Ultrasound, physical examination, and CA 125 measurement for the detection of recurrence after conservative surgery for early borderline ovarian tumors

BACKGROUND: Borderline ovarian tumors often affect women of childbearing age and the prognosis is outstanding. Given the young age of several patients and the good prognosis, fertility-sparing surgery is considered adequate for stage I tumors. However, women treated conservatively have a relatively small but well-defined risk of recurrence and no study has specifically addressed the optimal follow-up technique. METHODS: From 1981 to 1997, 164 women underwent fertility-sparing surgery for stage I borderline ovarian tumor and were followed prospectively. After surgery all women underwent physical examination and ultrasound examination every 3 months for 2 years after first diagnosis and every 6 months thereafter. Measurement of serum CA 125 levels was planned every 6 months in patients with a serous tumor. RESULTS: With a median follow-up of 71, months 28 women treated with fertility-sparing surgery (28/164 = 17%) had either recurrence of borderline tumor (23) or recurrence with carcinoma. Complete details of follow-up procedures are available for 24 women and they represent the study population. An abnormal adnexal mass was detected in 18 of 19 women with recurrent borderline tumor. One patient had diagnosis due to persistent free fluid. All five women with invasive carcinoma had diagnosis of a complex adnexal mass. Gynecologic examination was suspicious (palpable mass) in 7 cases and obviously abnormal (large mass or nodules) in another 7. CA 125 serum levels were elevated in 8 cases. CONCLUSION: Transvaginal ultrasound is currently the most effective diagnostic technique for the follow-up of young patients treated conservatively for early borderline ovarian tumor.     

Struma ovarii associated with Pseudo-Meig's syndrome and high serum level of CA 125; a case report

Background

Serum CA125 is routinely used in the follow up of ovarian cancer. The objective of the present study was to evaluate the usefulness of CA125 in the detection of ovarian cancer recurrence.

Methods

This retrospective case study was carried out at a tertiary gynaecological cancer centre in Australia. Patients with all cell types of epithelial ovarian cancer (EOC) treated between 2003 and2010 were considered eligible. We excluded patients whose aim of treatment was palliative, had no follow-up, had no pre-operative CA125 reading or had pre-operative CA125 levels < 35 U/mL. After primary treatment, patients were followed up as per guidelines suggested by National Comprehensive Cancer Network (NCCN). We recorded if symptoms, findings from physical examination, imaging or serum CA125 levels led to the diagnosis of recurrence. An increase in CA125 levels to twice the postoperative nadir was considered as "doubling" at any time during follow up.

Results

Analysis is based on 56 patients who completed primary treatment and who presented for a total of 274 follow-up episodes. Of those, 29 patients (52%) developed a recurrence within the follow up period. Recurrence was diagnosed by CA125 alone in 14 of 29 patients (48%). CA125 was not elevated in 7 patients (24%) who recurred. Doubling of CA125 from nadir was observed in 27/29 patients. Of those 27 patients the doubling from nadir occurred within the normal range of 35 U/ml in 3 cases and outside the normal range in 24 cases. Multivariate analysis suggests that doubling of serum CA125 (OR 5.10, p 0.036) and nadir CA125 > 10 U/ml (OR 2.86, p 0.01) remained the only independent factors to predict ovarian cancer recurrence.

Conclusions

The present paper proposes the validation of a novel CA125 algorithm aiming to detect recurrent EOC. These data may allow us to investigate novel ways of follow up that do not require a patient's physical attendance at a clinic (virtual follow-up).     

