不同部位子宫内膜异位症与血清CA125水平的关系

目的:探讨血清CA125水平与不同部位的子宫内膜异位症之间的相关性。方法:选择经手术或腹腔镜确诊的内异症患者63例和排除内异症的对照组30例,按内异症发生部位的不同分为3组:Ⅰ组(卵巢内异组)34例;Ⅱ组(阴道直肠隔内异组)15例;Ⅲ组(腹壁切口内异组)14例。Ⅳ组为对照组,系临床和病理检查排除了内异症的健康者。术前采取空腹静脉血,用化学发光法测定各组血清中CA125水平。结果:(1)卵巢内异组、阴道直肠内异组的血清CA125水平均显著高于对照组(P<0·05);腹壁切口内异组CA125水平显著低于卵巢内异组(P<0·05),而与阴道直肠隔内异症组、对照组比较无统计学差异(P>0·05);(2)以血清CA125≥35U/ml为临界值,CA125诊断各组内异症的敏感性分别为:卵巢内异症52·94%,阴道直肠内异症40·00%,腹壁切口内异症21·43%。诊断特异性为96·67%。结论:CA125在诊断子宫内膜异位症发生方面具有一定的价值,但并不是敏感指标。单凭血清CA125不能鉴别不同部位的子宫内异症。     

Endometriosis on laparotomy scar. A three-case report

Endometriosis of surgical scar is a rare late complication of cesarean section. 3 cases of endometriosis after Pfannenstiel-type laparotomy are reported. The typical surgical presentation, present in all 3 cases, is a nodule on laparotomy scar after cesaren section, spontanously painful during the menstrual period. Ultrasound, performed in two cases, and cytological examination, performed in one, proved to be ineffective in establishing the diagnosis. The histopathological analysis of surgical specimens revealed in all cases multiple foci of well developed endometrial tissue scattered in a sclerotic stroma. Both stromal and glandular components of the endometrial mucosa were present showing the typical changes of the various phases of the menstrual cycle. In our opinion, an accurate clinical history should directly lead the surgeon to the excision with inclusion of the needle tract, whenever biopsy is performed. Surgical excision is at present the most appropriate diagnostic and therapeutic procedure. Received: 3 November 2000 / Accepted: 30 November 2000     

Cesarean scar endometriosis. A report of two cases

BACKGROUND: Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric/gynecologic procedures. Cesarean section scar endometriosis may be more common than reflected in the literature and has a distinct presentation and treatment. CASES: Two patients with histories of cesarean sections presented with a painful, enlarging mass involving the cesarean section scar. The pain was cyclic and strongest just prior to menstruation. Both patients were treated with surgical excision, and both specimens had endometriosis confirmed by histopathology. CONCLUSION: Endometriosis involving a cesarean section scar may be more common than thought. Patients typically present with a history of cesarean section or other obstetric/gynecologic surgery and are found to have a mass involving the scar, with symptoms intensifying prior to each menstrual cycle. Surgical excision is the treatment of choice, providing both diagnostic and therapeutic intervention.     

175例子宫内膜异位症患者血清CA125水平的回顾性分析

目的:分析子宫内膜异位症患者合并子宫内膜息肉的情况,探讨血清CA125水平与痛经、内异症rAFS分期、病灶部位的相关性,为临床上更好地解读CA125水平提供依据。方法:回顾性分析2010年1月至12月我院术中或术后病理诊断为子宫内膜异位症的175例患者的临床资料。结果:(1)20.0%的子宫内膜异位症患者合并子宫内膜息肉;(2)36.6%的内异症患者有中、重度痛经,痛经程度与血清CA125水平无相关性;(3)Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期内异症患者的平均CA125水平分别为21.5U/ml、28.4U/ml、38.6U/ml、57.1U/ml,Ⅲ～Ⅳ期内异症患者血清CA125水平高于Ⅰ～Ⅱ期患者(P<0.05);(4)腹膜型、混合型、卵巢型内异症患者血清CA125的阳性率分别为21.4%、63.0%和67.4%,混合型、卵巢型内异症患者血清CA125阳性率显著高于腹膜型(P<0.001)。结论:血清CA125水平不能作为内异症合并子宫内膜息肉的预测指标;血清CA125水平可用于辅助鉴别内异症的分期和病灶部位,但是CA125对于内异症的早期诊断缺乏敏感性。     

Use of CA125 fluctuation during the menstrual cycle as a tool in the clinical diagnosis of endometriosis; a preliminary report

