Elevated Serum CA-125 Levels Research Articles

CA125 expression in patients with non-Hodgkin's lymphoma

The present study investigated the possible clinical significance of serum CA125 levels in patients with non-Hodgkin's lymphoma (NHL) and the mechanism of secretion. Serum CA125 levels in 335 patients with NHL were measured by enzyme-linked immunosorbent assay. The tissue CA125 expression in 22 patients with NHL was performed on paraffin section by immunohistochemical methods. One hundred and ninety-eight cases (59.1%) were found to have elevated serum CA125 levels. Serum CA125 levels were associated with clinical stage, effusions, high serum lactate dehydrogenase and β2-M levels, and response to therapy. Microscopically, immunohistochemical staining revealed that malignant tumor cells demonstrated negative CA125 expression in all of the 22 cases. Our results suggested that serum CA125 levels could be an interesting tumor marker in NHL. The immunohistochemical study suggested that CA125 appeared not to be secreted by lymphoma cells directly.

CA19-9 may have clinical significance in mature cystic teratomas of the ovary

The objective of this study was to evaluate size, bilaterality, histopathologic origin, and the serum levels of some tumor markers in patients with mature cystic teratomas (MCTs) of the ovary. Retrospective study of 80 patients operated at Department of Obstetrics and Gynecology, Gulhane Military Medical Academy, Turkey, between the years 1998 and 2003 was performed. The mean age was 33.1 +/- 11.3 years (median 34; range 15-69). The mean tumor diameter was 7.2 +/- 4.5 cm (median 5; range 3-20). The mean serum CA19-9 level was 101.2 +/- 179.7 IU/mL (range 1-841, normal value < 37), the mean serum CA125 level was 32.0 +/- 37.8 U/mL (range 2.2-205, normal value < 35), the mean carcino-embryogenic antigen (CEA) level was 1.46 +/- 1.20 ng/mL (range 0.2-4.8, normal value 3.4), and the mean serum alpha-fetoprotein (AFP) level was 2.7 +/- 3.0 ng/mL (range 0.1-10.5, normal value <8.1). The elevated rate of CA19-9, CA125, CEA, and AFP was 38.8% (31/80), 25% (18/72), 9.1% (4/44), and 8.7% (4/46), respectively. The bilaterality rate was 27.5% (22/80). Patients with an elevated serum CA19-9 level showed significantly higher bilaterality rate (51.6% versus 12.2%, P < 0.05) than the patients with low levels. Likelihood ratio for bilaterality was 2.8 for CA19-9 and 4.6 for CA125. Bilateral teratomas showed a significantly higher rate of ectodermal component than the unilateral ones (100% versus 74.3%, P < 0.05). Ovarian MCTs were diagnosed especially during the reproductive period. CA19-9 may be the only important marker in the diagnosis of MCTs. Elevated levels of CA19-9 and CA125 may be an indicator of bilaterality. Since levels of CA19-9 and CA125 may be elevated in both benign and malignant conditions, interpretation of these findings must be made in light of the clinical condition of the patient.