Serum CA 125 is an independent prognostic factor in cervical adenocarcinoma

OBJECTIVE: The purpose of this study was to determine the prognostic significance of a pretreatment serum CA 125 value in patients who were diagnosed with adenocarcinoma of the cervix. STUDY DESIGN: All patients who were diagnosed with adenocarcinoma or adenosquamous carcinoma of the cervix and treated definitively between 1986 and 1998 were eligible. The relationship between pretreatment serum CA 125 values and various clinical factors was evaluated. RESULTS: Seventy-three patients had pretreatment CA 125 drawn, with values that ranged from 5 to 683 U/mL and all patients were included in this study. A CA 125 value of >or=30 U/mL was defined as elevated by the receiver operating characteristic curve analysis and used for all subsequent analyses. Elevated serum CA 125 values were identified in 33% of the 73 patients. On the basis of the univariate analyses, an elevated pretreatment CA 125 value was associated significantly with advanced International Federation of Gynecology and Obstetrics stage (>IIA, P =.01), high grade (2 or 3, P =.04), tumor diameter >4 cm (P <.01), and positive pelvic or para-aortic lymph nodes (P =.002). The median survival time was 2.8 years for patients with a pretreatment CA 125 value of >or=30 U/mL and not yet reached for patients with values of <30 U/mL(P <.001). Pretreatment clinical variables that included CA 125 value, age, stage, grade, and tumor diameter were evaluated in a Cox proportional hazards model, and an elevated CA 125 value was the most significant predictor of survival (P <.001). CONCLUSION: Serum CA 125 is an independent prognostic marker for patients with cervical adenocarcinoma.     

Long-term follow-up of ovarian cancer with monthly determinations of serum CA 125.

Monthly serum CA 125 determinations were used for monitoring of 33 patients with advanced nonmucinous epithelial ovarian cancer during the follow-up after the primary treatment. The observation time ranged between 3 and 7 years. All patients had elevated CA 125 levels at the start of chemotherapy with subsequent normalization during treatment. Seventeen patients were classified as having no evidence of disease during the whole follow-up period. Out of 649 samples analyzed from these patients only 6 of the samples from 4 patients were greater than 35 U/ml (rate of false positives, 0.9%). These high values were all singular; the serum samples for the preceding and following months were normal. Out of 20 verified recurrences in 15 patients, 19 had elevated CA 125 levels (sensitivity, 95.0%). The CA 125 increase was the only sign that initiated clinical investigation in 16 recurrences (sensitivity for early diagnosis, 80.0%). With examination under anesthesia, fine needle aspiration for cytology, CT scan, and sometimes laparoscopy or laparotomy a relapse could be verified in 13 of these cases (sensitivity for the whole procedure, 65.0%). In 2 recurrences the increase in CA 125 was obvious at the same time as the clinical evidence of recurrence and in 1 case the elevation was delayed. One additional patient is presently under investigation because of an increase in CA 125. We conclude that monitoring with monthly determinations of serum CA 125 is a reliable method with very few false-positive values. We regard this as a step forward in the management of the follow-up of ovarian cancer patients.     

Elevated serum levels of macrophage colony-stimulating factor and OVX1, 11 months prior to the diagnosis of stage IC ovarian cancer

In published trials, CA125 has been utilized to trigger ultrasound examination for the early detection of ovarian cancer. Although serum CA125 levels can be elevated prior to clinical detection of ovarian cancer, only approximately half of patients with stage I disease will have an abnormal value. A combination of CA125, macrophage colony-stimulating factor (M-CSF) and the mucin marker OVX1 will detect> 95% of stage I patients, but it is not known whether the markers can be elevated prior to clinical detection of the disease. A postmenopausal patient was found to have small unilocular bilateral cystic adnexal lesions during an abdominal ultrasound examination. No pelvic abnormality could be palpated. Serum levels of the CA125 antigen were within the normal range. Progressive ultrasound changes prompted a laparotomy II months later, and the diagnosis of a stage IC serous cystadenocarcinoma of the ovary was established. A retrospective analysis of stored serum samples revealed that this patient had elevated serum levels of M-CSF and OVX1 at the time of the original ultrasound scan. Interpreted within the context of a potential screening strategy for ovarian cancer, these data illustrate that either or both of these tumor markers and/or ultrasound could have identified this ovarian cancer many months prior to the actual diagnosis, while the disease was at an early stage.     

CA 125: a useful marker in endometrial carcinoma

In a retrospective study 121 patients with endometrial cancer were examined. In addition, 20 primary endometrial adenocarcinomas were tested immunohistochemically for CA 125. All tumor tissues were demonstrated to contain CA 125. However, only 25% of 110 patients had elevated CA 125 levels in serum before treatment. The incidence of elevated CA 125 serum levels increased with higher tumor staging up to 55% and 86% in surgical Stages III and IV, respectively. In Stage I and II disease (International Federation of Gynecology and Obstetrics) elevated serum levels before treatment correlated with the presence of tumor tissues outside the uterine body or outside the uterus, respectively, as was determined histopathologically after operation. In addition a close correlation between elevated levels and vessel invasion of tumor cells was revealed. Serum levels of CA 125 paralleled the clinical course of disease. Tumor recurrence in the abdomen can be preceded by an increase of serum CA 125 levels.     

