Elevated CA-125 Levels Research Articles

A Case of Meigs' Syndrome: The (18)F-FDG PET/CT Findings.

The findings of an ovarian mass with marked ascites and pleural effusion are highly suggestive of malignancy, especially in a postmenopausal female with an elevated level of CA-125. However, benign conditions such as Meigs' syndrome should be considered in the differential diagnosis if the primary mass shows benign features. (18)F-FDG is known to be useful to differentiate between malignant and benign diseases, and this utility is also promising in the case of ovarian tumor. We present here a case of Meigs' syndrome that was evaluated by (18)F-FDG PET/CT, and this helped the preoperative diagnosis be made. (18)F-FDG PET/CT is a promising modality to diagnose the pathological character of an ovarian tumor preoperatively, which can lead to a proper therapeutic plan.

Metastatic Medullary Thyroid Cancer Presenting with Elevated Levels of CA 19-9 and CA 125

Calcitonin and carcinoembryonic antigen (CEA) are established markers of medullary thyroid cancer (MTC), used in the diagnosis and monitoring of disease and its progression. In clinical practice, various other tumor markers are utilized in the follow-up of different malignancies, although their utility has not been well described in MTC. CA 19-9 antigen, routinely used in the monitoring of pancreatic cancer, also has been detected in the tissue of approximately 6% of MTCs. However, its presence has never been reported in the serum of these patients. Elevation of CA 125 antigen, utilized as a tumor marker for ovarian cancer, has never been reported in MTC. We report a novel finding of metastatic MTC presenting with elevated CA 19-9 and CA 125 serum levels, with concurrent tissue staining for these antigens. A 56-year-old woman with multiple endocrine neoplasia 2B syndrome, post subtotal thyroidectomy for MTC in childhood, presented with extensive metastatic spread of MTC to the lungs and liver, 47 years after the original diagnosis. The patient's calcitonin level decreased from 2950 to 261 pg/mL (reference range: <20 pg/mL) over a 20-year period. The serum CEA level was elevated at 6800 ng/mL (reference range: <5.1 ng/mL). Because of a concern for an alternate malignancy, serum CA 19-9 and CA 125 tumor markers were measured and found to be significantly elevated, at 39,334 U/mL (reference range: <35.1 U/mL) and 96.2 U/mL (reference range: 7-41 U/mL), respectively. Immunostaining of the metastatic MTC tissue showed patchy staining for calcitonin, strongly positive staining for CEA and CA 19-9, and weakly positive staining for CA 125. Drawing from experience with CA 19-9 and CA 125 tumor markers in other malignancies, we propose that they may be associated with aggressive forms of MTC with significant metastatic potential.

Role of Vimentin in the Inhibitory Effects of Low-Molecular-Weight Heparin on PC-3M Cell Adhesion to, and Migration through, Endothelium

Low-molecular-weight heparin (LMWH) has been used in cancer patients with venous thromboembolic complications, resulting in a higher survival rate and an inhibitory action on experimental metastasis. In the present study, human umbilical vein endothelial cells (HUVECs) were treated with LMWH for 24 h. We found that the resulting HUVECs could significantly inhibit the highly metastatic human prostate cancer cell line (PC-3M) in terms of its adhesion to the endothelium and migration across the endothelium, according to scanning electron microscopy. We also determined the elevated levels of endothelial intercellular Ca(2+) concentration after the adhesion of PC-3M cells to HUVECs was greatly reduced by incubation with LMWH. Using proteomics, we surveyed the global protein changes in HUVECs after LMWH treatment and identified four down-regulated proteins that were possible isoforms of cytoskeletal vimentin intermediate filaments, cartilage-derived C-type lectin, and serine/threonine protein phosphatase 1β (PP-1B). LMWH affected the morphology of vimentin and the expression levels of α(v) integrin and PP-1B in HUVECs bound to PC-3M cells. Vimentin assists in the adhesion of PC-3M cells, which was confirmed by short interfering RNA experiments. Furthermore, the direct binding of purified vimentin protein with LMWH was detected with surface plasmon resonance methods. However, when we used fluorescence-labeled heparin for 24 h to identify whether this binding occurred within cells, heparin was distributed principally around endothelial cells. Taken together, these findings suggest that the monoincubation of LMWH with HUVECs could inhibit PC-3M cell adhesion to, and migration through, endothelium. LMWH's regulation of vimentin plays a role in the antimetastatic action.

