejuif, France
- Department of Gynaecology and Breast Surgery, Pitié Salpêtrière Hospital, Institut Universitaire de Cancérologie, Sorbonne University, Paris, France
| | - C. A. R. Lok
- Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
| | - R. Fruscio
- Division of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - M. J. Halaska
- Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - F. Amant
- Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
- Division of Gynaecologic Oncology, University Hospitals Leuven, Leuven, Belgium
- Centre for Gynaecologic Oncology Amsterdam, Academic Medical Centre, Amsterdam, Netherlands
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Hepner A, Negrini D, Hase EA, Exman P, Testa L, Trinconi AF, Filassi JR, Francisco RPV, Zugaib M, O'Connor TL, Martin MG. Cancer During Pregnancy: The Oncologist Overview. World J Oncol 2019; 10:28-34. [PMID: 30834049 PMCID: PMC6396773 DOI: 10.14740/wjon1177] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/31/2018] [Indexed: 01/11/2023] Open
Abstract
Although a rare and challenging condition, cancer during pregnancy should promptly be identified and treated. Not only standards of care guidelines for the underlying disease are taken into account, but also fetal safety might be weighted for clinical decisions. Frequent lack of experience and knowledge about this condition could lead to late diagnosis, imprecise management, suboptimal treatment and fetal and maternal harm. Therefore, this review aims to summarize the current evidence regarding the epidemiology, clinical presentation, diagnostic workup, staging and treatment, including novel treatment modalities for patients diagnosed with cancer during pregnancy.
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Affiliation(s)
- Adriana Hepner
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Negrini
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eliane Azeka Hase
- Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Pedro Exman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura Testa
- Medical Oncology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Angela F Trinconi
- Mastology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jose Roberto Filassi
- Mastology Service, Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Tracey L O'Connor
- Department of Medicine, Roswell Park Comprehensive Cancer Center, The Jacobs School of Medicine, University of Buffalo, Buffalo, NY, USA
| | - Michael Gary Martin
- Division of Hematology and Oncology, University of Tennessee Health Science Center/West Cancer Center, Memphis, TN, USA
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Balashova EE, Lokhov PG, Ponomarenko EA, Markin SS, Lisitsa AV, Archakov AI. Metabolomic diagnostics and human digital image. Per Med 2019; 16:133-144. [PMID: 30767631 DOI: 10.2217/pme-2018-0066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The existing clinical laboratory practice has limitations in terms of specificity and sensitivity of diagnosis, making the introduction of new methods in medicine more topical. Application of 'omics' technologies, especially metabolomics, allows overcoming these limitations. The composition of blood metabolites reflects the physical state of an organism at the molecular level. The analysis of blood metabolome can serve as effective means of diagnosis, implementation of which in healthcare is timely and relevant. This paper demonstrates the versatility of metabolomic diagnostics, its applicability to various diseases. We discussed the standard of human digital image, which includes the metabolomic data sufficient to make an accurate assessment of general health and carry out precision diagnostics of a wide range of diseases.
