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Chen J, Sun Q, Zhu T, Li K. Ovarian hyperstimulation syndrome and pregnancy luteoma mimicking malignant ascites: a rare case report. J Ovarian Res 2023; 16:97. [PMID: 37194026 DOI: 10.1186/s13048-023-01186-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/06/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND During pregnancy, both ovarian hyperstimulation syndrome (OHSS) and pregnancy luteoma could manifest as massive ascites, enlarged ovaries, or elevated serum levels of cancer antigen 125 (CA125), and atypical cells may be found in the ascitic fluid of OHSS patients. Whether this should be treated aggressively as peritoneal carcinomatosis is controversial. CASE PRESENTATION A 35-year-old G2P1A1 woman with secondary infertility had a successful pregnancy after one cycle of assisted reproductive technology. The patient complained of lower abdominal distension, oliguria, and poor appetite 19 days after embryo transplantation. She was diagnosed with late-onset OHSS. Although the size of the ovaries decreased bilaterally to the normal range at 12 weeks of gestation after prompt medical care, the ascites increased again after an initial decreasing trend. Elevated serum levels of CA125 (191.1 IU/mL), and suspected adenocarcinoma cells were observed in the ascitic fluid. Although further magnetic resonance imaging examination or diagnostic laparoscopy was recommended, the patient was provided with supportive treatment and closely monitored upon her request. Surprisingly, her ascites diminished, and serum level of CA125 started to decline at 19 weeks of gestation. During cesarean section, pathological examination of the solid mass in the right ovary revealed pregnancy luteoma, which was presumably the other cause of the intractable ascites. CONCLUSIONS Caution should be exercised in cases of suspicious malignant ascites during pregnancy. This may due to OHSS or pregnancy luteoma, in which abnormalities usually regress spontaneously.
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Affiliation(s)
- Jing Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, Hubei, 430030, China
| | - Qian Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, Hubei, 430030, China
| | - Tao Zhu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, Hubei, 430030, China
| | - Kezhen Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave. Wuhan, Hubei, 430030, China.
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Farkas B, Boldizsar F, Bohonyi N, Farkas N, Marczi S, Kovacs GL, Bodis J, Koppan M. Comparative analysis of abdominal fluid cytokine levels in ovarian hyperstimulation syndrome (OHSS). J Ovarian Res 2020; 13:25. [PMID: 32138790 PMCID: PMC7057507 DOI: 10.1186/s13048-020-00624-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a rare, yet severe, iatrogenic complication of ovulation induction therapy during assisted reproductive procedures. Our group previously detected atypical cells in the ascitic fluid of OHSS patients, although no malignancy developed during follow up. Here, the aim was to perform a comparative analysis of the cytokines present in the abdominal fluid of patients affected by OHSS versus patients with advanced ovarian cancer, a benign adnexal mass, or ovarian endometriosis. METHODS This prospective, non-randomized study was conducted at the Clinical Center of the University of Pecs Department of Obstetrics and Gynecology/Reproductive Center between October 2016 and March 2018. Abdominal fluid samples were obtained from 76 patients and subjected to Luminex analysis. The samples were collected from patients with OHSS (OHSS; n = 16), advanced ovarian cancer (OC; n = 22), a benign adnexal mass (BAM; n = 21), or ovarian endometriosis (EM; n = 17). Data were subjected to the non-parametric Kruskal-Wallis test and Spearman's rank correlation coefficient to identify statistical differences between the four study groups. RESULTS Leukocytosis and hemoconcentration were detected in the peripheral blood of OHSS patients. Abdominal fluid analysis further revealed significantly higher levels of interleukin (IL)-6, IL-8, IL-10, and transforming growth factor (TGF)-β in both the OHSS and OC groups compared to the BAM and EM groups. The highest concentration of vascular endothelial growth factor (VEGF) was detected in the OC group, while a significantly lower level was detected in the OHSS group. Moreover, VEGF levels in OC and OHSS groups were significantly elevated compared to the levels in the BAM and EM groups. CONCLUSIONS Vasoactive and hematogenic cytokines were present at higher levels in both the OHSS and OC abdominal fluid samples compared to the fluid samples obtained from the peritoneal cavity of the BAM patients. It is possible that these cytokines play an important role in the formation of ascites.