Carcinoma indiferenciado de trompa

Primary carcinoma of the fallopian tube is a rare entity. Preoperative diagnosis is difficult and these tumors are usually detected during surgery or on histopathological examination. We describe the case of a 61-year-old woman with pelvic pain, left adnexal mass and elevated Ca125 levels. Diagnostic tests were compatible with uterine sarcoma or primary left ovarian carcinoma with uterine invasion. Histopathological analysis showed a primary undifferentiated carcinoma of the left fallopian tube involving the uterus and cervix. The patient is currently undergoing chemotherapy.

Isolation and functional characterization of an allatotropin receptor from Manduca sexta

Manduca sexta allatotropin (Manse-AT) is a multifunctional neuropeptide whose actions include the stimulation of juvenile hormone biosynthesis, myotropic stimulation, cardioacceleratory functions, and inhibition of active ion transport. Manse-AT is a member of a structurally related peptide family that is widely found in insects and also in other invertebrates. Its precise role depends on the insect species and developmental stage. In some lepidopteran insects including M. sexta, structurally-related AT-like (ATL) peptides can be derived from alternatively spliced mRNAs transcribed from the AT gene. We have isolated a cDNA for an AT receptor (ATR) from M. sexta by a PCR-based approach using the sequence of the ATR from Bombyx mori. The sequence of the M. sexta ATR is similar to several G protein-coupled receptors from other insect species and to the mammalian orexin receptor. We demonstrate that the M. sexta ATR expressed in vertebrate cell lines is activated in a dose-responsive manner by Manse-AT and each Manse-ATL peptide in the rank order ATL-I > ATL-II > ATL-III > AT, and functional analysis in multiple cell lines suggest that the receptor is coupled through elevated levels of Ca 2+ and cAMP. In feeding larvae, Manse-ATR mRNA is present at highest levels in the Malpighian tubules, followed by the midgut, hindgut, testes, and corpora allata, consistent with its action on multiple target tissues. In the adult corpora cardiaca–corpora allata complex, Manse-ATR mRNA is present at relatively low levels in both sexes.

Isolated ovarian tuberculosis mimicking ovarian carcinoma: Case report and literature review

Although genitourinary tuberculosis is common, reports of isolated ovarian tuberculosis are rare. However, its presentation can mimick that of an ovarian tumour, leading to diagnostic difficulties. A woman of 17 years presented with chronic pelvic pain, weight loss, a right ovarian mass on ultrasound, and a significantly elevated CA-125 level. A diagnosis of ovarian carcinoma was made, and laparotomy was performed with resection of the right ovary. Postoperative histological examination, however, revealed classic tuberculoid appearances, with no signs of malignancy. Antituberculosis treatment was commenced, with full resolution of her symptoms and a decrease in CA-125 level. Isolated ovarian tuberculosis is most common in young women living in endemic zones. CA-125 can be raised in both conditions, and imaging is rarely conclusive. Intraoperative frozen section of tissue specimens can be helpful if available. Early diagnosis of ovarian tuberculosis is vital as untreated disease can lead to infertility.

Molecular profiling as a possible prognostic marker for patients with cancer of unknown primary treated using platinum doublet chemotherapy.

e21040 Background: Platinum doublet chemotherapy regimens (PD) are considered standard treatment for cancer of unknown primary (CUP). In this study, we assessed whether molecular profiling (MP) could predict the prognosis of patients (pts) who had CUP and were treated using PD. Methods: This retrospective study involved 71 pts who were diagnosed as having CUP adenocarcinoma, were treated using PD, and whose tissue samples were available between 1997 and 2008. We excluded favorable subsets of CUP; female pts with elevated CA125 levels, male pts with elevated PSA levels, female pts with metastasis only in the axillary lymph nodes. We constructed an MP panel by using immunohistochemistry (IHC) and PCR results. This panel included the following biomarkers for identifying the origin of CUP: CK 7, CK 17, CK 19, CK 20, CDX-2, WT1, PAX8, TTF1, mammaglobin, GCDFP, PSA, uroplakin, (all by IHC) and K-ras mutation (by PCR). We also assessed EGFR and K-ras mutations that had been identified using MP for the lung cancer and colorectal cancer profiles. Results: Of the 71 pts, a primary tumor site profile was identified for 58 pts (81.7%): lung (N = 17), colorectum (N = 13), ovary (N = 9), prostate (N = 7), liver/kidney (N = 6), breast (N = 4), and bladder (N = 2); the primary tumor site was undetermined in the remaining pts (UND) (N = 13). Progression-free survival (PFS) and overall survival (OS) for the different sites were determined by MP: lung, 6.8 and 17.4 months (m); colorectum, 4.8 and 13.8 m; ovary, 11.2 and 23.3 m; prostate, 11.0 and 18.0 m; liver/kidney, 3.0 and 6.6 m; breast, 4.5 and 8.2 m; bladder, 2.7 and 5.0 m; and UND, 4.9 and 10.0 m, respectively. Multivariate analysis revealed PFS and OS were significantly varied depending on these tumor groups (p = 0.049 and p = 0.008). The pts with prostate, colon, breast, ovary, or lung cancer profiles were identified as having longer OS than did the pts with the other profiles (p = 0.025, p = 0.014, p = 0.015, p < 0.001, p = 0.005, respectively). We identified 3 of 13 K-ras mutations for the colorectal cancer profile and 1 of 17 EGFR mutations for the lung cancer profile. Conclusions: MP is a simple method and may be able to predict the prognosis of pts with CUP treated using PD.

