Extremely elevated serum CA125 due to endometriosis

Enhancing endometrioma management: Diagnostic biomarkers and predictive outcomes in Ruptured vs. Non-Ruptured cases

OBJECTIVE

To compare the outcomes between patients undergoing surgery for ruptured endometrioma versus non-ruptured endometrioma.

STUDY DESIGN

The study was conducted at Health Sciences University, Etlik Zübeyde Hanım Training and Research Hospital Infertility Clinic. All patients who had a histopathology report of endometrioma between January 2014 and December 2020 were recruited. Patient files, surgery notes and laboratory values were extracted from the electronic recording system and patients with ruptured endometriomas (RE) or non-ruptured endometriomas (NRE) were compared.

RESULTS

Overall, 181 patients were recruited to the study. No rupture was detected in 146 (80.7 %) patients while 35 patients (19.3 %) underwent surgery for RE. Pre-operative CRP, CA 125, CA 19-9, CA 15-3, CEA and mean platelet volume (MPV) values and postoperative MPV and neutrophil/lymphocyte ratio (NLR) values were statistically significantly higher (p < 0.01) in the RE group compared to the NRE group. Post-operative lymphocyte (p = 0.029) and eosinophyl (p = 0.015) values were significantly lower in the RE group compared to the NRE group. Among the preoperative biomarkers that are evaluated for prediction of rupture; MPV, CA 19-9 and CA-15.3 had a high specifity (>75 %) but a rather low sensitivity (<60 %), meanwhile CRP, CA-125 and CEA had high sensitivity but a low specifity.

CONCLUSION

RE patients had significantly higher preoperative CRP, CA 125, CA 19-9, CA 15-3, CEA, and MPV values and postoperative MPV and NLR values while postoperative, lymphocyte and eosinophyl values were significantly lower compared with the NRE patients. Prospective studies with larger sample sizes are needed to determine biomarkers and parameters that can be used for non-invasive diagnosis of endometriosis and predict the possibility of endometrioma rupture.

Accuracy of CCL20 expression level as a liquid biopsy-based diagnostic biomarker for ovarian carcinoma

Objective

The study aimed to investigate the potentiality of chemokines, including MCP-1, CCL15, CCL20, and CXCL14, as biomarkers for differential diagnosis between benign tumors and ovarian cancer (OC).

Methods

A cross-sectional study was conducted in women aged &gt;18 years who had adnexal masses treated with elective surgery at the HRH Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, between 2020 and 2021. The preoperative MCP-1, CCL15, CCL20, and CXCL14 serum levels were measured using a sandwich enzyme-linked immunosorbent assay. Preoperative diagnosis was defined according to the risk of malignancy index. The histological diagnosis and cancer subtype were confirmed using pathological specimens.

Results

Ninety-eight participants were preoperatively diagnosed with malignant tumors. The pathological diagnosis confirmed OC in 33 patients and disclosed 27 misdiagnosed cases, of which endometriotic cyst was the most common (44.44%). CCL20 and CA125 serum levels were significantly higher in the patients with cancer than in those with benign. In addition, CCL20 level could differentiate between benign and early-stage malignancy. Furthermore, only CCL20 levels could distinguish endometriotic cysts from OC, whereas CA125 levels could not. Concordant with the serum protein level, the increased mRNA level of CCL20 was observed in ovarian cancers comparing with that in benign tissues. We found that CCL20 levels could differentiate between benign tumors and OC with 60.61% sensitivity and 75.44% specificity at the optimal cutoff value of 38.79 pg/ml. Finally, the logistic regression model integrating CCL20, CA125, and menopause status promoted diagnostic accuracy by increasing the specificity to 91.23%.

Conclusions

Our study revealed the potential usefulness of CCL20 level as a biomarker for diagnosing early-stage OC with endometriosis differentiation. We recommend further studies to confirm the accuracy of CCL20 levels with the current diagnosis in a large patient sample.

Elevated CA 125 in a CASE of Leaking Endometrioma

Extremely elevated CA 125, usually suggestive of ovarian malignancy, can be found in physiological or benign conditions such as endometriosis. We present a case of an extremely elevated serum CA 125 level in a patient with stage four endometriosis and bilateral unruptured ovarian endometriomas, with evidence of leakage unilaterally. To avoid costly and unnecessarily invasive tests and procedures it is important to consider the differential diagnosis of endometriosis and/or leaking endometrioma in patients with a profoundly elevated CA 125 level.

High CA-125 and CA19-9 levels in spontaneous ruptured ovarian endometriomas

BACKGROUND

To evaluate the clinical significance of serum CA-125 and CA19-9 in women with spontaneous ruptured ovarian endometriomas.