CA19-9 may have clinical significance in mature cystic teratomas of the ovary

The objective of this study was to evaluate size, bilaterality, histopathologic origin, and the serum levels of some tumor markers in patients with mature cystic teratomas (MCTs) of the ovary. Retrospective study of 80 patients operated at Department of Obstetrics and Gynecology, Gulhane Military Medical Academy, Turkey, between the years 1998 and 2003 was performed. The mean age was 33.1 ± 11.3 years (median 34; range 15–69). The mean tumor diameter was 7.2 ± 4.5 cm (median 5; range 3–20). The mean serum CA19-9 level was 101.2 ± 179.7 IU/mL (range 1–841, normal value &lt;37), the mean serum CA125 level was 32.0 ± 37.8 U/mL (range 2.2–205, normal value &lt;35), the mean carcino-embryogenic antigen (CEA) level was 1.46 ± 1.20 ng/mL (range 0.2–4.8, normal value 3.4), and the mean serum alpha-fetoprotein (AFP) level was 2.7 ± 3.0 ng/mL (range 0.1–10.5, normal value &lt;8.1). The elevated rate of CA19-9, CA125, CEA, and AFP was 38.8% (31/80), 25% (18/72), 9.1% (4/44), and 8.7% (4/46), respectively. The bilaterality rate was 27.5% (22/80). Patients with an elevated serum CA19-9 level showed significantly higher bilaterality rate (51.6% versus 12.2%,P&lt; 0.05) than the patients with low levels. Likelihood ratio for bilaterality was 2.8 for CA19-9 and 4.6 for CA125. Bilateral teratomas showed a significantly higher rate of ectodermal component than the unilateral ones (100% versus 74.3%,P&lt; 0.05). Ovarian MCTs were diagnosed especially during the reproductive period. CA19-9 may be the only important marker in the diagnosis of MCTs. Elevated levels of CA19-9 and CA125 may be an indicator of bilaterality. Since levels of CA19-9 and CA125 may be elevated in both benign and malignant conditions, interpretation of these findings must be made in light of the clinical condition of the patient.

Markedly Elevated CA 19–9 Levels in a Patient with Jaundice

Carbohydrate antigen 19–9 (CA 19–9) can be elevated in pancreatic adenocarcinoma, other GI malignancies, and a host of benign conditions. Few cases however have been reported with values markedly elevated in a benign condition. We report a case of a patient with a markedly elevated CA 19–9 that led to an exhaustive workup to find a non-existent pancreatic “mass”. Case: A 43 year-old male was admitted for evaulation of abdominal pain, nausea, and vomiting. He also noted progressive jaundice and a 50 lb weight loss over 6 months. Prior to admission, he was on a 6 month alcholic binge. Exam revealed jaundice, scleral icterus, and hepatomegaly. Initial labs: Total bilirubin 27.2 mg/dl, direct bilirubin of 17.5 mg/dl, AST 136 IU/L, ALT 126 IU/L, and alkaline phosphatase 359 IU/L. CT of the abdomen showed a 7 cm pancreatic pseudocyst with suspicion of mass. Because of the “suspicion of mass”, and profound jaundice, a CA 19–9 was obtained (5275 U/ML). Because the CA 19–9 was elevated, an extensive workup was undertaken to evaluate the “mass”. MRCP showed fatty infiltration of liver, pancreatic pseudocyst, and chronic pancreatitis, but no dilatation of the common bile duct. A viral hepatitis panel, EBV, CMV, and HIV were negative. The patients bilirubin increased to 38 mg/dl by one week after admission. Because of continued concern for malignancy, an ERCP was performed which showed no abnormalities. Ductal brushings were negative for malignant cells. A Fine needle aspiration of the pseudocyst showed no malignant cells. After one week, the bilirubin started to fall and by 1 month, it was 1.1 mg/dl. A repeat CA 19–9 at 1 month was 8584 U/ml. An endoscopic ultrasound again revealed no mass. CA 19–9 levels decreased to 171 U/ml at 2 month follow up. A repeat CT scan 6 months after presentation showed a decrease in the size of the pseudocyst and no “mass”. At 6 months, the patient has stopped drinking and is asymptomatic. Conclusions: Markedly elevated serum levels of CA 19–9 are associated with pancreatic cancer, however, it can also occur in some non-malignant conditions. Ordering a CA 19–9 test in a situation where there is limited suspicion of pancreatic carcinoma (questionable mass) may lead to an unnecessary, risky, and expensive work-up.