Serum CA 125 measurements in the diagnosis of endometriosis recurrence

Seventy-one women underwent follow-up laparoscopy for persistent infertility six to 24 months after conservative treatment of endometriosis. The disease was staged according to the revised American Fertility Society classification of 1985. The serum CA 125 concentration was also measured in each patient to evaluate its efficacy in the diagnosis of endometriosis recurrence. The patients with stages I and II endometriosis had serum CA 125 levels not significantly higher than in the patients with negative findings, whereas those with stages III and IV endometriosis presented significantly higher levels (P less than .005 and P less than .001, respectively) than the disease-free women. The sensitivity of serum CA 125 measurements in the diagnosis of endometriosis recurrence was 14.8%, the specificity was 100%, and the predictive values of normal (less than 35 U/mL) and elevated levels were 27 and 100%, respectively. In some cases, serum CA 125 measurements may be used instead of follow-up laparoscopy, or to indicate when laparoscopy should be performed or postponed.     

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)     

正电子发射体层显像-CT检查联合CA125连续检测诊断早期无症状的复发性卵巢上皮性癌的价值

目的评估正电子发射体层显像（PET）-CT检查联合CA125连续检测在早期无症状的复发性卵巢上皮性癌（卵巢癌）诊断中的价值。方法对26例在山东省肿瘤医院初治、手术病理分期为Ⅱ-Ⅵ期的卵巢癌患者,在接受肿瘤细胞减灭术并经多疗程化疗达到完全缓解后又出现可疑复发者进行PET-CT检查。此类患者CA125水平已降至正常值（即35kU／L）以下并稳定一段时间后,连续3次测定均呈持续升高趋势,但CT检查未能发现可疑病灶,或虽发现可疑病灶但病变范围不能确定。其中,16例给予再次化疗和（或）放疗,10例接受再次肿瘤细胞减灭术。结果（1）26例患者中,17例CA125水平≥35kU／L,其中14例CT检查显示盆腹腔存在复发灶的患者中,PET-CT检查发现10例病变范围与CT检查一致,4例除盆腹腔病灶外尚伴有远处转移;3例CT检查未发现明确病灶者中,PET-CT检查均提示存在盆腹腔复发,1例发现骨转移。另9例CA125水平〈35kU／L,其中3例CT检查和PET-CT检查均发现盆腹腔复发灶,6例CT检查未发现明确病变者中PET-CT检查均发现1处以上可疑复发或转移灶。（2）10例再次手术者中,CA125水平≥35kU／L者6例,〈35kU／L者4例;4例CT检查发现可疑病灶及6例CT检查阴性者中,PET-CT检查均提示存在至少1处代谢异常部位（病灶数为1～5个）。（3）10例再次手术者中,CT检查发现的可疑病灶,术后病理检查均证实为转移灶;PET-CT检查提示的异常代谢部位手术后病理检查也证实均为转移灶。（4）再次手术后1个月,4例术前CA125水平〈35kU／L者,术后CA125水平均明显下降,其中位数水平降低了3．2倍;6例术前CA125水平≥35kU／L者,4例术后CA125水平〈35kU／L,1例化疗2个疗程后降至〈35kU／L,1例持续升高。结论PET-CT检查能发现临床前期的复发灶或常规辅助检查未能发现或明确的复发灶,PET-CT检查联合CA125连续检测诊断复发性卵巢癌的准确性高,是诊断卵巢癌早期复发的可靠手段。PET-CT检查引导下可以提高再次肿瘤细胞减灭术的准确性和彻底性。     

Comparison between primary peritoneal and epithelial ovarian carcinoma: a population-based study

OBJECTIVE: This study was undertaken to characterize primary peritoneal carcinoma (PPC) compared with ovarian carcinoma (OvC). STUDY DESIGN: Within the framework of a nationwide epidemiologic Israeli study, 95 PPC patients were identified and compared with 117 FIGO stage III-IV epithelial OvC patients matched by age and continent of birth. Data were abstracted from medical records and personal interviews. RESULTS: Our data confirm the similarities between PPC and OvC. A higher rate of abdominal distention, volume of ascites, and malignant cells in ascitic fluid and lower rate of pelvic palpable mass and personal breast cancer history were found in the PPC compared with the OvC group. The overall survival was similar in both groups (30-33 months). In optimally cytoreduced patients, survival was better in the OvC group. Diameter of residual disease was associated with better survival only in the OvC group. CONCLUSION: The clinical differences do not enable a preoperative distinction between the neoplasms.     