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Affiliation(s)
- Elena E Balashova
- Department of Proteomics & Mass Spectrometry, Institute of Biomedical Chemistry, Pogodinskaya st 10, 119121, Moscow, Russia
| | - Petr G Lokhov
- Department of Proteomics & Mass Spectrometry, Institute of Biomedical Chemistry, Pogodinskaya st 10, 119121, Moscow, Russia
| | - Elena A Ponomarenko
- Department of Proteomics & Mass Spectrometry, Institute of Biomedical Chemistry, Pogodinskaya st 10, 119121, Moscow, Russia.,PostGenTech LLC, Pogodinskaya st 10, 119121, Moscow, Russia
| | - Sergey S Markin
- Department of Proteomics & Mass Spectrometry, Institute of Biomedical Chemistry, Pogodinskaya st 10, 119121, Moscow, Russia
| | - Andrey V Lisitsa
- Department of Proteomics & Mass Spectrometry, Institute of Biomedical Chemistry, Pogodinskaya st 10, 119121, Moscow, Russia
| | - Alexander I Archakov
- Department of Proteomics & Mass Spectrometry, Institute of Biomedical Chemistry, Pogodinskaya st 10, 119121, Moscow, Russia
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Mor A, Tal R, Haberman S, Kalgi B, Nasab SH, Minkoff H. Same-day confirmation of intrauterine pregnancy failure in women with first- and early second-trimester bleeding. Fertil Steril 2019; 109:1060-1064. [PMID: 29935643 DOI: 10.1016/j.fertnstert.2018.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/02/2018] [Accepted: 02/02/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine if alpha-fetoprotein (AFP) concentration in vaginal blood, in the setting of dissolved fetal tissue, is significantly higher than its concentration in the maternal serum. DESIGN A prospective cohort study. SETTING Medical center. PATIENT(S) Four groups of women were evaluated: 1) with missed/incomplete miscarriage with vaginal bleeding; 2) with threatened miscarriage; 3) with vaginal bleeding during cerclage placement; and 4) undergoing dilation and curettage (D&C). INTERVENTIONS(S) None. MAIN OUTCOME MEASURE(S) In each patient, AFP concentration in the vaginal blood or in the liquid component of the evacuated products of conception (POC; D&C group) was compared with the AFP concentration in the maternal serum. RESULT(S) The median (range) concentration ratios of AFP in vaginal blood (or POC) to AFP in maternal serum were 24.5 (5.1-8,620) and 957 (4.6-24,216) for the missed/incomplete (n = 30) and the D&C (n = 22) groups, respectively, whereas they were only 1.2 (0.4-13.4) and 1.01 (0.7-1.5) for the threatened miscarriage (n = 15) and cerclage (n = 9) groups, respectively. Receiver operating characteristic (ROC) analysis demonstrated 100% sensitivity and 86.7% specificity for the detection of the passage of fetal tissue (ratio 4.3, area under the ROC curve 0.96). CONCLUSION(S) Higher concentrations of AFP in vaginal blood than in maternal serum may indicate the presence of dissolved fetal tissue (i.e., confirming a failed pregnancy).
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Affiliation(s)
- Amir Mor
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Reshef Tal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Shoshana Haberman
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Bharati Kalgi
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Susan Hosseini Nasab
- Department of Obstetrics and Gynecology, University of Texas Health Science Center, Houston, Texas
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
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Zhang M, Zhang Y, Fu J, Zhang L. Serum CA125 levels are decreased in rectal cancer but increased in fibrosis-associated diseases and in most types of cancers. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 162:241-252. [DOI: 10.1016/bs.pmbts.2018.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
The incidence of cancer in pregnancy is increasing. The most frequent malignancies include breast and cervical cancers. Diagnosis may be complicated by late presentation. Imaging during pregnancy should consider risks to the fetus. Diagnostic work-up, including tumor markers, can be influenced by the physiology of pregnancy. Treatment of cancer can often be safely administered with good maternal and fetal outcomes. Chemotherapy, radiotherapy, and surgery must be adapted to the pregnancy state. Counselling and emotional support are an essential part of management.