OBJECTIVE: To elucidate whether endometriosis can be diagnosed clinically by assessing the differences between serum CA125 levels during menstruation and during the rest of the menstrual cycle. METHODS: The study was performed in 28 patients who underwent laparoscopy to check for pelvic causes of infertility. Patients with endometriosis were selected as the study group, and patients with normal laparoscopic findings functioned as the control group. Blood specimens were taken for CA125 determination during menstruation and during the rest of the menstrual cycle. Mean serum CA125 concentrations were compared by the two-sample t-test for between-group comparisons and the paired t-test for within-group comparisons. The receiver operating characteristic curve was applied to assess the usefulness of CA125 level changes during the menstrual cycle in the clinical diagnosis of endometriosis. RESULTS: The mean CA125 concentrations of healthy women during menstruation and during the rest of the menstrual cycle were 12.2 and 10 U ml(-1), respectively. In this group, the mean CA125 concentration was an average of 22% higher during menstruation than during the rest of the menstrual cycle (P < 0.001). The patients with endometriosis showed a similar pattern to that of normal women, but the levels differed by 198.3% in these patients (P < 0.001). Mean CA125 concentrations of these patients during menstruation and in the rest of the cycle were 35.8 and 12 U ml(-1), respectively. The mean CA125 concentration during menstruation was significantly higher in patients with endometriosis than in normal women (P < 0.001), but CA125 concentrations at other points in the menstrual cycle were found to be similar in both groups (P > 0.05). ROC curve analyses set a cutoff of 83% (percentage increment of CA125 level during menstruation compared with that on days without menstrual bleeding), which gives a sensitivity of 93% and specificity of 92%, with a corresponding likelihood ratio of 11.3. CONCLUSIONS: It may be possible to diagnose endometriosis clinically by assessment of the differences in CA125 level during menstruation as against the remainder of the menstrual cycle.     

Immunohistochemical analysis of CA125, CA19-9, and Ki-67 in stage III or IV endometriosis: positive correlation between serum CA125 level and endometriotic epithelial cell proliferation

BACKGROUND: Serum levels of CA125 and CA 19-9 are often elevated in patients with endometriosis, but the clinical or biological significance of this is not well established. The aim of the present study was to compare serum and tissue levels of CA125 and CA19-9, and to examine the correlation between these levels and cell proliferation using immunohistochemical analysis in stage III or IV endometriosis. METHODS: Forty-five cases diagnosed histologically as endometriosis were analyzed (26 cases were stage III and 19 were stage IV using the revised American Fertility Society classification). The preoperative serum levels of CA125 and CA19-9 were measured by immunoradiometric assay. Immunohistochemical analysis was performed using antibodies against CA125, CA199, and Ki-67 (a representative marker of cell proliferation). RESULTS: The serum levels of CA125 and CA19-9 were elevated (over the cutoff values) in 25 cases and 21 cases, respectively. There was no significant correlation between serum CA125 and serum CA19-9 levels (correlation coefficient [q]=0.19). The serum CA19-9 level correlated well with the degree of immunostaining for CA19-9 (q=0.57), but not with the Ki-67 labeling index. The serum CA125 level did not show a strong correlation with CA125 staining (q=0.41), but it correlated well with the Ki-67 labeling index (q=0.53). CONCLUSIONS: The present study indicates that the serum CA125 level may correlate with the proliferative activity of epithelial cells in endometriotic lesions.     

剖宫产手术与子宫内膜异位症

剖宫产切口部位子宫内膜异位症（Cesarean section scar endometriosis，CSE）是指具有分泌功能子宫内膜腺体或间质异位到剖宫产切口瘢痕处。CSE发生率为0.2%～0.45%，目前发病机制仍不清楚。超声及MRI是常用的诊断方法。CSE主要治疗手段为手术治疗，药物治疗尚有争议。     

Usefulness of CA19-9 versus CA125 for the diagnosis of endometriosis

OBJECTIVE: To investigate the clinical value of the serum CA19-9 level in comparison with the serum CA125 level for diagnosing and determining the severity of endometriosis. DESIGN: Retrospective study. SETTING: Department of Comprehensive Reproductive Medicine in a university hospital. PATIENT(S): One hundred one women with endometriosis and 22 without endometriosis participated in this study. INTERVENTION(S): Blood samples were collected before the operation (laparoscopy, oophrectomy, cystectomy, and/or hysterectomy), and tissue samples of ovarian chocolate cysts were collected during the operation. MAIN OUTCOME MEASURE(S): The serum CA19-9 and CA125 levels and the localization of these antigens in ovarian chocolate cysts. RESULT(S): The mean serum CA19-9 levels in patients at all stages of endometriosis were significantly higher than those in patients without endometriosis, and serum CA19-9 levels significantly correlated with the Revised American Fertility Society classification scores. Intense staining of CA19-9 was observed in 15 of the 20 samples of ovarian chocolate cysts. CONCLUSION(S): CA19-9 is a useful marker for determining the severity of endometriosis.     