Serum CA 125, carcinoembryonic antigen, and CA 19-9 as tumor markers in borderline ovarian tumors

OBJECTIVES: The goals of this study were to analyze preoperative serum levels of CA 125, carcinoembryonic antigen (CEA), and CA 19-9 in patients with borderline ovarian tumors and to investigate if routine assessment of these markers in follow-up may lead to earlier detection of recurrence. METHODS: For patient identification a database was used, in which data from all patients treated for gynecologic malignancies in the Department of Gynecologic Oncology, University Hospital Groningen, The Netherlands, are compiled. Between 1982 and 1997, 44 patients with borderline ovarian tumors were identified. Clinical data and serum CA-125 and CEA levels were retrieved from the database. CA 19-9 levels were determined in retrospect in available stored preoperative (24 patients) and follow-up (43 patients) serum samples. RESULTS: Preoperative CA 125 levels were elevated in 8 of 33 (24%), CEA levels in 3 of 32 (9%), and CA 19-9 levels in 11 of 24 (46%) cases. In patients with mucinous tumors preoperative CA 19-9 was more frequently elevated (8/14, 57%) than CA 125 (3/20, 15%) (P = 0.02) or CEA (2/18, 11%) (P = 0.02). Complete follow-up serum CA 125, CEA, and CA 19-9 levels were available for 43 of 44 patients. Median follow-up was 84 months (range, 22-204). During follow-up two patients (5%) had recurrent disease. In one patient CA 125 became elevated at the time of recurrence; in the other patient (in retrospect) the CA 19-9 level did not return to normal after surgery, but kept rising, preceding clinical symptoms of recurrence for 13 months. CONCLUSIONS: If one chooses to use serum markers in follow-up of mucinous borderline ovarian tumors CA 19-9 should be included. Measurement of serum tumor markers in the follow-up of patients with borderline ovarian tumors may lead to earlier detection of recurrence in only a very small proportion of patients, while the clinical value of earlier detection of recurrence remains to be established.     

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.     

The value of CA 125 determination in the serum of patients with ovarian cancer

The circulating ovarian cancer associated antigen CA 125 was determined in serum of 63 patients with ovarian malignancies by radioimmunometric solid phase assay using the monoclonal antibody OC 125 as catcher and tracer. The results of 41 patients with 43 active tumour situations were compared with the CA 125 serum levels of 27 patients without recurrence after therapy of ovarian cancer and 49 benign ovarian tumours. Significant differences exist between these three groups (p less than 0.001) with elevated values (greater than 35 U/ml) in 84 per cent in ovarian carcinoma, 22 per cent in benign tumours and nought per cent in woman without recurrence in follow-up. The pre-operative sensitivity in ovarian cancer is 93 per cent (in epithelial carcinoma 96 per cent) with a distinct dependence of the CA 125 serum levels on the stage of the disease (stage III and IV versus stage I and II; p less than 0.01). A positive correlation of CA 125 values to clinical status was found in 82 per cent in follow-up. Increasing values of CA 125 can detect the recurrence any months earlier than the clinical examination. Decreasing serum levels in chemotherapy don't reflect the objective tumour remission in every case. Because of elevated values in benign and inflammatory adnexal tumours and the relative low sensitivity in borderline cases (three of seven patients greater than 35 U/ml) the CA 125 assay seems not be suitable for a screening method. However it is a substantial amplification in control of therapeutic success and an early detection of recurrence of ovarian cancer disease.     