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Affiliation(s)
- Matthys H Botha
- Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, Stellenbosch, South Africa
| | - Shalini Rajaram
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Wang Z, Zhou F, Xiao X, Ying C. Serum levels of human epididymis protein 4 are more stable than cancer antigen 125 in early and mid-term pregnancy. J Obstet Gynaecol Res 2018; 44:2053-2058. [PMID: 30125422 DOI: 10.1111/jog.13764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/29/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Zhiheng Wang
- Clinical Laboratory; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Fangfang Zhou
- Department of Nephrology; Ruijin Hospital of Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Xirong Xiao
- Department of Obstetrics; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Chunmei Ying
- Clinical Laboratory; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
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A Review of the Management of Loss of Pregnancy in the Emergency Department. J Emerg Nurs 2018; 44:146-155. [DOI: 10.1016/j.jen.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 10/29/2017] [Accepted: 11/04/2017] [Indexed: 12/30/2022]
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Liang G, Fang X, Lin X, Feng X, Lu H, Wan Y, Gu Z. Cross-reactivity between MUC1 antigen and MCA: false elevation of serum CA 15-3 level in pregnant and lactating women by Ma695-Ma552-based assay. Breast Cancer Res Treat 2018; 169:341-347. [PMID: 29396666 DOI: 10.1007/s10549-018-4700-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Cancer antigen 153 (CA 15-3) is one of the most commonly used biomarkers of breast cancer. However, elevated CA 15-3 is reported in pregnant and lactating women more frequently on Beckman DxI 800 immunoassay system (Ma695-Ma552 antibody pair) than on Abbott ARCHITECT system (115D8-DF3 antibody pair) in laboratory methodological evaluation. We conducted this study in order to figure out the reason behind this phenomenon. METHODS Serum CA 15-3 concentration was analyzed in 426 subjects, including 180 patients with breast cancer, 121 patients with benign breast disease, and 125 healthy volunteers (45 pregnant and 80 non-pregnant women). CA 15-3 assay was further validated using another cohort of 112 pregnant or postpartum women. Immunological cross reaction was analyzed by Western blotting and immunoprecipitation. RESULTS The serum CA 15-3 level was abnormally higher in almost 95% of the pregnant and lactating women detected using Ma695-Ma552 antibody pair (median: 71.4 U/mL) than that detected using 115D8-DF3 antibody pair (median: 16.5 U/mL). Western blotting and immunoprecipitation indicated that such a significant difference was mainly due to the cross reaction between monoclonal antibody Ma552 and mucin-like carcinoma-associated antigen (MCA). CONCLUSIONS The CA 15-3 assay using 115D8-DF3 antibody pair is more suitable for monitoring therapy in pregnancy-associated breast cancer.
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Affiliation(s)
- Guangshu Liang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Streets, Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Xuqian Fang
- Department of Pathology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, People's Republic of China
| | - Xiaoyi Lin
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Streets, Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Xiaojing Feng
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Streets, Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Huangying Lu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Streets, Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Yinglei Wan
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Streets, Ruijin Second Road, Shanghai, 200025, People's Republic of China
| | - Zhidong Gu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Streets, Ruijin Second Road, Shanghai, 200025, People's Republic of China.
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Lu J, Zheng Z, Zhang Q, Li G, Li F, Le Z, Huang J, Xie X, Zhang J. Measurement of HE4 and CA125 and establishment of reference intervals for the ROMA index in the sera of pregnant women. J Clin Lab Anal 2017; 32:e22368. [PMID: 29194801 DOI: 10.1002/jcla.22368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/09/2017] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) are biomarkers for ovarian cancer. Their specificity and sensitivity are often limited during pregnancy as a result of great fluctuations. The risk of ovarian malignancy algorithm (ROMA) score, which combines CA125, HE4, and menopausal status, may improve diagnostic performance. There are no reports regarding the ROMA index in pregnant women. Therefore, the aim of our study was to establish appropriate reference intervals (RIs) for the ROMA index in pregnant Chinese women and compare them with those of CA125 and HE4 during pregnancy. METHODS Serum concentrations of CA125 and HE4 were simultaneously measured in healthy pregnant women via electrochemiluminescence immunoassay (ECLIA). The ROMA index was calculated using premenopausal algorithms. RESULTS The RIs for the ROMA index calculated by premenopausal algorithms were substantially closer to the normal range in the first 2 trimesters. For pregnant women, the great misclassifications identified in CA125 may be reversed by the use of ROMA index. CONCLUSIONS We established the RIs for HE4 and CA125, as well as the ROMA index, in pregnant women at different gestational periods. The ROMA index is suggested to be a more promising tumor marker for pregnant women diagnosed with malignance.
