Humans ; Female ; Blood Platelets ; Ovarian Neoplasms/diagnosis*

Herein, a rare case of ovarian granulosa cell tumor, presenting as Meigs' syndrome, with elevated carbohydrate antigen 125 (CA125), is reported. A 69-year-old woman was admitted for the investigation of abdominal fullness and dyspnea. A preoperative examination revealed a huge pelvic tumor and an abdominopelvic magnetic resonance image (MRI) assumed ovarian cancer. A chest computed tomography (CT) scan revealed pleural effusion. A laparotomy confirmed the huge mass to be an ovarian tumor. A total abdominal hysterectomy (TAH), with a bilateral salpingo-oophorectomy (BSO) and partial omentectomy, was performed. Although short-term intrathoracic drainage was required, the hydrothorax and ascites rapidly resolved in the postoperative period.
Aged ; CA-125 Antigen/*blood ; Diagnosis, Differential ; Female ; Granulosa Cell Tumor/*diagnosis ; Humans ; Meige Syndrome/*diagnosis ; Ovarian Neoplasms/*diagnosis

PURPOSE: Mycobacterium tuberculosis is endemic in Korea. Because tuberculous peritonitis is characterized by ascites, abdominal pain, abdominal mass and elevation of serum CA-125, it can be confused with ovarian malignancies. The aim of this study was to evaluate the significance of serum CA-125 level in the differential diagnosis of tuberculous peritonitis and ovarian malignancy in a Mycobacterium tuberculosis-endemic area. MATERIALS AND METHODS: The medical records of patients diagnosed with tuberculous peritonitis (n=48) or epithelial ovarian malignancy (n=370) at Samsung Medical Center from January 2000 to October 2009 were retrospectively reviewed. RESULTS: Median serum CA-125 level in the epithelial ovarian cancer group was significantly higher than that in the tuberculous peritonitis group (p< or =0.01). Only one patient (2.1%) in the tuberculous peritonitis group had a serum CA-125 level over 2000 U/mL. However, 109 patients (29.5%) in the epithelial ovarian cancer group had a serum CA-125 level over 2000 U/mL. At the CA-125 ranges of 400 to 599 and 600 to 799, the proportions of those with tuberculous peritonitis were 24% and 21.9%, respectively. At a serum CA-125 level over 1000 U/mL, however, the proportion of tuberculous peritonitis was much lower (2.1%). CONCLUSION: Tuberculous peritonitis should be considered in the evaluation of female patients with ascites and high serum CA-125.
Ascites/*blood ; CA-125 Antigen/*blood ; Diagnosis, Differential ; Female ; Humans ; Multivariate Analysis ; Ovarian Neoplasms/blood/*diagnosis ; Peritonitis, Tuberculous/blood/*diagnosis ; Republic of Korea ; Retrospective Studies

OBJECTIVE: Thrombocytosis is an adverse prognostic factor in many types of cancer. We investigated if pre-treatment increased platelet counts provide prognostic information specifically in patients with stage III and IV serous ovarian cancer which is the most common clinical presentation of ovarian cancer. METHODS: Platelet number on diagnosis of stage III and IV serous ovarian adenocarcinoma was evaluated in 91 patients for whom there were complete follow-up data on progression and survival. Survival and progression free survival of patients with normal platelet counts (150-350 x10(9)/L) was compared with that of patients with thrombocytosis (>350x10(9)/L) by chi2 and logrank tests. RESULTS: The median age of the patients was 66 years-old. From the 91 patients, 52 (57.1%) had normal platelet counts (median, 273x10(9)/L; range, 153-350) at diagnosis of their disease and 39 patients (42.9%) had thrombocytosis (median, 463x10(9)/L; range, 354-631). In the group of patients with normal platelet counts, 24 of the 52 patients had died with a median survival of 43 months (range, 3-100). In the group of patients with thrombocytosis, 24 of the 39 patients had died with a median survival of 23 months (range, 4-79). In the entire group of 91 patients there was a statistically significant difference of the overall survival and progression-free survival between the two groups (logrank test P=0.02 and P=0.007, respectively). CONCLUSION: In this retrospective analysis of stage III and IV ovarian cancer patients, thrombocytosis at the time of diagnosis had prognostic value regarding overall survival and progression-free survival.
Adenocarcinoma ; Blood Platelets ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Ovarian Neoplasms* ; Platelet Count ; Prognosis ; Retrospective Studies ; Thrombocytosis*

OBJECTIVETo evaluate the ability of a risk of malignancy index (RMI), based on serum CA125 level, ultrasound findings and menopausal status, to discriminate benign from malignant pelvic mass.