Prognostic value of serum HE4 in patients with advanced ovarian,fallopian tube,and peritoneal carcinoma

In this study, the prognostic value of serum HE4 was investigated in patients with advanced ovarian, fallopian tube, and peritoneal carcinoma. Serum HE4 and CA125 levels were measured in both patients and controls, and the response of treatment and the detection of recurrence were evaluated by serum HE4 and CA125 levels in the patients. The results showed that the levels of serum HE4 and CA125 were significantly higher in advanced patients than those seen in benign disease controls (p < 0.001). Compared with CA125, HE4 had higher specificity, but lower sensitivity. Furthermore, serum HE4 was closely associated with the response of treatment and recurrence, the effective response rate for therapy treatment showed by HE4 was higher than CA125, and a serum HE4 level was correlated with a sensitivity of 82.8% and a specificity of 99%, a positive predictive value (PPV) of 97.7%, and a negative predictive value (NPV) of 77.9% to show the presence of recurrence; the accuracy of HE4 for recurrence prediction after treatment was 88.6%. Our study indicated that serum HE4 levels are effective for diagnosis, evaluating the response of treatment and predicting recurrence in patients with advanced ovarian, fallopian tube, and peritoneal carcinoma.     

Serum CA 125 levels in patients with a provisional diagnosis of pelvic inflammatory disease. Clinical and theoretical implications

In 50 patients with a provisional diagnosis of pelvic inflammatory disease (PID), CA 125 concentrations in serum were measured before laparoscopy and during hospitalization, using an enzyme immunoassay. The findings at laparoscopy were graded on the basis of the extent of inflammatory peritoneal involvement (grades 0-3; normal observations having a score of 0). On admission, 66% of the patients had serum CA 125 concentrations in excess of the cut-off value of 16 U/ml (range: 20-1300 U/ml). The serum CA 125 concentration before laparoscopy correlated with the extent of inflammatory peritoneal involvement (eta = 0.74). The predictive value of an elevated serum CA 125 level to indicate the presence of salpingitis (grades 1-3) was 97%. However, the predictive value of a normal CA 125 level indicating normal observations at laparoscopy (grade 0) was only 47%. During treatment and follow-up, the serum CA 125 concentration returned gradually to normal levels. It was concluded that the finding of an elevated serum CA 125 level confirms the diagnosis of peritoneal involvement in patients with a clinical diagnosis of PID.     

Peritoneal tuberculosis with pelvic abdominal mass, ascites and elevated CA 125 mimicking advanced ovarian carcinoma: A series of 10 cases

Abstract. Bilgin T, Karabay A, Dolar E, Develioğlu OH. Peritoneal tuberculosis with pelvic abdominal mass, ascites, and elevated CA 125 mimicking advanced ovarian carcinoma.
Ten patients with peritoneal tuberculosis who were operated on for suspected advanced ovarian cancer during a 5-year period were analyzed. These 10 cases constituted 1.4% of the 728 new gynecologic cancer cases diagnosed and treated at our department during the same time period. Data were obtained from patients' files and pathology reports. The mean age of cases was 40.6 ± 6.1 (median 37; range 18–72). Ascites was present together with ill-defined nodularities or thickening in the Douglas pouch and/or in the adnexal areas on pelvic examination in all patients but three, who presented with well-demarcated adnexal masses of about 5 cm in diameter. All patients had elevated serum CA 125 levels with a median of 331 U/ml, (40–560 U/ml). Ultrasound and abdominopelvic CT examinations revealed omental and mesenteric thickening in addition to ascites in all patients, cystic ovarian masses or ovarian enlargement in five, and peritoneal implants in two. Abdominal paracentesis performed in the six cases in whom the findings were felt to be most inconclusive for the diagnosis of ovarian cancer revealed clear exudative fluid with benign cells. Mycobacteria could not be demonstrated on direct preparations. Tuberculosis was diagnosed at laparotomy in all. Patients received antituberculous therapy and serum CA 125 levels returned to normal within 2 months after the beginning of treatment. This case series demonstrates a high rate of misdiagnosis between advanced ovarian cancer and peritoneal tuberculosis. Whereas abdominal paracentesis is useless in ruling out peritoneal tuberculosis, and serum CA 125 levels are not helpful in the differential diagnosis, the latter marker may be useful in the follow-up of patients.     