METHODS

From January 2006 to April 2015, a total of 1653 women were diagnosed with ovarian endometriomas, and 43 women were diagnosed with the spontaneous rupture of their ovarian endometrioma. In addition, 70 women diagnosed with unruptured ovarian endometriomas were chosen to serve as control subjects. Serum CA-125 and CA19-9 levels, together with the clinical materials, were collected.

RESULTS

Serum CA-125, CA19-9, and the combined biomarkers were shown to be obviously elevated in the spontaneous ruptured ovarian endometrioma group (p=0.001, p=0.001, p=0.001, respectively). The AUC value for the combined biomarkers was 0.992 (95% CI, 0.981-1.000), with a high sensitivity and specificity of nearly 100% and 93.6%, respectively. Moreover, the maximum diameter of the mass was significantly (p=0.001) increased in the ruptured group.

CONCLUSIONS

Serum CA-125 and CA19-9 were significantly increased in patients with spontaneous ruptured ovarian endometriomas. Moreover, the combined biomarkers were better than either CA-125 or CA19-9 alone in the diagnosis of a spontaneous rupture of the ovarian endometrioma.

Extremely elevated CA-125 in benign ovarian disease due to stretch of the peritoneum

Serum concentrations of CA-125 are rarely elevated beyond 1000 U/ml in benign conditions of the ovary in postmenopausal women. In this report, the authors present an unusual case of a 78-year-old woman with an extremely elevated CA-125 concentration of 2897 U/ml without the presence of a malignancy, ascites or pleural effusion. Imaging revealed a large intra-abdominal cystic mass with irregular solid deviations on CT scan, most likely arising from an ovary. Exploratory laparotomy was performed with suspicion of ovarian cancer but histopathological analysis revealed benign serous cystic adenofibroma. This case report highlights the diagnostic challenge of extremely increased levels of CA-125 in postmenopausal women. A possible explanation for this CA-125 elevation could be the mechanical stretch of the peritoneum.

Highly sensitive detection of HER2 extracellular domain in the serum of breast cancer patients by piezoelectric microcantilevers

Rapid and sensitive detection of serum tumor biomarkers are needed to monitor cancer patients for disease progression. Highly sensitive piezoelectric microcantilever sensors (PEMS) offer an attractive tool for biomarker detection; however, their utility in the complex environment encountered in serum has yet to be determined. As a proof of concept, we have functionalized PEMS with antibodies that specifically bind to HER2, a biomarker (antigen) that is commonly overexpressed in the blood of breast cancer patients. The function and sensitivity of these anti-HER2 PEMS biosensors was initially assessed using recombinant HER2 spiked into human serum. Their ability to detect native HER2 present in the serum of breast cancer patients was then determined. We have found that the anti-HER2 PEMS were able to accurately detect both recombinant and naturally occurring HER2 at clinically relevant levels (>2 ng/mL). This indicates that PEMS-based biosensors provide a potentially effective tool for biomarker detection.

Identification of anti-α-enolase autoantibody as a novel serum marker for endometriosis

Diagnosis of endometriosis needs invasive maneuvers. New serum marker that possesses both high sensitivity and high specificity has long been desired. To establish novel serum marker for endometriosis, serum autoantibodies (autoAbs) were investigated using proteomic approach. AutoAbs in sera of endometriotic patients and healthy controls were analyzed using a mesothelial cell line, 2-DE and Western blotting. Proteins in reacted spots were identified using MALDI TOF-MS with MASCOT analysis. ELISAs were established using recombinant proteins and autoAb-titers were estimated in sera of endometriotic patients, disease and healthy controls. Several autoAbs were identified. Anti-α-enolase (Eno1)-autoAb levels in endometriotic patients were significantly elevated compared with both healthy and disease controls. Sensitivity and specificity of serum anti-Eno1-autoAb was nearly comparable to serum CA125. When anti-Eno1-autoAb and CA125 assays were combined, diagnostic sensitivity and accuracy improved. Serum anti-Eno1-autoAb can be a new serum endometriotic marker and it is useful as a supplement assay for CA125. This study validates further clinical evaluation of this novel marker.