METHODSOne hundred and forty women with pelvic masses, at age 30 of years or more were admitted to the Peking Union Medical College Hospital between January 1998 and June 1999. The sensitivity, specificity and positive predictive value of serum CA125 level, ultrasound findings and the menopausal status in diagnosis of ovarian cancer were evaluated separately or combined into the RMI.

RESULTSRMI was more accurate than any individual criterion in diagnosing cancer. Using an RMI cutoff level of 200 to indicate malignancy, the RMI derived from this data set gave a sensitivity of 87.3%, a specificity of 84.4%, and a positive predictive value of 82.1%.

CONCLUSIONSRMI is able to correctly discriminate malignant from benign pelvic mass. It can be introduced easily into clinical practice to facilitate the selection of patients for primary surgery.

CA-125 Antigen ; blood ; Female ; Humans ; Menopause ; Ovarian Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

Autoimmune hemolytic anemia associated with an ovarian teratoma is a very rare disease. However, treating teratoma is the only method to cure the hemolytic anemia, so it is necessary to include ovarian teratoma in the differential diagnosis of autoimmune hemolytic anemia. We report herein on a case of a young adult patient who had severe autoimmune hemolytic anemia that was induced by an ovarian teratoma. A 25-yr-old woman complained of general weakness and dizziness for 1 week. The hemoglobin level was 4.2 g/dL, and the direct and indirect antiglobulin tests were all positive. The abdominal computed tomography scan revealed a huge left ovarian mass, and this indicated a teratoma. She was refractory to corticosteroid therapy; however, after surgical resection of the ovarian mass, the hemoglobin level and the reticulocyte count were gradually normalized. The mass was well encapsulated and contained hair and teeth. She was diagnosed as having autoimmune hemolytic anemia associated with an ovarian teratoma. To the best of our knowledge, this is the first such a case to be reported in Korea.
Teratoma/*complications/diagnosis/surgery ; Ovarian Neoplasms/*complications/diagnosis/surgery ; Humans ; Female ; Diagnosis, Differential ; Blood Transfusion ; Anemia, Hemolytic, Autoimmune/diagnosis/*etiology/therapy ; Adult ; Adrenal Cortex Hormones/therapeutic use

OBJECTIVETo evaluate the clinical pathological characteristics, treatment and prognosis of ovarian carcinosarcoma.

METHODSThe clinical, pathological and follow-up data of 12 cases of ovarian carcinosarcoma treated in Cancer Center of Sun Yat-sen University from May, 2002 to May, 2009 were analyzed retrospectively.

RESULTSThe 12 patients with ovarian carcinosarcoma had a median age of 55 years at diagnosis, among whom 10 were postmenopausal women. The patients sought medical attention for such symptoms as pelvic and/or abdominal pain, abdominal distention and ascites. Ten patients showed elevated serum CA125 level ad admission, and postoperative chemotherapy resulted in lowered CA125 level within normal range in 7 of them; in 8 cases, CA125 level increased with disease recurrence. Pelvic mass was found by such imaging examinations as CT, MRI and ultrasound in all cases. A definite diagnosis was obtained by postoperative pathological examination. All the patients received surgical resection and platinum-based adjuvant chemotherapy. Two patients achieved disease-free survival after the treatment. Disease relapse occurred in 10 cases within 2 years after surgery, among whom 2 showed disease remission after a secondary surgery and/or chemotherapy, and 1 was receiving chemotherapy; death occurred in 5 cases, and 2 cases were lost to the follow-up.

CONCLUSIONSOvarian carcinosarcoma has a poor prognosis. Primary surgery and platinum-based postoperative adjuvant chemotherapy is the main treatment for ovarian carcinosarcoma. The prognosis of ovarian carcinosarcoma is associated with the residual disease after surgery. The patients with disease recurrence may obtain remission and survival through a secondary surgery and/or chemotherapy. Serum CA125 can be used as a marker for monitoring the chemotherapeutic effect in clinical observation and follow-up visits.

Aged ; CA-125 Antigen ; blood ; Carcinosarcoma ; diagnosis ; therapy ; Female ; Humans ; Membrane Proteins ; blood ; Middle Aged ; Ovarian Neoplasms ; diagnosis ; therapy ; Prognosis ; Retrospective Studies

OBJECTIVETo assess the effects of platelet and fibrinogen on progressive ovarian cancer.

METHODSThe platelet counts and fibrinogen levels were measured in 180 initially treated ovarian cancer patients within 2 weeks before and 1 week after operation and 6 months after chemotherapy. The results were compared with those of 40 patients with epithelial ovarian neoplasms.