Greatly Elevated Serum CA-125 Level in a Patient with a Ruptured Endometrioma

Introduction: The clinical relevancy of the serum CA-125 antigen level in assessing gynecologic malignancy has been well established, particularly in ovarian cancer. However, there have been limited case studies reported in the literature of patients with benign disease who have exhibited extremely high CA-125 levels. Case Report: A 43-year-old woman presented with abdominal pain. Her preoperative serum CA-125 level was 2275 U/mL, suggestive of an ovarian malignancy. Surgical findings and histologic evaluation revealed a ruptured ovarian endometrioma. Conclusion: The serum CA-125 marker has often been used to assess malignancy status. Because there are only scant cases of patients with highly elevated CA-125 levels who have exhibited benign findings reported in the literature, gynecologic patients who present with greatly elevated serum CA-125 levels and a pelvic mass should be evaluated for an ovarian malignancy. (J GYNECOL SURG 21:117)

Prognostic Importance of Preoperative CA-125 in International Federation of Gynecology and Obstetrics Stage I Epithelial Ovarian Cancer: An Australian Multicenter Study

To evaluate the prognostic significance of preoperative CA-125 levels on overall survival of patients with International Federation of Gynecology and Obstetrics (FIGO) stage I epithelial ovarian cancer (EOC). Data from 518 patients with FIGO stage I EOC treated in seven gynecologic oncology centers throughout Australia between 1990 and 2002 were analyzed. Patients with borderline tumors and nonepithelial ovarian carcinomas were excluded, as were women in whom CA-125 had not been determined preoperatively. Preoperative CA-125 levels were studied in surgically staged and incompletely staged patients and compared with prognostic factors, such as substage, grade, and histologic type. Multivariate Cox models were calculated. CA-125 levels more than 30 U/mL were associated with higher grade, substage 1B and 1C, nonmucinous histologic type, and older age. In univariate analysis, higher histologic grade, the absence of surgical staging, and preoperative CA-125 levels more than 30 U/mL were associated with impaired survival. Multivariate analysis identified histologic grade, preoperative CA-125, and surgical staging as independent predictors for survival. In the subgroup of completely surgically staged patients, the 5-year overall survival rate was 82% (95% CI, 76% to 88%) for patients with CA-125 levels more than 30 U/mL and 95% (95% CI, 90% to 99%) for patients with CA-125 levels of 30 U/mL or less (P = .028). In the group of incompletely staged patients, the 5-year survival rates were similar for patients with elevated and normal serum CA-125 levels. Complete surgical staging, histologic grade, and preoperative serum CA-125 levels are independent prognostic factors and should be included in the decision making for chemotherapy.

Discordance Between Serum Level and Tissue Immunohistochemical Staining of CA125 in Endometrioid Adenocarcinoma of the Uterine Corpus

This study was designed to correlate tissue expression of CA125 with the corresponding serum value in endometrial cancer. The records of 52 endometrioid adenocarcinomas diagnosed were reviewed. Serum CA125 levels were examined before definitive surgery, and 20 U/ml was used as the cutoff value. Immunohistochemical staining for CA125 was assessed according to the ImmunoReactive Score. Statistical analyzes were performed to identify independent factor for high serum CA125 levels, including CA125 staining and the conventional pathologic features. Elevated serum CA125 levels were found in 15 of 52 patients (29%) (range, 0.1-172.1; mean 22.6 U/ml). The frequency of positive CA125 tissue staining (35/52, 67%) tended to be higher than that of elevated serum levels (p = 0.046). Fifteen patients with elevated serum CA125 levels statistically differed from the remaining 37 patients with normal serum CA125 level with respect to International Federation of Gynecology and Obstetrics (FIGO) stage (p = 0.027) and lymph node metastasis (p = 0.024), and tended to have positive washing cytology (p = 0.052). In multivariate analysis, elevated serum CA125 significantly correlated only with FIGO stage III, but not with tumor size or CA125 tissue staining. Intrauterine tumor may not be the main source of serum CA125 in endometrial cancer, and elevated serum level is closely related to the presence of disseminated cancer cells in the peritoneal cavity.