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Affiliation(s)
- Jie Lu
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhipeng Zheng
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi Zhang
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guoli Li
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Biomedical Research Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fengying Li
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhian Le
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Huang
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyou Xie
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Biomedical Research Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Zhang
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Biomedical Research Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Abstract
Multiple mechanisms of epigenetic control that include DNA methylation, histone modification, noncoding RNAs, and mitotic gene bookmarking play pivotal roles in stringent gene regulation during lineage commitment and maintenance. Experimental evidence indicates that bivalent chromatin domains, i.e., genome regions that are marked by both H3K4me3 (activating) and H3K27me3 (repressive) histone modifications, are a key property of pluripotent stem cells. Bivalency of developmental genes during the G1 phase of the pluripotent stem cell cycle contributes to cell fate decisions. Recently, some cancer types have been shown to exhibit partial recapitulation of bivalent chromatin modifications that are lost along with pluripotency, suggesting a mechanism by which cancer cells reacquire properties that are characteristic of undifferentiated, multipotent cells. This bivalent epigenetic control of oncofetal gene expression in cancer cells may offer novel insights into the onset and progression of cancer and may provide specific and selective options for diagnosis as well as for therapeutic intervention.
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Shigemi D, Kamoi S, Matsuda A, Takeshita T. A Complicated Case of Pregnancy Involving a Presacral Epidermoid Cyst. J NIPPON MED SCH 2017; 84:100-104. [PMID: 28502958 DOI: 10.1272/jnms.84.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although presacral developmental cysts, including epidermoid cysts, are relatively rare diseases, an intrapelvic mass found for the first time in early pregnancy should be followed-up with the possibility of presacral developmental cysts in mind to be alert to the signs of local infection and malignancy. We treated a pregnant patient with presacral cystic disease. During pregnancy, percutaneous fenestration was performed because the cyst caused severe compression symptoms and complicated bacterial infection. Laparoscopic total cyst excision was performed after cesarean section. There is no suggested criterion to make a decision for the delivery mode. The mass should be removed completely to reduce the risk of recurrence and malignant progression.
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Affiliation(s)
- Daisuke Shigemi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital
| | - Seiryu Kamoi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital
| | - Akihisa Matsuda
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
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Keihani S, Kameli SM, Hojjat A, Kajbafzadeh AM. Reply by the Authors. Urology 2016; 101:173-174. [PMID: 28011274 DOI: 10.1016/j.urology.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Sorena Keihani
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Maryam Kameli
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Asal Hojjat
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
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Nothnick WB, Falcone T, Joshi N, Fazleabas AT, Graham A. Serum miR-451a Levels Are Significantly Elevated in Women With Endometriosis and Recapitulated in Baboons ( Papio anubis) With Experimentally-Induced Disease. Reprod Sci 2016; 24:1195-1202. [PMID: 27920341 DOI: 10.1177/1933719116681519] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We have previously demonstrated that human microRNA-451a (miR-451a) endometriotic lesion expression is significantly higher compared to that of the corresponding eutopic endometrium. The objective of the current study was to examine the relationship between lesion and serum content of miR-451a and to determine the utility of serum miR-451a in distinguishing between women with and without visible signs of endometriosis. Eighty-one participants were enrolled in this study, 41 with confirmed endometriosis and 40 without visible signs of endometriosis at laparoscopy (n = 20) or symptoms of endometriosis (pain, infertility n = 20). Experimental endometriosis was also induced in 8 baboons. Blood, endometriotic lesions, and eutopic endometrial samples were collected from women undergoing laparoscopy for surgical removal of endometriosis. Blood was also collected from control participants with no signs and symptoms associated with the disease as well as from baboons prior to, and then 1, 3, 6, 9, and 15 months postinduction of endometriosis. MicroRNA-451a was assessed by quantitative real-time polymerase chain reaction in all samples. In humans, serum miR-451a levels positively correlated with endometriotic lesion miR-451a content, and sera levels were significantly higher in these participants compared to controls. The area under the curve (AUC) for miR-451a was 0.8599. In baboons, serum miR-451a reached statistically significant peak levels at 6 months postinduction of endometriosis. We conclude from this study that sera miR-451a levels positively correlated with endometriotic lesion content and are significantly greater compared to sera levels in women without visible signs or symptoms of endometriosis. MicroRNA-451a may serve as a serum diagnostic marker for endometriosis.