Relationship of quality of life at presentation to resected pancreas cancer pathologic features.

e19631 Background: Relationship of pain or depression to pancreas tumor invasiveness is unclear. Methods: Patients with resected pancreas adenocarcinoma (n=126) filled out measures of quality of life (FACT-HEP), depression (Center for Epidemiologic Studies – Depression; CES-D) and pain (Brief Pain Inventory – Short Form, BPI) at their one-month post-operative clinic visit. This study correlated baseline pre-operative baseline labs and pain with post-operative pathological parameters and scores on the psychological questionnaires. Results: Bivarate correlations were performed and further analyses completed when pathological variables and psychological variables were significant at the p<0.05 level. Seventy-five percent (75%) of patients endorsed moderate to severe depressive symptomatology. Depression was predicted by the size of tumor (p<0.02), but none of the other pathological variables. One third of the patients (33%) reported no pain. We found that patients with high and low depression, as measured by the CES-D, did not differ in tumor size, neural or vascular involvement, positive margin, local invasion or pancreatitis. However, higher depression levels correlated with increased lymph node invasion (p<0.029). Lower emotional well-being was associated with positive margins (p<0.03). Pain severity, measured by BPI was not predicted by any of the pathological variables. However, interference in life activities due to pain was associated with tumor size (p<0.01). Patients with metastases noted lower functional well-being (p<0.02) and higher pain interference in life activities (p<0.05) than patients without metastases and also had higher CA 19-9 levels (p<0.027). Patients with neural invasion reported lower emotional well-being than those with without invasion (p<0.05) and patients with lymph node involvement reported lower social/family well-being (p<0.05). Elevated CA19-9 levels positively correlated with neural, vascular and lymph node invasion (p<0.05), pancreatitis and lower physical well-being (p<0.05). Conclusions: Baseline pain and depression correlated poorly with pathological features, but elevated CA 19-9 levels correlated well.

Relation of high CA125 and CA19-9 levels with recent rupture of endometrioma

Most of endometriomas with CA125 level over 1,000 IU/mL have related with rupture. This is important in differential diagnosis from malign ovarian disease. However, the mechanism of elevation of CA125 in patients with endometrioma is not clear. We reviewed elevation of CA125 level over 1,000 IU/mL in endometriomas and attempted to explore possible mechanisms of this elevation together with presentation of our current case. A review of the literature suggests that extremely elevated CA125 level combined with high CA19-9 level may indicate a recent rupture of endometrioma.

Ovarian fibroma with marked ascites and elevated serum levels of CA-125 in a young girl

We report a case of ovarian fibroma with marked ascites and elevated serum CA-125 levels in a young girl. Ovarian fibromas are rare in children. They usually present as a solid mass and may be associated with ascites and elevated serum CA-125 levels. Because of their solid nature and these associations, they can be mistaken for a malignant tumor, resulting in unnecessary oophorectomy. Ovarian fibromas are benign neoplasms, and the prognosis is extremely good. Surgical management should be an ovarian-sparing tumor excision. Although uncommon in pediatric patients, ovarian fibromas should be included in the differential diagnosis of ovarian mass in children.

Reply: Letter to the Editor by Zorli et al.

