Plasma D-Dimer Measurement as a Marker of Gynecologic Tumors: Comparison with CA 125

Background

Fibrin is formed and degraded Intra-abdominally in ovarian cancer, and the cross-linked fibrin degradation product, D-dimer (D-D), has been found in increased concentrations In the plasma of these patients.

Methods

D-dimer and Ca 125 levels were determined simultaneously in 110 patients with gynecologic neoplasms. D-dimer and Ca 125 assays were performed using the Dimertest Stripwell EIA Kit (Ortho) and CA 125-11 EIA assay (Roche), respectively.

Results

D-dimer plasma and Ca 125 serum levels were significantly higher in patients with ovarian cancer (mean ± SE = 894.2 ± 173.7 ng/ml and 760.5 ± 292.7 U/ml, respectively) than in those with uterine cancer (mean DD ± SE = 109.7 ± 23.5 ng/ml and mean Ca 125 ± SE = 50.0 ± 23.1 U/ml) or those with benign disease (mean D-D ± SE = 70.5 ± 5.5 ng/ml and mean Ca 125 ± SE = 6.6 ± 2.8 U/ml). The levels of both markers Increased with regard to ovarian cancer disease status. Mean D-D ± SE was 90.0 ± 22.8 ng/ml and mean Ca 125 ± SE was 2.1 ±1.2 U/ml in patients with complete remission; mean D-D ± SE was 143.3 ± 33.5 ng/ml and mean Ca 125 ± SE was 26.2 ± 13.6 U/ml in patients with partial remission. In active disease, both markers had very high levels: D-D mean ± SE = 1021.6 ± 173.0 ng/ml and Ca 125 mean ± SE = 1154.7 ± 458.1 U/ml. In all groups of ovarian cancer patients, D-dimer sensitivity was better than that of Ca 125. In advanced ovarian cancer patients, the D-dimer concentration in ascites was up to 100 fold that in plasma.

Conclusions

Our results suggest that D-dimer can serve as a sensitive indicator to monitor the extent and course of the disease in ovarian cancer patients. The patient follow-up is ongoing to establish the predictive value of D-dimer measurement with respect to prognosis.

[Lymphocytic subpopulations in malignant ascites of ovarian origin. Flow cytometric analysis]

A flow-cytometric analysis of ascitic fluid (AF) and peripheral blood lymphocyte subpopulations (LS) was performed on 16 patients with ovarian malignancy (OM) and 5 with metastatic peritoneal carcinomatosis (MPC). AF lymphocytes are 58% of total leukocytes in OM patients, 37% in MPC patients, while blood lymphocytes are 14% and 17%, respectively. AF absolute lymphocyte count (total and individual LS) is higher in OM patients. OM patients AF lymphocytes are: T = 70%, CD4+ = -37%, CD8+ = 32% (CD4/CD8 = 1.39), B = 5%, NK cells = 4-10%, CD25+ = 20%, CD69+ = 15%, CD71+ = 3%. In MPC patients the values are generally similar, though CD4+ cells are +7%, CD8+ cells = -14% (CD4/CD8 = 3.17), CD69+ cells = -8%. Untreated OM patients have a AF total and percent lymphocyte count higher than treated ones. Among the latter, however, the CD4/CD8 ratio as well as the number of CD4+, inducer, CD25+ and CD71+ cells are higher. In terms of percent values, the most striking differences involve total T and B lymphocytes (81-87% vs 56-62%, and 10% vs 2%, respectively). With the only exception of absolute NK cell count, OM patients show no correlation between AF and peripheral blood LS pattern. These results agree only partially with data from the literature. Pathophysiologic and clinical considerations support the practical usefulness of LS analysis in AF from OM patients.

[Epidemiology of female ano-genital condylomata acuminata. In relation to the presence of specific types of the human papillomavirus]

The presence of 7 human papillomavirus (HPV) types in genital condylomata acuminata (GCA) from 94 otherwise healthy women was detected by in situ hybridization, employing 3 different DNA probe cocktails (6/11, 16/18 and 31/35/51). HPV+ and HPV- GCA did not differ significantly as to the multiplicity and site of lesions, nor the prevalence of younger age, previous pregnancies or abortions, oral contraception, concurrent vaginal infection, aspecific PAP-test abnormalities and cutaneous hypo-anergy. Of note is that 13/18 HPV+ GCA (72.2%) lodged HPV types (16, 18, 31, 35, 51) which are more commonly related to dysplastic and neoplastic lesions of the female genital tract.

High Incidence of Von Willebrand’s Disease in a Little Area of South Italy

In a little region of South Italy(Puglia),we have evidenced 20 families (f.) with von Willebrand’s disease(vWd). The following tests were performed: BT, PR, RIPA, FVIII: C, FVIIIR: AG, FVIIIR:RCo and electrophoretic mobility (EM) of FVIII-related protein. 4 f. showed an autosomic recessive inheritance and severe bleeding tendency, every laboratory value was definitely abnormal. 16 f. showed an autosomic dominant inheritance and moderate bleeding tendency. Of these: 4 f. had classical vWd with all parameters reduced and normal EM; 3 f. showed a vWd vari ant (FVIII:C and FVIIIR:RCo reduced, FVIIIR:AG normal), the EM being abnormal in one and the RIPA increased in an other; 6 f. presented a decreased FVIIlR:RCo with normal FVIII:C and FVIIIR:AG (the EM was always normal); 3 f. showed an isolated deficiency of FVIIIR:RCo respectively combined with 1) FV deficiency (Bari variant), 2) FXII deficiency (San Diego variant), 3) hereditary hemorrhagic telangectasia.