A case of unilateral gravid macromastia in 23-year-old japanese woman associated with elevated serum CA19-9

We report a rare case of gravid macromastia (GM) treated after delivery. A 23-year-old woman with left breast enlargement was referred to our hospital. Laboratory investigations revealed an elevated serum CA19-9 level of 200.3 U/ml. Gravid macromastia was diagnosed by clinical examination (US, MRI) and 11G mammotome biopsy. Tumorectomy of the left breast and mammoplasty were performed. The mass had proliferated to the exclusion of normal gland. Histological examination revealed abundant proliferation of stromal loose connective tissue and interposed fat cells surrounding normal and lactating lobules. The epithelial cells were positive for CA19-9 on immunohistochemical staining. Serum CA19-9 decreased to normal levels 3 months after operation. GM is exceedingly rare and occurs in less than 0.001-0.003% of all pregnant women. Once established, the condition is likely to continue to successive pregnancies. This benign tumor is sometimes difficult to distinguish from malignant tumors since it shows few histological characteristics and grows rapidly. Attention is necessary to diagnose tumors of the breast during pregnancy.

Analysis of Metastatic Involvement of Interpectoral (Rotter's) Lymph Nodes Related to Tumor Location, Size, Grade and Hormone Receptor Status in Breast Cancer

This study was aimed at analyzing metastatic involvement in interpectoral (Rotter's) lymph nodes in relation to tumor location, size, grade and hormone receptor status in primary breast cancer. The study included 172 female patients undergoing surgery for breast cancer at the University Hospital for Tumors, Zagreb, Croatia from November 2001 to August 2003. In addition to the standard surgical procedure, interpectoral (Rotter's) lymph nodes were removed in all of the patients. Serum levels of the tumor marker CA 15-3 were determined before surgery and hormone receptor status after surgery. Rotter's lymph nodes were identified in 67% of the patients, with metastatic involvement being found in 20% of the Rotter's nodes. Metastatic involvement of Rotter's nodes in patients with negative and positive axillary lymph nodes was 4% and 35%, respectively. When we looked at the location of the tumor in patients with metastatic involvement of Rotter's nodes, we found that tumors located in the upper quadrants were more prone to metastasis to Rotter's nodes; there was a significant positive correlation between tumor location and positive Rotter's nodes (r = 0.953, P = 0.012). As regards tumor size, Rotter's nodes were identified in 15%, 20% and 30% of stage T1 (< 2 cm), T2 (2-5 cm) and T3 (> 5 cm) tumors, respectively. Hormone receptor status showed no statistically significant difference in the expression of estrogen and progesterone receptors between patients with and those without positive Rotter's nodes. Of 35 Rotter's node-positive patients, 31.4% had elevated serum levels of CA 15-3; the level was significantly higher in Rotter's-positive patients compared to those with negative (or absent) Rotter's nodes. The results show that one-fifth of breast cancer patients, or even one-third of those with positive axillary lymph nodes, are discharged with positive interpectoral lymph nodes that remain undiagnosed. As the nodes can be surgically removed without additional mutilation, exploration of Rotter's lymph nodes should be introduced into routine clinical practice.

Combined positron emission tomography and computed tomography for the detection of recurrent ovarian mucinous adenocarcinoma

Background The role of combined positron emission tomography and computed tomography (PET-CT) in the diagnosis of recurrent ovarian mucinous adenocarcinoma is uncertain because of previous reports that PET has limited sensitivity in the detection of mucinous neoplasms. Case A 71-year-old white woman presented with complaints of right lower quadrant pain and a palpable adnexal mass. Physical examination and transvaginal ultrasonography revealed a 12 × 13 cm cystic mass in the left side of the pelvis. Exploratory laparotomy, optimal tumor-reductive surgery, total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, and omentectomy were performed. The diagnosis was FIGO stage IIIC well-differentiated ovarian mucinous adenocarcinoma. The patient was treated with 6 cycles of carboplatin and paclitaxel. Four months after completing chemotherapy, the patient was noted to have an elevated serum CA125 level (72 U/mL), being otherwise asymptomatic. Findings on abdominal and pelvic CT were compatible with postsurgical changes. PET-CT was performed and revealed increased metabolism along the posterior aspect of the right rectus abdominis muscle and abutting the anterior wall of an adjacent loop of bowel. Conclusion PET-CT may identify clinically occult recurrent ovarian mucinous adenocarcinoma.