The letter by Zorli et al. highlights that right heart failure may be an independent cause of CA125 elevation. The topic of CA125 as a marker of congestive heart failure is very interesting and I am glad the authors found my article enjoyable. As elevations of CA125 are not solely limited to specific causes of heart failure I had only included references (originally numbered 52 and 53) that indirectly related to right heart failure in tricuspid stenosis [ [1] Gupta S. Maheshwari A. Wuntkal R. Mazid T. Tongaonkar H.B. Diagnostic dilemma in an elderly woman with intractable ascites and elevated CA-125 level. J Assoc Phys India. 2006; 54: 655-656 PubMed Google Scholar ] and atrial septal defect [ [2] Mathew B. Bhatia V. Mahy I.R. Ahmed I. Francis L. Elevation of the tumor marker CA125 in right heart failure. South Med J. 2004; 97: 1013-1014 Crossref PubMed Scopus (12) Google Scholar ]. The authors’ recent work adds to the specific link of CA125 to right heart failure, and is a useful addendum to readers, however this was not available to me at the time of writing my review. Of particular interest is the question of whether heart failure and inflammation act synergistically to elevate serum CA125 levels and this could be quite important in COPD where inflammation is often present.

Pseudomyxoma peritonei treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: results from a single centre

Pseudomyxoma peritonei (PMP) is a rare, slowly progressive disease whose prognosis depends primarily on the completeness of cytoreduction. The value of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and of additional factors predicting long-term outcome and disease-free survival (DFS) remains poorly understood. This study aims to analyse survival rates and prognostic factors in patients undergoing maximal cytoreduction and HIPEC. Thirty patients were selected from a prospective database of records for patients undergoing cytoreduction and HIPEC with mitomycin C or paclitaxel. Overall survival (OS), DFS, and the prognostic factors influencing them, were examined using multivariate analysis. Median follow-up was 44 months (range, 8-144). Histological classification of PMPs was DPAM in 6/30 of cases, PMCA-I in 10/30 and PMCA in 14/30. Complete cytoreduction (CC-0 and CC-1) was achieved in 28/30 of patients and CC-2 in 2/30. Median OS was 111 months (range 0-230) and five-year OS rate was 67%. Median DFS was 53.5 months (range 0-120) and 5-year DFS rate was 44%. Incomplete cytoreduction, lymph node involvement and PCI>20 were associated with poor prognosis for OS, while lymph node involvement, elevated CA-125 levels, unfavourable histology and previous chemotherapy were associated with poor outcomes for DFS. There was morbidity of Grade 3 or higher in 9/30. Post-operative mortality occurred in 1 case. Cytoreduction plus peritonectomy procedures combined with HIPEC is a safe treatment and could improve survival rates. Since the optimal cytoreduction is the primary prognostic factor, patients should be centralised under the care of experienced teams.

Performance of Serum CA125 as a Prognostic Biomarker in Patients With Uterine Papillary Serous Carcinoma

Serum CA125 is a potential biomarker for metastatic disease and recurrence in patients with uterine papillary serous carcinoma (UPSC). All patients with UPSC who had preoperative CA125 measurement and surgical staging between 1998 and 2008 at the participating institutions were included in this analysis (N = 52). Data were extracted from patients' records. Fisher exact and χ² tests were used to assess the association of CA125 levels with clinical and pathological variables. The correlation between CA125 levels (high/low) and lymph node metastases (positive/negative) was evaluated using Spearman correlation coefficients. The association of CA125 elevation with recurrence-free survival was assessed using Cox proportional hazards regression modeling. Preoperative CA125 elevation (>30 U/mL) was observed in 9 (17%) patients and was associated with advanced International Federation of Gynecologists and Obstetricians (FIGO) stage III/IV disease (P = 0.002), lymph node involvement (P = 0.007), and presence of omental metastases (P = 0.001). Disease recurrence and survival data were available for 51 of the 52 patients. During a mean follow-up time of 36 months, 15 (29%) patients experienced disease recurrence and 10 (19%) patients died. There was a moderate positive correlation between CA125 levels and lymph node metastases (r² = 0.39). On multivariate survival analysis, an elevated CA125 level compared to nonelevated CA-125 was not associated with disease recurrence (hazard ratio, 1.61; 95% confidence interval, 0.55-4.77). Preoperative CA125 levels were significantly associated with metastatic disease in patients with UPSC. However, in this study of surgically staged UPSC patients, preoperative CA125 elevation was not an independent predictor of disease recurrence.