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Affiliation(s)
- Warren B Nothnick
- 1 Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.,2 Center for Reproductive Sciences, Institute for Reproductive Health and Regenerative Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tommaso Falcone
- 3 Department of Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Niraj Joshi
- 4 Department of Obstetrics and Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Asgerally T Fazleabas
- 4 Department of Obstetrics and Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Amanda Graham
- 1 Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
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Qu W, Li J, Duan P, Tang Z, Guo F, Chen H, Zhu X, Jiang SW. Physiopathological factors affecting the diagnostic value of serum HE4-test for gynecologic malignancies. Expert Rev Mol Diagn 2016; 16:1271-1282. [PMID: 27784171 DOI: 10.1080/14737159.2016.1251317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Serum epididymis protein 4 (HE4) represents a useful biomarker for the management of ovarian cancer and endometrial cancer patients. However, HE4 levels are affected by many physiopathological conditions or disorders that should be taken into consideration for an efficient application of this biomarker. Areas covered: The review provides an up-to-date reference on the multiple physiopathological factors that cause fluctuation of HE4 serum levels, and evaluates their impact on HE4-test in clinical settings. Potential mechanisms underlying the regulation of HE4 expression are also discussed. The review is based on data from literature search of PubMed and the author's opinions. Expert commentary: Studies have shown that physiopathological factors such as age, infection/inflammation, renal function, menopause and hormonal levels impose significant impacts on HE4 serum levels. HE4 amount shed into the circulation is related to HE4 expression and secretion by tumor as well as normal tissues, which is affected by cancer heterogeneity, vascular permeability, renal clearance and HE4 degradation. Investigation on interfering factors builds a basis for the construction of a quantitative logarithm for individualized application of HE4-test in clinical settings.
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Affiliation(s)
- Wanglei Qu
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Jinping Li
- b Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA
| | - Ping Duan
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Zuoqing Tang
- c Department of Medical Genetics, School of Basic Medical Sciences , Capital Medical University , Beijing , China
| | - Fengbiao Guo
- b Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA
- d Department of Histology and Embryology , Shantou University Medical College , Shantou , Guangdong , China
| | - Haibin Chen
- d Department of Histology and Embryology , Shantou University Medical College , Shantou , Guangdong , China
| | - Xueqiong Zhu
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Shi-Wen Jiang
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
- b Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA
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Kajbafzadeh AM, Keihani S, Kameli SM, Hojjat A. Maternal Urinary Carbohydrate Antigen 19-9 as a Novel Biomarker for Evaluating Fetal Hydronephrosis: A Pilot Study. Urology 2016; 101:90-93. [PMID: 27825745 DOI: 10.1016/j.urology.2016.10.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/14/2016] [Accepted: 10/25/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate maternal urinary CA19-9 as a potential marker to diagnose severe antenatal hydronephrosis (ANH) during pregnancy and to compare the values with those in normal pregnancies as controls. PATIENTS AND METHODS A total of 20 women in their third pregnancy trimester were enrolled. An anteroposterior pelvic diameter (APD) of ≥15 was considered as severe ANH. Case group consisted of 10 women with a diagnosis of severe ANH. Ten women with similar age, gestational age, fetal sex, normal ultrasonography, and no history of any congenital anomalies were chosen as controls. Urine samples were collected and maternal urinary CA19-9 was measured. The levels in case and control groups were compared using Mann-Whitney U test. RESULTS Each group consisted of nine mothers with male fetuses and one with female fetus. The APD in the ANH group ranged from 17 to 40 mm. Five of 10 children in the ANH group also had contralateral APD of ≥4 mm (bilateral ANH). The mean age and gestational age of pregnant women in the two groups were comparable. The mean maternal CA19-9 was significantly higher in the ANH group compared with the controls (mean: 134.5 U/mL vs 22.2 U/mL, P < .001). CONCLUSION To our best knowledge, this is the first time that maternal urinary CA19-9 has been used as a marker for ANH. Based on these pilot data, CA19-9 levels are significantly higher in the urine of pregnant women carrying fetuses with severe ANH, and it may have the potential to serve as a noninvasive and useful biomarker to diagnose ANH.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sorena Keihani