Metastatic colorectal adenocarcinoma involving the ovary with elevated serum CA125: a potential diagnostic pitfall

OBJECTIVES: Elevated serum levels of CA125 are observed not only in association with primary ovarian epithelial neoplasms but also in a variety of other clinical settings, including ovarian involvement by metastatic disease. There is considerable overlap in gross and histologic features between primary ovarian tumors and metastatic colorectal adenocarcinoma, which can make diagnosis particularly challenging in the setting of an increased CA125 level. The aims of this study were to determine how frequently serum CA125 is elevated in women with ovarian involvement by metastatic colorectal adenocarcinoma and to compare the features of cases with and without associated elevations of serum CA125. METHODS: Eighty-nine cases of histologically confirmed ovarian involvement by metastatic colorectal adenocarcinoma were identified by retrospective review. Clinicopathologic data were analyzed, including preoperative serum CA125 level (available in 42 cases). Features of cases with an associated increase in serum CA125 were compared with those of cases with no such elevation. RESULTS: Twenty-nine patients had an elevated serum CA125 level (>35 U/mL) preoperatively (range 39.0-556.3, median 143.0, mean 199.1). Thirteen patients had a serum CA125 level within the reference range, while forty-seven patients had no preoperative testing for serum CA125. Clinical, gross, and histologic features of cases with an associated increase in serum CA125 were generally similar to those of cases with a non-elevated serum CA125 concentration. In three cases, the tumor was initially diagnosed as an ovarian primary. CONCLUSIONS: At least 32.6% of women with ovarian involvement by metastatic colorectal adenocarcinoma have an elevated serum CA125 level prior to oophorectomy. Such cases do not differ significantly from cases lacking such an association with respect to a variety of clinicopathologic features. The possibility of metastasis from a colorectal carcinoma merits consideration in the formation of the differential diagnosis for a woman with an adnexal mass and elevated serum CA125, even in the absence of an established history of gastrointestinal malignancy.     

Pleomorphic Rhabdomyosarcoma of the Uterus in a Postmenopausal Woman with Elevated Serum CA125

BACKGROUND: Pure rhabdomyosarcoma of the uterus is an exceedingly rare tumor. While there are no commonly associated tumor markers, a previously reported case confirmed CA125 production by a pure uterine rhabdomyosarcoma. CASE: We describe a postmenopausal woman who presented with vaginal bleeding and was diagnosed with pleomorphic rhabdomyosarcoma of the uterus. Of particular interest was an elevated serum CA125 level at presentation. Immunohistochemical staining with CA125 antibody, however, showed no activity within the tumor. Despite aggressive therapy, the patient experienced distant nodal metastases and succumbed to the disease within 25 months of diagnosis. CONCLUSION: Our patient illustrates the typical presentation and aggressive behavior of this rare neoplasm. While serum CA125 may be a useful tumor marker in selected patients, elevated levels do not directly reflect tumor burden when associated with negative immunohistochemical staining.     

Serial measurement of CA 125 in patients with primary carcinoma of the fallopian tube

Serial assay of serum CA 125 was carried out in five patients with advanced primary carcinoma of the fallopian tube. Pretreatmental levels of these patients were elevated, ranging from 145 to 535 U/ml (305 +/- 140.1, mean +/- SD). All patients showed rapid decreases in response to treatment; however, reelevations were noted in two patients concomitant with recurrence. In the remaining three patients, who are alive with no evidence of recurrence at 52, 29, and 21 months, serum CA 125 levels remained below 5 U/ml after remission. These results suggest that CA 125 is useful in monitoring patients with primary carcinoma of the fallopian tube.     

Serum CA 125 in acute pelvic inflammatory disease

Serum levels of CA 125 and other selected tumour markers were measured in 31 patients with proven pelvic inflammatory disease (PID). Ten (32%) of the patients had elevated CA 125, one (4%) had elevated CEA, and none had elevated CA 15-3, AFP or beta 2-microglobulin. Compared to patients with normal CA 125, patients with elevated CA 125 were older, more often users of intrauterine contraceptive devices, had longer duration of symptoms, higher erythrocyte sedimentation rates, and more often had an adnexal mass on pelvic examination. There was a correlation between CA 125 levels and the severity of adnexal inflammation as defined by laparoscopy. Isolation of specific micro-organisms from the upper genital tract was not associated with elevated CA 125. In most women serum levels of CA 125 decreased during treatment. PID should be considered as a major cause of positive CA 125 findings among young women.