Triacylglycerol Accumulation Activates the Mitochondrial Apoptosis Pathway in Macrophages

Programmed cell death of lipid-laden macrophages is a prominent feature of atherosclerotic lesions and mostly ascribed to accumulation of excess intracellular cholesterol. The present in vitro study investigated whether intracellular triacylglycerol (TG) accumulation could activate a similar apoptotic response in macrophages. To address this question, we utilized peritoneal macrophages isolated from mice lacking adipose triglyceride lipase (ATGL), the major enzyme responsible for TG hydrolysis in multiple tissues. In Atgl−/− macrophages, we observed elevated levels of cytosolic Ca2+ and reactive oxygen species, stimulated cytochrome c release, and nuclear localization of apoptosis-inducing factor. Fragmented mitochondria prior to cell death were indicative of the mitochondrial apoptosis pathway being triggered as a consequence of defective lipolysis. Other typical markers of apoptosis, such as externalization of phosphatidylserine in the plasma membrane, caspase 3 and poly(ADP-ribose) polymerase cleavage, were increased in Atgl−/− macrophages. An artificial increase of cellular TG levels by incubating wild-type macrophages with very low density lipoprotein closely mimicked the apoptotic phenotype observed in Atgl−/− macrophages. Results obtained during the present study define a novel pathway linking intracellular TG accumulation to mitochondrial dysfunction and programmed cell death in macrophages.

Unilateral malignant struma ovarii in a case of bilateral ovarian teratoma with raised CA-125 level: A rare case with treatment dilemmas

Struma ovarii are specialized form of mature ovarian teratoma comprised predominantly of thyroid tissue (>50%). Most of the struma ovarii are benign; rarely can they undergo malignant transformation. Elevated CA-125 levels with benign struma ovarii have been seen in only 5 cases in literature. The association of malignant struma ovarii and high CA-125 levels with pseudo-Meig syndrome has been reported in only 2 cases in English literature. We describe a case of a 46-year-old multigravida who presented with an abdominal mass and raised CA-125 levels. Radiological investigations revealed bilateral cystic adnexal masses with ossified elements on left side suggesting a teratoma. Intraoperative frozen section and final pathology revealed bilateral teratoma with follicular variant of papillary thyroid carcinoma arising in the left ovary. To the best of our knowledge, this is the first case of malignant struma ovarii in combination with bilateral teratoma. The dilemmas related to preoperative diagnoses with elevated CA-125 levels, mimicking an epithelial ovarian neoplasm; intraoperative frozen section consultation; management and follow-up issues in this rare malignancy are discussed.

Port-site metastasis of advanced primary peritoneal cancer after laparoscopic peritoneal biopsy: A case report

Due to the advancement in laparoscopic surgery in gynecology, laparoscopic surgery of patients with gynecologic malignancy is widely used. A 69-year-old woman who had elevated serum level of CA-125 and malignant ascites was transferred from general surgery after laparoscopic peritoneal biopsy. She complained about 2.5 cm sized abdominal wall mass which developed only 1week after surgery. With the impression of ovarian cancer with port-site metastasis, we performed debulking operation and abdominal wall mass excision. The final pathology confirmed primary peritoneal serous papillary adenocarcinoma. Whenever a female patient has elevated serum level of CA-125 and ascites cytology shows adenocarcinoma, she should be referred to gynecologic oncologists fiAnd considering the primary peritoneal or ovarian cancer, primary debulking operation by gynecologic oncolog ist is recommended.

Significance of the serum CA-125 level in intrauterine insemination cycles

ObjectiveThere are limited data regarding the significance of elevated serum CA-125 level during IUI cycles, even though it is used widely during the initial evaluation of infertile patients. The aim of this study was to investigate the prognostic value of serum CA-125 levels during IUI cycles.MethodsAmong the patients with controlled ovarian stimulation and IUI cycles at Seoul National University Hospital from Jan 2005 through Dec 2009, 92 cases with no identified endometriotic lesion, ovarian tumor, salpingeal lesion, or uterine myoma were selected. To compare the clinical characteristics between the pregnancy group and the non-pregnancy group, the Mann-Whitney U test and Fisher's exact test were used.ResultsThe overall pregnancy rate was 18.5% (17/92). The pregnancy group showed a higher number of follicles 16 mm in diameter (p=0.036), endometrial thickness (p<0.001), ampules of gonadotropin (p=0.009), and higher body mass index (p=0.022) than the non-pregnancy group. No significant difference was observed in the serum CA-125 level or the proportion of patients with CA-125 exceeding 17 IU/mL between the two groups.ConclusionThe prognostic value of serum CA-125 level among infertile patients with IUI cycles is considered limited.

