CA125、CA19．9、CEA在卵巢上皮性交界性肿瘤中的临床价值

目的：探讨测定血清CA125、CA19．9、CEA在诊断卵巢上皮性交界性肿瘤中的临床价值。方法：回顾分析卵巢交界性肿瘤50例血清CA125、CA19．9、CEA水平与临床资料。结果：浆液性及粘液性肿瘤中CA125的阳性率分别为53．85％和60％，差异无显著性（P＞0．05），临床分期晚者CA125阳性率有增高趋势；粘液性肿瘤中CA19．9的阳性率为43．75％；CEA阳性率为12％，仅见于粘液性或以粘液性为主的肿瘤中；与术前相比，术后CA125、CA19．9水平及阳性率均显著下降（P＜0．05）。结论：CA125、CA19．9对卵巢上皮性交界性肿瘤的术前诊断及疗效监测有一定价值，CEA则在鉴别组织学类型中有一定价值。     

eIF-4E、OPN在上皮性卵巢癌患者血清中的表达及临床意义

目的:检测eIF-4E、OPN在上皮性卵巢癌患者血清中的表达,探讨eIF-4E、OPN作为肿瘤标志物,与CA125联合检测的临床意义。方法:采集卵巢上皮性癌46例,卵巢交界性上皮性肿瘤16例、卵巢良性上皮性肿瘤12例及健康妇女12例的血清标本,用双抗体夹心(ELISA)法检测血清标本中eIF-4E、OPN的浓度,血清CA125浓度用化学发光法检测。结果:卵巢恶性肿瘤组及交界性肿瘤组血清中eIF-4E、OPN、CA125的浓度明显高于卵巢良性肿瘤组及正常对照组。eIF-4E检测阳性率63.04%,OPN检测阳性率76.9%,CA125检测阳性率71.74%,eIF-4E和CA125联合检测阳性率93.48%,OPN和CA125联合检测阳性率89.13%,eIF-4E、OPN及CA125三者联合检测阳性率97.83%。Ⅲ、Ⅳ期卵巢癌患者血清中CA125、eIF-4E、OPN浓度明显高于Ⅰ、Ⅱ期。结论:eIF-4E、OPN可作为卵巢肿瘤标志物,用于卵巢癌早期诊断,与CA125联合检测有较高的临床应用价值。     

术前测定血清CA125、CA199、CA724、CEA和GM-CSF在鉴别附件包块性质中的作用

探讨术前测定患者血清CA12 5、CA19 9、CA72 4、CEA和GM -CSF水平在鉴别附件包块良恶性质中的作用。方法 :74例附件包块患者术前 1周内采外周血 ,用固相免疫放射法测定各种肿瘤标志物浓度 ,并与术后组织学诊断比较。计算各标志物单独和联合应用诊断卵巢癌的相应诊断参数。结果 :( 1)CA12 5(临界值 70U/ml)鉴别卵巢肿瘤性质的敏感性和特异性分别为 85 71%和 82 61% ,CA19 9(临界值 30U/ml)分别为 4 2 86%和 73 33% ,CA72 4 (临界值 3 8U/ml)分别为 53 57%和 90 90 % ,CEA(临界值 5ng/ml)分别为 4 6 4 3%和 4 8 89% ;( 2 )联合应用肿瘤标志物 :CA12 5联合CA19 9的敏感性和特异性分别为 89 2 9%和 73 33% ;CA12 5联合CA72 4的敏感性和特异性分别为 89 2 9%和 75 56% ;CA12 5联合CEA的敏感性和特异性分别为 92 86%和 4 0 0 0 % ;( 3)如果去除 9例子宫内膜异位症 ,CA12 5、CA19 9、CA72 4和CEA的特异性分别增至 89 19% ,80 55% ,94 2 9%和4 7 2 2 %。结论 :此项研究应用的肿瘤标志物中以CA12 5最为敏感。将CA12 5临界值定为 70U/ml时诊断效果最佳。CA72 4的特异性最高 ,但诊断卵巢癌的敏感性低。CEA的诊断价值有限 ,GM -CSF则无价值。CA12 5与其他肿瘤标志物联合检测时诊断的特异性会部分丧失。?     

卵巢上皮性交界性肿瘤87例临床分析

卵巢上皮性交界性肿瘤是一种具有潜在的或不典型增生能力的卵巢肿瘤 ,主要病理类型为粘液性和浆液性。我们对 87例卵巢上皮性交界性肿瘤的临床资料进行回顾性分析 ,探讨其术前辅助诊断及治疗方法。1　资料与方法1.1　临床资料　 1990年 1月至 2 0 0 2年 6月在上海医科大学妇产科医院和 1995年 1月至 2 0 0 2年 6月在浙江省温岭市第一人民医院收治的经病理证实为卵巢上皮性交界性肿瘤患者 87例 ,13～ 76岁 ,平均 4 3.5岁 ,绝经者 2 1例 (2 4 .14 % )。以盆腔肿块为主要症状者 5 6例 (6 4 .32 % ) ,腹胀 16例(18.18% ) ,阴道出血 9例 (10 .35 …     