Abdominal/pelvic Coccidioidomycosis

Background Coccidioidomycosis is the second most common endemic fungal infection in the southwestern United States. Rarely, this fungal infection exhibits symptoms suggestive of peritoneal malignancy, such as ascites and abdominal pelvic masses. Case We present a case involving a 51-year-old woman who presented with abdominal pain, ascites, and elevated serum CA-125 levels in 1995. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Final pathology revealed Coccidioidomycosis. Following prolonged treatment with fluconazole, her fungal symptoms resolved completely. Conclusion Patients with Coccidioidomycosis have a good prognosis if they are optimally diagnosed and treated. Ascites and elevated serum CA-125 levels associated with Coccidioidomycosis are not documented in the literature. Although extremely rare, abdominal Coccidioidomycosis could be considered in the differential diagnosis in patients who present with ascites or elevated serum CA-125 levels.

Serous psammocarcinoma of the ovary: a case report and review of literature

Background. Serous psammocarcinoma is a form of ovarian carcinoma, characterized by massive psammoma body formation, invasiveness, and low-grade cytological features. We reported a new bilateral case of serous psammocarcinoma. We also reviewed the literature in order to delineate clinical, pathological, and prognostic features of this rare neoplasm. Case History. A 66-year-old white woman was admitted to our Institution for a voluminous abdomino-pelvic mass, which was suspected to be a leiomyoma of the uterus. Abdominal computed tomography scan revealed a heavily calcified abdominopelvic mass with cystic areas. The origin of this lesion was unclear in diverse scanning of computed tomography. Elevated serum CA-125 levels suggested the eventuality of an ovarian neoplasm. Thus, the patient underwent an exploratory laparotomy. Intraoperatory findings showed two ovarian calcified lesions. The surface of omentum was covered with a white nodule. Pathological findings were consistent with serous psammocarcinoma with invasive implant of the omentum. Conclusion. Serous psammocarcinoma is a rare form of ovarian carcinoma with only 13 cases reported in literature. Patient's age can range from 18 to 76 years. Prognostic factors suggest that this neoplasm has more favorable prognosis than usual serous carcinomas. It is important to differentiate these two neoplasms and other pelvic mass, such as calcified leiomyoma.

Can Optimal Primary Cytoreduction Be Predicted in Advanced-Stage Epithelial Ovarian Cancer?

Forty patients (median age, 59.5 years) with stage III ovarian cancer underwent primary cytoreductive surgery at Cambridge Cancer Centre. Their median preoperative serum CA-125 levels were 467 U/mL (range, 19-10,000 U/mL). Only 2 women did not have an elevated serum CA-125 level. After surgery, the residual tumor was 1 cm or less in 22 patients (55%) and considered optimally cytoreduced. Residual disease was 1 to 2 cm in 4 patients and larger than 2 cm in 14 (35%). These patients had suboptimal cytoreduction. They had significantly higher preoperative serum CA-125 levels than those who had optimal cytoreduction (P = 0.021). The data were used to generate a receiver-operating characteristic (ROC) curve. The highest point of both sensitivity and specificity for prediction of optimal cytoreduction was achieved at a serum CA-125 threshold level of 500 U/mL (sensitivity 0.72, 95% confidence interval [CI] = 0.47-0.90; specificity 0.73, 95% CI = 0.50-0.89). In this study, 16 of the 21 patients (76%) who had optimal cytoreduction and 5 of the 18 (24%) who had suboptimal cytoreduction had serum CA-125 levels of less than 500 U/mL. Therefore, a serum CA-125 level of less than 500 U/mL had a positive predictive value of 68% and negative predictive value of 76% for optimal tumor cytoreduction.