Clinical significance of CA19-9 for endometriosis

We investigated the usefulness of measuring the serum CA19-9 concentration in the diagnosis and therapeutic monitoring of endometriosis, and compared it with the serum CA125 concentration. We added an immunohistochemical study on CA19-9 and CA125 to find their localization in the various lesions of endometriosis. 1. The positive rate of serum CA19-9 in patients with endometriosis is 52.0% and that of CA125 is 48.0%. When both markers are examined, their positive rate increases to 71.4%. 2. As the Beecham classification stage advanced, the serum CA19-9 positive rate tended to increase. 3. The patients with endometriosis were followed up after surgery or during Danazol therapy. CA19-9 correlated closely with the clinical course. 4. The immunohistochemistry of CA19-9 shows that it localizes in chocolate cysts, but not in the lesions of adenomyosis. CA125 is seen in both lesions. The localizing of CA19-9 is thus seen to be different from that of CA125. It is concluded that the measurement of the serum CA19-9 concentration combined with that of CA125 is useful in the diagnosis and therapeutic monitoring of endometriosis.     

Tumor markers in endometriosis.

OBJECTIVES: The objective of the present study was to determine the concentrations of CA 125, CA 15-3, CA 19-9, carcioembryogenic antigen (CEA), alpha-fetoprotein (AFP) and beta-2 microglobulin (B2MG) in patients with pelvic endometriosis. METHOD: Fifty women were divided into two groups: group A (control) had no endometriosis or other diseases, and group B consisted of 35 women with pelvic endometriosis. All women were submitted to serum determination of CA 125, CA 15-3, CA 19-9, CEA, AFP and B2MG. Samples were collected during the menstrual cycle and 1 week later. RESULTS: Mean CA 125 concentrations were altered in patients with endometriosis, but all 50 patients studied presented normal CEA, AFP and B2MG concentrations. Small variations detected in CA 19-9 and CA 15-3 had no statistical significance. CONCLUSION: CA 125 is the only important marker in the diagnosis of stages III/IV of endometriosis, especially when blood samples for its determination are obtained during the first 3 days of the menstrual cycle.     

Endometriosis cutánea: a propósito de un caso

Endometriosis consists of the presence of endometrial tissue outside the uterine cavity. This entity is relatively common in women of reproductive age. The most frequent location is the ovary but multiple sites have been described in the literature, including the skin. Cutaneous endometriosis is often related to previous abdominal and pelvic surgery and the site of occurrence is often a surgical scar. In women of reproductive age with a nodule in a surgical scar, a thorough history to determine if there is pain and a cyclical increase in size can guide the diagnosis. Treatment should always be resection for diagnostic confirmation, which is always histopathological.     

血清CA19-9及CA125测定诊断子宫内膜异位症

目的:探讨血清CA19-9及CA125测定对子宫内膜异位症(EMs)的诊断价值。方法:采用放射免疫法测定55例EMs患者血清CA19-9及CA125水平,并与同期门诊健康妇女(对照组)进行比较。结果:EMs组及对照组血清CA19-9和CA125检测值的中位数及阳性率分别为27.81 U/mL、43.6%,11.78 U/mL、0和24.2 U/mL、36.3%,9.02 U/mL、4.0%。两组间差异均有统计学意义(均P<0.05)。中重度(Ⅲ～Ⅳ期)EMs患者与轻度(Ⅰ～Ⅱ期)患者血清CA19-9和CA125中位数和阳性率分别为42.38 U/mL、57.9%,17.36 U/mL、11.8%和34.75 U/mL、50.0%,15.3U/mL、5.9%,不同分期间差异有统计学意义(均P<0.05)。血清CA19-9和CA125诊断EMs的敏感度、特异度及准确度分别为43.6%、100%、61.25%及36.3%、96.0%、55.0%。结论:血清CA125和CA19-9在EMs患者中均有明显升高,测定两种血清标记物水平可协助EMs的诊断;两者血清水平与EMs患者病情程度有关。     