Extraordinarily elevated serum levels of CA 19-9 and rapid decrease after succesfull therapy: A case report and review of literature

Carbohydrate antigen 19-9 is most valuable as a serum marker for pancreatic and biliary cancer, but increased concentrations occur in several other gastrointestinal malignancies. A carbohydrate antigen 19-9 value of >1,000 U/ml usually indicates a digestive cancer and has been reported to have a specificity greater than 99% for pancreatic cancer; nevertheless, false-positive results owing to benign diseases such as pancreatitis or liver cirrhosis have been noted. We present a patient with cholelithiasis and choledocholithiasis with acute cholangitis who had very high serum levels of carbohydrate antigen 19-9 (9586 IU/ml). The rapid decrease in carbohydrate antigen 19-9 after successful treatment was as interesting as the pretreatment high serum level of carbohydrate antigen 19-9.

A Complicated Hematometra and Fallopian Tubal Occlusion in Uterine Didelphys With Unilateral Cervical Atresia

Uterine anomalies are uncommon Mullerian malformations without known etiology. Many hypotheses have been put forward to explain these anomalies such as the involvement of genetic, environmental, and pharmacological issues [1]. The incidence is reported to be between 0.5–5.0% of all women [2]. However, a congenital uterine anomaly involving cervical atresia is extremely rare. We report a patient, diagnosed with a uterine anomaly, who underwent a primary laparotomy for unilateral endometrioma without resectioning of the rudimentary horn. Postoperatively, the patient received 6 months of gonadotropin-releasing hormone agonist (GnRHa) treatment as a conservative therapy. After completion of the GnRHa therapy, endometriosis recurred and a hematometra developed. This occurred after her menstrual cycle had resumed for 3 months post GnRHa treatment. The patient underwent a second laparotomy and the rudimentary horn was resectioned. Recovery after the operation was uneventful. The final diagnosis of the uterine anomaly in this patient was uterine didelphys with unilateral cervical atresia. A 23-year-old nulligravid woman had complained of dysmenorrhea since menarche at the age of 14 years in 1999 and this had been partially relieved with medical management. At the age of 22 years during April 2007, the patient presented with acute abdominal pain in the left lower quadrant, in which an abdominal mass was palpable. Pelvic ultrasonography by a primary gynecologist revealed a 10 × 10 × 10 cm complex mass of the left adnexa with multiple cysts and septa. A bimanual pelvic examination showed a single vagina and single cervix. Computed tomography (CT) revealed a multicystic mass associated with the left ovary, possibly endometrioma, and two uterine horns indicating the possibility of a bicornuate uterus (Figures A and B). The right kidney was enlarged and the left kidney was absent. An elevated serum CA-125 level of 8,640 U/mL was noted. The patient underwent exploratory laparotomy by the primary gynecologist. The findings included a 10 cm left ovarian endometrioma, severe endometriosis involving the cul-de-sac and the pelvis, as well as layering of hemosiderin throughout the uterine horns, the pelvis and the omentum. Fibrous adhesions involving the sigmoid colon, small intestine and pelvic sidewall were also noted. The right uterine horn and the right fallopian tube were normal in appearance; a right ovary could also be identified. The uterine anomaly was thought to be a bicornuate uterus. Left partial oophorectomy and lysis of the adhesions were performed. The pathological findings revealed ovarian endometrioma and endometriotic cysts that had endometrial epithelium and hemosiderin-laden macrophages. Postoperatively, the patient recovered quickly and was prescribed 6 months of GnRHa therapy.

Highly elevated serum CA-125 levels in patients with non-malignant gynecological diseases

To identify patients with highly elevated serum CA-125 levels and analyze their clinical characteristics. Patients with non-malignant gynecologic disease (NMGDs, n = 41), in whom serum CA-125 levels were over 1,000 IU/ml were retrospectively enrolled in the study. Seventy-one patients with epithelial ovarian cancer (EOC), in whom, serum CA-125 levels were over 1,000 IU/ml were included as the comparison group. Clinical parameters were compared between the two groups. In NMGDs group, 43.90% of the patients had endometriosis. The median of serum CA-125 level in NMGDs was much lower than that of EOC subjects (P < 0.001). Compared to EOC group, the patients in NMGDs group were much younger (P < 0.001) and had fewer histories of pelvic masses (P < 0.001) but had more clinical complaints such as acute abdominal symptoms (P < 0.001) and/or abnormal vaginal bleeding (P = 0.022). Clinical progresses of these two groups were correlated with changes of serum CA-125 levels by follow-up for up to 386 days. High levels of serum CA-125 were found not only in the EOC, but also in some NMGDs, especially in the reproductive patients with complaints of acute abdomen symptoms or abnormal vaginal bleeding.