Non-Hodgkin's lymphoma presenting as a pelvic mass with elevated CA-125

Background. We report a case of pelvic lymphoma with an elevated serum CA-125 level, initially misdiagnosed as ovarian carcinoma. A review of the literature is presented and a possible mechanism for CA-125 elevation in diseases other than ovarian cancer is discussed. Case. A 50-year-old woman presented with symptoms of progressive dyspnea, early satiety, fatigue, and weight loss. Workup revealed a pelvic mass and an elevated CA-125 level. Paclitaxel and carboplatin were administered to facilitate therapy and provide symptomatic relief for a presumed bulky ovarian carcinoma. A biopsy was obtained after the initiation of chemotherapy, yielding the diagnosis of diffuse large B cell non-Hodgkin's lymphoma, stage II-B. A regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone followed by radiotherapy resulted in long-term disease remission. A search of the literature revealed several clinical series describing the elevation of CA-125 in a variety of diseases, both benign and malignant. Conclusions. In the setting of a newly diagnosed pelvic mass, care should be taken when interpreting an elevated CA-125 level. While ovarian cancer is high on the list of differential diagnoses, lymphoma cannot be excluded until a tissue diagnosis is obtained.

A syndrome of hereditary pancreatic adenocarcinoma and cysts of the liver and kidneys

Pancreatic adenocarcinoma is the fifth leading cause of cancer death in developed countries. Several family and population studies have suggested that there is a genetic predisposition in about 10% of cases. Despite this, pedigrees showing a definite Mendelian inheritance pattern are quite rare. Recently, a family came to our attention with several cases of pancreatic adenocarcinoma. A detailed family medical history was obtained from the index patient. Medical records, including death certificates, histopathology, radiology, and laboratory reports from several family members were reviewed. Computerized tomography scans and CA19-9 serum assays were performed on selected family members. The family seems to have a syndrome of autosomal dominant adenocarcinoma of the pancreas, accompanied by multiple cysts of the liver and kidneys. Affected family members without pancreatic cancer have elevated serum CA19-9 levels. This seems to be a previously undescribed syndrome. The family may be carrying a tumor suppressor gene mutation specific for pancreatic adenocarcinoma.

Primary pancreatic lymphoma with elevated serum CA19-9 level

Primary pancreatic lymphoma with elevated serum CA19-9 level

Prognostic Value of Carcinoembryonic Antigen, CA 19-9 and CA 72-4 in Gastric Carcinoma

The prognostic value of preoperative serum levels of carcinoembryonic antigen (CEA), CA 19-9 and CA 72-4 tumor markers was investigated in patients with gastric cancer. Eighty-two patients who underwent surgical resection of gastric cancer were entered in the study. Correlation analyses showed that CA 72-4 was more frequently positive in patients with advanced tumors (p = 0.04), lymph node invasion (p = 0.02), liver metastasis (p = 0.02) and peritoneal involvement (p = 0.03). CA 19-9 was more frequently positive in patients with advanced tumors (p = 0.01) and with serosal (p = 0.04), lymph node (p = 0.008) and peritoneal involvement (p = 0.02). CEA was more frequently positive in patients with liver metastasis (p = 0.03). Low 3-year cumulative survival was significantly associated with elevated serum levels of CA 72-4 (p = 0.004), CA 19-9 (p = 0.001) and CEA (p < 0.001). Age, tumor stage and CA 72-4 provided prognostic information in the multivariate analysis. Patients with elevated serum levels of CA 72-4 showed a 4.2 times higher risk of death than patients with low levels of the marker. Our results suggest that CA 72-4 has prognostic value in gastric cancer, and patients with a high preoperative serum level of CA 72-4 have a greater risk of death due to gastric cancer.

Evaluation of serum CEA and CA19-9 levels as prognostic factors in patients with gastric cancer.