Serum CA 125 levels before, during and after treatment for endometriosis

Objectives: The aim of this study was to assess the treatment of endometriosis with a gonadotropin-releasing hormone (GnRH) agonist in terms of changes to the extent of disease and to CA 125 levels as well as to recurrence during follow-up. Methods: The levels of serum CA 125 were evaluated in 66 patients with endometriosis diagnosed and staged by laparoscopy according to the revised American Fertility Society classification, who received a 6-month course of a GnRH agonist. Serum CA 125 levels were measured before, during (3 and 6 months after the initiation of therapy) and 6 months after cessation of therapy. Results: Patients with minimal and mild endometriosis had significantly higher mean pretreatment values than control subjects in the luteal phase of the cycle or than postmenopausal women (P < 0.05), but the overall mean value was still below 35 U/ml. Levels of CA 125 fell during treatment to those found in normal controls, but rose again after the end of treatment. The sensitivity and specificity of CA 125 were 75% and 83.3%, respectively, and its positive predictive value as a marker of recurrence was 46.36%. Conclusion: These data suggest that CA 125 may be a reliable indicator for monitoring the efficacy of GnRH agonist treatment of endometriosis, but its value as a predictor of recurrence is low, probably due to the suppression of all CA 125 sources such as endometrium, ovaries and implants.     

Caesarean section greatly increases risk of scar endometriosis

Objective

To estimate the incidence of scar endometriosis after different surgical procedures.

Study design

A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated.

Results

Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p < 0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years.

Conclusion

Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis.     

Serum CA 125 as a marker for patients with external endometriosis

Serum CA 125 levels were assayed in 75 healthy female controls and 34 patients with external endometriosis prior to treatment, during treatment, and after treatment. The results of the assay showed that the mean pretreatment serum CA 125 level of the patients with external endometriosis (80.7 U/mL) was significantly (P less than .001) higher than that of the controls (17.9 U/mL). This difference was even more pronounced for those patients with progressive (stage III or IV) endometriosis (mean = 114.0 U/mL). Thus, the assay of serum CA 125 may be useful as an auxiliary tool in the diagnosis of progressive endometriosis. Although the high pretreatment level of serum CA 125 decreased after danazol treatment of 400 mg/day to within the normal limits, usually within 4 to 12 weeks, laparoscopic examinations indicated that most of the endometriosis cases were not cured until 12-16 weeks of danazol treatment.     

Use of serum-soluble intercellular adhesion molecule-1 as a new marker of endometriosis

OBJECTIVE: To investigate the hypothesis that soluble intercellular adhesions molecule-1 (sICAM-1) may be used as a new serum marker of endometriosis. DESIGN: Prospective cohort study. SETTING: An academic department specializing in gynecologic laparoscopy. PATIENT(S): Consecutive series of 120 women of reproductive age who underwent laparoscopy for benign gynecologic conditions. INTERVENTION(S): Data were collected on baseline clinical characteristics, and surgical and histologic diagnosis. MAIN OUTCOME MEASURE(S): Serum concentration of both CA125 and sICAM-1. RESULT(S): Endometriosis was documented in 71 women (stage I to II in 24 cases and stage III to IV in 47 cases). Serum levels of sICAM-1 were only slightly but not significantly increased in women with endometriosis compared with women without the disease. However, serum concentration of sICAM-1 in the 21 women who were found to have deep peritoneal endometriosis was significantly enhanced when compared with both women without the disease and those with other forms of endometriosis. The sensitivity and specificity of sICAM-1 in detecting deep peritoneal endometriosis were 0.19 and 0.97, respectively; whereas those of CA125 were 0.14 and 0.92, respectively. When both parameters were used concomitantly, the sensitivity and specificity were 0.28 and 0.92, respectively. CONCLUSION(S): Although the present study tends to support a role of sICAM-1 in the development of endometriosis, serum concentrations of this molecule do not seem to be an effective indicator for the diagnosis of either the early or advanced stage of endometriosis. However, an integrated clinical and laboratory approach using both CA125 and sICAM-1 may be helpful in specifically identifying women with deep peritoneal endometriosis.     

CA 125 levels in monitoring therapy for endometriosis and in prediction of recurrence.