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Affiliation(s)
- Balint Farkas
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary. .,Member of the HAS-UP Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (HAS), Pecs, Hungary.
| | - Ferenc Boldizsar
- Department of Immunology and Biotechnology, University of Pecs, School of Medicine, Pecs, Hungary
| | - Noemi Bohonyi
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary
| | - Nelli Farkas
- School of Medicine, Institute of Bioanalysis, University of Pecs, Pecs, Hungary
| | - Saska Marczi
- Laboratory of Molecular and HLA Diagnostics, University Hospital Osijek, Clinical Institute of Transfusion Medicine, Osijek, Croatia.,Department of Medical, Chemistry, Biochemistry and Clinical Chemistry, University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Gabor L Kovacs
- Member of the HAS-UP Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (HAS), Pecs, Hungary.,Szentágothai Research Center, University of Pecs, Pecs, Hungary.,Department of Laboratory Medicine, Faculty of Medicine, University of Pecs, Pecs, Hungary
| | - Jozsef Bodis
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary.,Member of the HAS-UP Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (HAS), Pecs, Hungary
| | - Miklos Koppan
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary
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Hallamaa M, Huhtinen K, Suvitie P, Perheentupa A. Serum concentrations of HE4 change little during in vitro fertilization. Acta Obstet Gynecol Scand 2014; 93:640-6. [PMID: 24734893 DOI: 10.1111/aogs.12393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 04/09/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Human epididymal secretory protein 4 (HE4) is a biomarker for ovarian cancer. The effect of follicle stimulating hormone (FSH) stimulation during in vitro fertilization (IVF) on HE4 was evaluated to determine whether substantial hormonal stimulation of the ovaries affects the serum levels of this marker. Findings were compared with serum concentrations of cancer antigen 125 (CA125), currently the most commonly used marker for ovarian cancer. DESIGN Prospective cohort study. SETTING University hospital infertility clinic. POPULATION Infertility patients undergoing IVF treatment. METHODS We determined the serum concentration of HE4 and CA125 in serial blood samples in 20 women treated with IVF. Samples were taken following gonadotrophin-releasing hormone agonist suppression, two to three times during FSH stimulation, at ovum pick-up and 2 weeks following embryo transfer at the time of the pregnancy test. Ovarian follicles were counted and serum estradiol concentrations measured throughout treatment. MAIN OUTCOME MEASURES Serum HE4, CA125 and estradiol concentrations. RESULTS Serum HE4 levels did not increase significantly during the FSH stimulation. The majority of values remained below the normal reference range (<70 pm) throughout the treatment. Serum CA125 concentration also remained low during stimulation. Serum estradiol concentration reflected the severity of ovarian stimulation during IVF, increasing 3.9-fold with stimulation. CONCLUSIONS Serum HE4 concentrations respond little if at all to supraphysiological ovarian stimulation, suggesting that the amount of circulating HE4 in women with normal ovaries is independent of gonadotropin stimulation. Hormonal stimulation of the ovaries is unlikely to affect the differential diagnosis of ovarian tumors with HE4.
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Affiliation(s)
- Marianne Hallamaa
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
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Chudecka-Głaz A, Cymbaluk-Płoska A, Menkiszak J, Sompolska-Rzechuła A, Byra E, Rzepka-Górska I. HE4 tumor marker concentration in neoplastic peritoneal effusion and in peritoneal fluid associated with benign gynecological diseases. J Ovarian Res 2014; 7:22. [PMID: 24528554 PMCID: PMC3940276 DOI: 10.1186/1757-2215-7-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 02/11/2014] [Indexed: 11/24/2022] Open
Abstract
Background The aim of our study was to evaluate the behaviour of the human epididymis protein 4 (HE4) in the peritoneal fluid encountered in various female genital diseases. Methods We enrolled 139 patients, 40 with ovarian cancer (group I), 82 with benign diseases (group II), and 17 with other malignant neoplasms (group III). The HE4 tumor marker concentrations were determined in serum, in the peritoneal effusion and ovarian cyst/ tumor fluids, CA125 in the serum only. We compared the groups, examined correlations and determined corresponding ROC curves. We evaluated the relationship between the HE4 marker concentration in the peritoneal effusion in the group I, depending on the selected prognostic parameters. Results The HE4 median value between the study groups did not differ statistically significantly and were as follows: in group I 3322 pmol/L, in the group II 2150 pmol/L and in the group III 627 pmol/L (p = 0.206376 for the groups I and II, p = 0.05929 for the groups I and III and p = 0.0797 for the groups II and III. In group I there were no differences found in the HE4 concentrations in the peritoneal fluid, depending on the stage, grade, the presence of neoplastic cells and the peritoneal dissemination. Conclusions The HE4 marker concentrations in the peritoneal fluid are highly irrespective of the pathology observed in the female sexual organ. Therefore, it seems that its determinations in the peritoneal fluid are completely useless in terms of diagnostics. More research is needed on the role of the HE4 marker, especially the place of its formation and possible use in the targeted therapy.
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Affiliation(s)
- Anita Chudecka-Głaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Al, Powstańców Wielkopolskich 72, Szczecin PL-70-111, Poland.
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