BACKGROUND: This clinicopathological study evaluated the utility of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 as predictors of locoregional recurrence and long-term disease-free survival in patients with gastric cancer.METHODS: During the period January 1989 to December 1994, 485 patients with primary gastric cancer were evaluated. Gastrectomies were performed in 434 patients. Prognostic factors were analyzed by the Kaplan-Meier method and multivariate analysis, using Cox regression.RESULTS: Elevated serum CEA and CA19-9 levels were observed in 92 of the 485 patients (19.0%), and in 95 of the 435 patients (21.8%), respectively, and both markers were elevated in 29 of these 435 patients (6.7%). Elevated serum CEA and CA19-9 levels correlated well with lymph node metastasis, lymphatic invasion, vessel invasion, stage grouping, depth of invasion, and curability. Patients with elevated serum CEA levels were at significantly higher risk of having all recurrence factors than were those with normal serum CEA levels. Patients with elevated serum CA19-9 levels were at significantly higher risk of having peritoneal metastases and distant metastases than were those with normal serum CA19-9 levels. A significant difference in the cumulative survival curves of patients was demonstrated between those with elevated and those with normal serum CEA or CA19-9 levels, even for patients at the same disease stage (stage III). Patients with elevated levels of both markers had a significantly worse prognosis than patients in whom the levels of both markers were normal. In patients who underwent gastrectomy, elevated serum CEA levels either preoperatively or within 3 weeks after gastrectomy were associated with significantly worse prognosis than were normal levels. When the cutoff level of serum CEA was increased to 10 ng/ml, serum CEA, age, lymph node metastasis, and surgical stage grouping were selected as independent prognostic factors by multivariate analysis of 14 prognostic factors, using Cox regression.CONCLUSION: Serum CEA and CA19-9 levels provide additional prognostic information in patients with primary gastric cancer. In particular, an elevated serum CEA level provides additional prognostic information and is a useful indicator of curability in patients who undergo gastrectomy. Serum CEA level is an independent prognostic factor in patients with primary gastric cancer.

Elevated Serum CA-125 Levels in Hemodialysis Patients with Peritoneal, Pleural, or Pericardial Fluids

Objective. Serum CA-125, an ovarian tumor marker, is used especially in the follow-up of ovarian cancer for monitoring the efficacy of therapy and for early detection of recurrence. A number of benign gynecologic as well as benign and malignant nongynecologic conditions are associated with elevated serum CA-125 levels. Malignant and nonmalignant serosal fluids were also found to be associated with high serum levels of CA-125, suggesting that the presence of fluid in the serosal cavities may stimulate its release.Methods. We performed a clinical study in 39 patients (21 females, 18 males) on chronic hemodialysis who were divided into two groups based on the presence of fluid in the serosal cavities (peritoneum, pleura, or pericardium) without clinical and radiologic evidence of neoplasia. There were 26 patients (16 females, 10 males) aged 50.11 ± 13.86 years (range, 20–76 years) in the serosal fluid-negative group (group 1) and 13 patients (8 females, 5 males) aged 45.30 ± 18.84 years (range, 17–73 years) in the serosal fluid-positive group (group 2). The control group consisted of 52 healthy volunteers (30 females, 22 males) aged 44.19 ± 12.59 years (range, 19–68 years).Results. Significantly elevated serum CA-125 levels were found in hemodialysis patients with serosal fluid (P < 0.05) when compared with both the hemodialysis patients without serosal fluid and the control group. There was no statistically significant difference between the control group and the patients without serosal fluids (P > 0.05).Conclusion. Although CA-125 can be considered a reliable tumor marker in patients undergoing hemodialysis, it should be interpreted with caution in patients with serosal fluids.

A CASE OF SPLENIC CYST WITH CA19-9 PRODUCTION

We experienced an extremely rare case of splenic cyst with a high serum CA19-9 level. A 21-year-old woman experienced left upper abdominal pain with sudden onset, and she was admitted to the department with a suspicion of intraabdominal mass. Ultrasonography, computed tomography, and magnetic resonance imaging of the abdomen revealed a large splenic cyst. Preoperative blood examination showed high levels of serum CA19-9 (16, 706U/ml)and CEA (34.5ng/ml). Under a diagnosis of CA19-9 producing splenic cyst, a laparoscopic splenectomy was performed. The cyst was 12cm in diameter and histopathologically epidemoid cyst. Intracystic CA19-9 and CEA levels were quite high (102, 820U/ml and 1, 169.3ng/ml, respectively). On immunohistochemical stainings with anti-CA19-9 and anti-CEA, the epithelium of the cyst revealed positive reactions. However, no malignancy was confirmed. Postoperative course was uneventful. After the surgery, both elevated serum CA19-9 and CEA levels normalized.