CA 125 levels were measured in the serum of 18 patients with laparoscopically diagnosed stage 2 to stage 4 endometriosis (American Fertility Society classification) and in eight normally cycling control women. All endometriosis patients were treated medically with either Danazol or Buserelin. CA 125 levels were measured during treatment and during the 18-month follow-up period. The mean CA 125 level in women with endometriosis was significantly higher than that observed in normal women (28.6 +/- 5.1 (+/- SE) units/mL vs. 11.1 +/- 1.1 units/mL). However, there was considerable overlap of values between controls and patients with stage 2 disease. The levels in patients with stage 3 or stage 4 disease were always greater than 20 units/mL. There was a significant positive correlation (r = .51) between the implant score and CA 125 levels, while there was no correlation between the total score (which includes adhesions and implants) and the CA 125 levels. Four of the patients who had recurrence of symptoms approximately 1 year after treatment had CA 125 levels close to pretreatment levels, and recurrence of endometriosis was confirmed by laparoscopy. The CA 125 levels in the rest of the patients remained suppressed during the follow-up periods. These results indicate that (1) CA 125 level can predict active endometriosis lesions in patients with stage 3 and stage 4 endometriosis, but is of no value for predicting adhesions; (2) CA 125 levels are useful in monitoring therapy during treatment; (3) during the follow-up period, elevations in CA 125 might predict recurrence of disease in women with stage 3 and stage 4 endometriosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Usefulness of measurement of serum CA125 levels in diagnosing and treating endometriosis

We investigated the usefulness of the measurement of serum CA125 levels for the diagnosis and therapeutic monitoring of endometriosis. An additional study concentrated on the production of CA125. 1. Elevated levels of serum CA125 were noted in 52 of 66 patients with endometriosis in which the positive rate was 78.8% and mean was 119.8 U/ml. The mean value and positive rate of serum CA125 levels in patients with adenomyosis were higher than those in pelvic endometriosis. 2. The correlation between preoperative serum CA125 levels and the extracted tissue weight was statistically significant. The tissue concentration of CA125 of adenomyosis was 1,479.3 +/- 1,087.1 U/g and that of pelvic endometriosis was 309.7 +/- 23.1 U/g wet weight. 3. The serum CA125 levels in patients with adenomyosis fell postoperatively, and all were below 35 U/ml within two weeks. The serum CA125 levels were below 35 U/ml in 13 out of 15 patients (86.7%) with pelvic endometriosis treated with danazol and the change in the serum CA125 levels was closely related to the clinical course. 4. Clinicopathological states with a high level of serum CA125 were observed in patients with normal and ectopic pregnancy, puerperium, ovarian hyperstimulation syndrome (OHSS) and peritonitis. It was concluded that the measurement of serum CA125 levels was useful in the diagnosis and therapeutic monitoring of endometriosis, and CA125 might be produced and/or secreted not only from the endometrium but also from the peritoneum.     

剖宫产术中的无瘤防御问题——腹壁子宫内膜异位症的预防

剖宫产术是产科学中最重要的手术干预措施，但术后可能发生腹壁切口子宫内膜异位症等远期并发症，且有报道部分病例发生癌变、预后较差；目前国内外对于预防剖宫产术后发生腹壁子宫内膜异位症尚无专项指南及专家共识，文章针对腹壁切口子宫内膜异位症这个临床关注点，探讨剖宫产术中无瘤防御问题。     

Effect of an in vitro fertilization program on serum CA 125, tumor-associated trypsin inhibitor, free beta-subunit of human chorionic gonadotropin, and common alpha-subunit of glycoprotein hormones

OBJECTIVE: To investigate the impact of an IVF program on serum levels of tumor markers CA 125, tumor-associated trypsin inhibitor, free hCG beta-subunit, and free glycoprotein hormone alpha-subunit. DESIGN: A prospective controlled clinical study. SETTING: Outpatient university infertility clinic. PATIENT(S): Seventy-one infertile patients (with tubal occlusion, pelvic endometriosis, or unexplained infertility) undergoing IVF and nine control women with regular menstrual cycles. INTERVENTION(S): Serial blood sampling before, during, and after IVF, or during one ovulatory menstrual cycle in the controls. MAIN OUTCOME MEASURE(S): Serum levels of CA 125, tumor-associated trypsin inhibitor, hCG-beta, and glycoprotein hormone-alpha. RESULT(S): Before IVF, all tumor markers were within the normal range except for CA 125, which was elevated in patients with endometriosis. IVF led to significant increases in CA 125 and glycoprotein hormone-alpha that differed from the changes seen during normal menstrual cycles. The luteal phase increase in CA 125 correlated with levels of E(2) and P and the number of follicles. Two months after IVF, levels of CA 125 were 12% higher than levels before treatment. Tumor-associated trypsin inhibitor and hCG-beta revealed no cyclicity. CONCLUSION(S): An IVF regimen increased the release of CA 125 and glycoprotein hormone-alpha. The CA 125 elevation after IVF implies a persistent effect of ovarian hyperstimulation on CA 125 release.