Quantitation of circulating tumor cells in blood samples from ovarian and prostate cancer patients using tumor-specific fluorescent ligands

Quantitation of circulating tumor cells (CTCs) can provide information on the stage of a malignancy, onset of disease progression and response to therapy. In an effort to more accurately quantitate CTCs, we have synthesized fluorescent conjugates of 2 high-affinity tumor-specific ligands (folate-AlexaFluor 488 and DUPA-FITC) that bind tumor cells >20-fold more efficiently than fluorescent antibodies. Here we determine whether these tumor-specific dyes can be exploited for quantitation of CTCs in peripheral blood samples from cancer patients. A CTC-enriched fraction was isolated from the peripheral blood of ovarian and prostate cancer patients by an optimized density gradient centrifugation protocol and labeled with the aforementioned fluorescent ligands. CTCs were then quantitated by flow cytometry. CTCs were detected in 18 of 20 ovarian cancer patients (mean 222 CTCs/ml; median 15 CTCs/ml; maximum 3,118 CTCs/ml), whereas CTC numbers in 16 gender-matched normal volunteers were negligible (mean 0.4 CTCs/ml; median 0.3 CTCs/ml; maximum 1.5 CTCs/ml; p < 0.001, chi(2)). CTCs were also detected in 10 of 13 prostate cancer patients (mean 26 CTCs/ml, median 14 CTCs/ml, maximum 94 CTCs/ml) but not in 18 gender-matched healthy donors (mean 0.8 CTCs/ml, median 1, maximum 3 CTC/ml; p < 0.0026, chi(2)). Tumor-specific fluorescent antibodies were much less efficient in quantitating CTCs because of their lower CTC labeling efficiency. Use of tumor-specific fluorescent ligands to label CTCs in peripheral blood can provide a simple, accurate and sensitive method for determining the number of cancer cells circulating in the bloodstream.

High levels of CA125 (over 1,000 IU/ml) in patients with gynecologic disease and no malignant conditions: three cases and literature review

OBJECTIVE

To report the very high serum levels of CA125 in patients with benign gynecologic disease which manifests as pelvic mass.

METHODS

Clinical data of three cases with high levels of CA125 over 1,000 IU/ml and benign gynecologic conditions were gathered. in Vali-Asr hospital.

RESULTS

Three patients were scheduled for laparatomy as ovarian cancer and leiomyosarcoma. Histologic results after laparatomy showed uterine myoma in two patients and endometrioma in a third patient.

CONCLUSION

High levels of CA125 over 1,000 IU/ml, may be showed in other gynecologic conditions with no malignancy. So, other clinical and imaging data could be helpful for differential diagnosis of these patients.

Ovarian endometrioid adenocarcinoma arising from endometriosis in a young woman

BACKGROUND

The risk of ovarian cancer increases in women with a long history of ovarian endometriosis, particularly in postmenopausal women. We present here a case of malignant transformation of endometriosis occurring over a short time in a young woman.

CASE

The 27-year-old woman underwent laparoscopic cystectomy and was diagnosed with left ovarian endometrioma with an accompanying high level of serum CA125 (734.6 U/mL). Fourteen months later, she underwent cytoreductive surgery for her ovarian cancer. Histological examination revealed endometrioid adenocarcinoma with transitions between endometriosis and adenocarcinoma. She was diagnosed as having stage IIIc of ovarian cancer with paraaortic lymphnode involvement.

CONCLUSION

We suggest that endometrial cyst of the ovary associated with high levels of serum CA125 should be managed with special care even in a young woman.

Cancer antigen 125 associated with multiple benign and malignant pathologies

BACKGROUND

Cancer antigen (CA) 125 tumor-associated antigen is a high molecular glycoprotein used for follow-up of epithelial ovarian cancer. The test is often requested as a differential diagnosis in patients with pleural or peritoneal fluid. This study analyzes the prevalence of CA-125 increases in a population of patients attending a general hospital and discusses the possible clinical implications of increased levels.

METHODS

On 4 different days, 380 CA-125 assays were performed in randomly selected patients attending our hospital. Serum CA-125 was measured with a commercial enzyme immunoassay, and clinical records were reviewed for assessment of clinical parameters.

RESULTS

Sixty-one patients (16%) had increased CA-125. The pathologies of these patients were heart failure in 9 (14.7%), lung disease 11 (18%), hepatic cirrhosis in 7 (11.4%), malignant tumors in 9 (14.7%), intra-abdominal nonhepatic disease in 6 (10%), previous surgery in 17 (27.8%), and miscellaneous in 2 (3%). Effusions were seen in 34 patients (55.7%).

CONCLUSIONS

Our data confirm the variety of benign and malignant pathologies coursing with increased CA-125. Cardiovascular and chronic liver disease were the most frequent diagnoses in patients with increased CA-125; this supports the opinion that CA-125 lacks utility as a marker for malignancy. CA-125 could have a role in the follow-up of cardiovascular, hepatic, and tumoral diseases with serosal involvement.

Elevated serum CA125 and CA19-9 due to the spontaneous rupture of ovarian endometrioma

A 23-year-old woman was suffered from ruptured ovarian endometrioma with an elevated CA125 and CA19-9 concentration; 9537 and 15,653IU/ml, respectively. Rapid decrease in serum CA125 and CA19-9 was recognized before surgery. Such high levels of both antigens have not been reported in a patient with endometriosis.