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Maryam Kameli
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Asal Hojjat
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
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47
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Difficulties with diagnosis of malignancies in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:19-32. [DOI: 10.1016/j.bpobgyn.2015.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/09/2015] [Indexed: 11/22/2022]
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48
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Mukhopadhyay A, Shinde A, Naik R. Ovarian cysts and cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 33:58-72. [DOI: 10.1016/j.bpobgyn.2015.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 12/27/2022]
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49
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Cavaco-Gomes J, Jorge Moreira C, Rocha A, Mota R, Paiva V, Costa A. Investigation and Management of Adnexal Masses in Pregnancy. SCIENTIFICA 2016; 2016:3012802. [PMID: 27119043 PMCID: PMC4826943 DOI: 10.1155/2016/3012802] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
Adnexal masses can be found in 0.19 to 8.8% of all pregnancies. Most masses are functional and asymptomatic and up to 70% resolve spontaneously in the second trimester. The main predictors of persistence are the size (>5 cm) and the imagiological morphocomplexity. Those that persist carry a low risk of malignancy (0 to 10%). Most malignant masses are diagnosed at early stages and more than 50% are borderline epithelial neoplasms. Ultrasound is the preferred method to stratify the risk of complications and malignancy, allowing medical approach planning. Pregnancy and some gestational disorders may modify the levels of tumor markers, whereby their interpretation during pregnancy should be cautious. Large masses are at increased risk of torsion, rupture, and dystocia. When surgery is indicated, laparoscopy is a safe technique and should ideally be carried out in the second trimester of pregnancy.
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Affiliation(s)
- João Cavaco-Gomes
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Cátia Jorge Moreira
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Anabela Rocha
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Raquel Mota
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Vera Paiva
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
| | - Antónia Costa
- Department of Obstetrics and Gynecology, São João Hospital Centre, 4200-319 Porto, Portugal
- Porto Medical Faculty, 4200-319 Porto, Portugal
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50
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Mor A, Tal R, Irani M, McCalla S, Haberman S, Garg D, Wajntraub B. Carcinoembryonic antigen as a biomarker for meconium-stained amniotic fluid. Int J Gynaecol Obstet 2015; 132:329-31. [PMID: 26674317 DOI: 10.1016/j.ijgo.2015.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/10/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess whether elevated carcinoembryonic antigen (CEA) concentration in amniotic fluid can indicate meconium-stained amniotic fluid (MSAF). METHODS In a prospective cohort study, women with a term singleton pregnancy who were in labor but had intact membranes were recruited at a center in Israel over a 5-month period in 2013. Only women who subsequently underwent artificial rupture of membranes following a clear medical indication were included. Samples of amniotic fluid, urine, and serum were collected. Amniotic fluid was examined by sight and classified as clear, MSAF, or undetermined. CEA concentration in the samples was measured. RESULTS Among 81 participants, 45 had clear amniotic fluid, 28 had MSAF, and eight had undetermined amniotic fluid. Mean CEA concentration was more than 10 times higher in MSAF (2658 μg/L, standard error 250) than in clear amniotic fluid (238 μg/L, standard error 29; P<0.001). Receiver operating characteristic curve analysis demonstrated a sensitivity of 96% and a specificity of 100% for distinguishing MSAF from clear amniotic fluid at a CEA cutoff of 799.2 μg/L. CEA concentrations in urine and serum were all within the normal range (≤5 μg/L), irrespective of amniotic fluid status. CONCLUSION High CEA concentrations in amniotic fluid can assist in the diagnosis of MSAF. These findings could provide the basis for a bedside test to detect MSAF following rupture of membranes.
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Affiliation(s)
- Amir Mor
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Reshef Tal
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Mohamad Irani
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sandra McCalla
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Shoshana Haberman
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Deepika Garg
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Birgitta Wajntraub
- Department of Obstetrics and Gynecology, Laniado Medical Center, Netanya, Israel
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