RESULTSThe platelet counts and fibrinogen levels were significantly higher in ovarian cancer patients than in patients with epithelial ovarian neoplasms (P < 0.05), significantly higher in late stage than in early stage (P < 0.05), and significantly lower after operation than before operation (P < 0.05). The platelet counts and fibrinogen levels were also significantly lower 6 months after operation in patients who responded well to the therapies than the levels before operation (P < 0.05); however, such difference did not exist between patients who were refractory to the therapies 6 months after treatment and the post-operation levels (P > 0.05).

CONCLUSIONSPlatelet and fibrinogen may be closely correlated with progressive ovarian cancer. Monitoring platelet counts and fibrinogen levels are instrumental for the early diagnosis of cancer and metastasis.

Adult ; Aged ; Cystadenocarcinoma, Serous ; blood ; Female ; Fibrinogen ; analysis ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; blood ; diagnosis ; Ovarian Neoplasms ; blood ; pathology ; Platelet Count ; Young Adult

This study is a multi-center clinical study, which aimed to compare CA125, HE4, and risk of ovarian malignancy algorithm (ROMA) in predicting epithelial ovarian cancer of Korean women with a pelvic mass. Prospectively, serum from 90 Korean women with ovarian mass was obtained prior to surgery. For control group, serum from 79 normal populations without ovarian mass was also obtained. The HE4 and CA125 data were registered and evaluated separately and ROMA was calculated for each sample. Total 67 benign tumors and 23 ovarian cancers were evaluated. Median serum levels of HE4 and CA125, and ROMA score were significantly higher in patients with ovarian cancer than those with benign ovarian tumor and normal population (P < 0.001). In ROC curve analysis for women with a pelvic mass, area under the curve (AUC) for HE4 and ROMA was higher than CA125. Statistical differences in each study compared to CA125 were marginal (P compared to CA125; 0.082 for HE4 and 0.069 for ROMA). Sub-analysis revealed that AUC for HE4 and ROMA was higher than AUC for CA125 in post-menopausal women with a pelvic mass, but there were no statistically significant differences (P compared to CA125; 0.160 for HE4 and 0.127 for ROMA). Our data suggested that both HE4 and ROMA score showed better performance than CA125 for the detection of ovarian cancer in women with a pelvic mass. HE4 and ROMA can be a useful independent diagnostic marker for epithelial ovarian cancer in Korean women.
Algorithms ; Area Under Curve ; Biomarkers, Tumor/blood ; CA-125 Antigen/*blood ; Case-Control Studies ; Female ; Humans ; Middle Aged ; Neoplasms, Glandular and Epithelial/*blood/*diagnosis ; Ovarian Neoplasms/*blood/*diagnosis ; Predictive Value of Tests ; Prospective Studies ; Proteins/*metabolism ; ROC Curve ; Reference Values ; Republic of Korea

OBJECTIVETo assess the value of color Doppler ultrasonography, contrast-enhanced ultrasound and detection of serum CA-125 levels in the differential diagnosis of ovarian masses.

METHODSThe findings of color Doppler ultrasonography, contrast-enhanced ultrasound and the serum levels of CA-125 were comparatively analyzed in 65 patients with ovarian masses, and the diagnostic accuracy of the 3 methods was estimated.

RESULTSOf the 65 cases of ovarian masses, 21 of the 35 patients with benign ovarian masses had serum CA-125 levels below 35 U/ml , and 28 of the 30 patients with malignant masses showed CA-125 levels over 35 U/ml. Color Doppler ultrasonography identified 30 benign and 22 malignant cases, but failed to produce definite results in 13 cases (including 5 with benign and 8 with malignant masses). By contrast-enhanced ultrasound, benign masses were found in 34 cases and malignant masses in 29 cases, and misdiagnosis occurred in 2 cases (including 1 case of thecoma and 1 of ovarian borderline tumor). With serum CA-125 detection, color Doppler ultrasonography and contrast-enhanced ultrasound, the diagnostic sensitivity for ovarian masses was 66.7%, 73.3%, and 96.7%, and the specificity was 60.0%, 85.7%, and 97.1%, respectively.

CONCLUSIONSDetection of serum CA-125 level and ultrasound examinations help in the diagnosis and differential diagnosis of benign and malignant ovarian masses. Compared with serum CA-125 detection and color Doppler ultrasonography, contrast-enhanced ultrasound is more informative on perfusion patterns of the ovarian masses to result in higher accuracy in early and differential diagnosis of the ovarian masses.

Adult ; CA-125 Antigen ; blood ; Contrast Media ; Diagnosis, Differential ; Female ; Humans ; Image Enhancement ; methods ; Middle Aged ; Ovarian Neoplasms ; diagnosis ; diagnostic imaging ; Ultrasonography, Doppler, Color ; methods ; Young Adult