AGR2在卵巢上皮性癌患者血清及癌组织中的表达及意义

目的:探讨卵巢上皮性癌血清和癌组织中人前梯度蛋白2(AGR2)的表达水平与卵巢上皮性癌发生、发展的关系及用于其诊断的意义.方法:采用ELISA法和电化学发光法检测40例卵巢上皮性癌、10例卵巢交界性肿瘤、20例卵巢良性肿瘤及17例健康体检者血清AGR2、CA125水平;采用免疫组化法检测各种卵巢肿瘤组织及因宫颈癌切除卵巢的15例正常卵巢组织中AGR2的表达情况,并结合临床病理参数进行分析.结果:①卵巢上皮性癌及卵巢交界性肿瘤组织AGR2的阳性表达率明显高于卵巢良性肿瘤及正常卵巢组织(P ＜0.05,P＜0.01).②卵巢上皮性癌及卵巢交界性肿瘤血清中AGR2水平明显高于卵巢良性肿瘤及健康体检者(P＜0.05).③卵巢上皮性癌血清AGR2水平及癌组织中AGR2的阳性表达率均与临床分期及淋巴结转移相关.④联合检测血清AGR2和CA 125曲线下面积与单独检测CA125、AGR2比较,差异均无统计学意义(P均＜0.05).结论:AGR2与卵巢上皮性癌的发生、发展有关.联合检测血清AGR2和CA 125对卵巢上皮性癌的早期诊断有参考价值.     

卵巢上皮性肿瘤cyclinE表达的临床意义

目的 :检测卵巢上皮性肿瘤中cyclinE的表达 ,分析其临床意义。方法 :应用免疫组化S -P法检测cyclinE在 2 0例良性、10例交界性、55例恶性卵巢上皮性肿瘤中的表达情况 ,并分析它们与临床病理指标的关系。结果 :cyclinE在良性、交界性、恶性卵巢上皮性肿瘤中表达总阳性率分别为 30 %、50 %、78.18% ,强阳性率分别为 10 %、2 0 %、4 3.6 % ,差异均有显著性。在恶性卵巢上皮性肿瘤中cyclinE阳性表达与低组织分化 ,淋巴结转移及腹水显著有关 (P <0 .0 5) ,cyclinE阳性的肿瘤细胞多发生转移 ,预后差。结论 :cyclinE在卵巢上皮性肿瘤中的表达 ,可作为估计卵巢肿瘤恶性程度和预后的重要指标之一     

卵巢交界性上皮性肿瘤的临床病理分析

目的　探讨影响卵巢交界性上皮性肿瘤预后的临床及病理因素。方法　回顾性分析我院 1973年 1月～ 2 0 0 0年 12月收治的 3 4例卵巢交界性上皮性肿瘤及 3 0例Ⅰ期卵巢上皮性癌 (卵巢癌 )患者的临床病理资料 ,并按 1999年WHO的组织学标准核对诊断。结果　 64例患者中 ,符合卵巢交界性上皮性肿瘤诊断者 3 7例 ,其中 6例微浸润的卵巢交界性上皮性肿瘤曾被误诊为Ⅰ期卵巢癌 ,1例卵巢交界性上皮性肿瘤为非浸润性腹膜种植。卵巢癌组织学类型以黏液性和浆液性为主 ,95 %为国际妇产科联盟 (FIGO)临床分期的Ⅰ期。患者均行手术治疗 ,其中 11例行保守手术者复发率为9% ;2 6例肿瘤细胞减灭术后给予环磷酰胺 +阿霉素 +顺铂 (CAP)方案为主的化学药物治疗 (化疗 )。已随访 5年、10年患者的生存率均达 10 0 %。经多因素相关分析显示 ,组织学类型和是否化疗是影响预后的因素 (P <0 0 1)。结论　卵巢交界性上皮性肿瘤患者以手术治疗为主 ,应适当辅以化疗     

IL-6、CRP、CA_(125)在卵巢肿瘤定性诊断中的价值及临床意义

目的 :探讨测定血清IL 6、CRP、CA12 5水平在卵巢肿瘤定性诊断中的价值及临床意义。方法 :取卵巢肿瘤 61例患者的血浆及 17例合并腹水患者的腹水 ,用ELISA法及胶乳凝集法测定IL 6、CA12 5、CRP。结果 :IL 6诊断卵巢癌敏感性为 80 .9% ,特异性为77.3%。CA12 5诊断卵巢癌敏感性为 85 .7% ,特异性为 80 .9%。这二项指标联合检测 ,敏感性为 92 .5 % ,特异性 73.9%。CRP诊断卵巢癌敏感性达 76.2 % ,特异性 60 .0 %。临床分期晚、组织分化低者血清及腹水IL 6、CA12 5水平明显升高。结论 :IL 6、CA12 5是卵巢肿瘤定性诊断的良好指标 ,联合检测可提高定性诊断的敏感性及特异性。腹水或血中IL 6、CA12 5水平可为卵巢癌早期诊断、分期及判断预后提供有效的参考指标。     

上皮性卵巢肿瘤患者血清和肿瘤组织中VEGF水平的检测

目的　通过对上皮性卵巢肿瘤患者肿瘤组织中血管内皮生长因子 (VEGF)表达的观察以及对术前血清VEGF水平的检测 ,探讨VEGF与上皮性卵巢肿瘤临床病理因素之间的关系。方法　应用免疫组织化学和ELISA方法 ,对 79例上皮性卵巢肿瘤患者 (包括 2 1例卵巢良性囊腺瘤 ,1 2例交界性卵巢肿瘤和 4 6例上皮性卵巢癌 )术前血清VEGF水平和术后组织标本中VEGF的表达进行了检测。结果　①上皮性卵巢癌组织VEGF阳性表达率 (78 2 6 % )显著高于交界性肿瘤 (4 1 6 7% )和良性囊腺瘤 (33 33% ) (P <0 0 1 ) ;上皮性卵巢癌中 ,晚期癌 (Ⅲ、Ⅳ期 )的VEGF阳性表达率 (92 0 0 % )显著高于早期癌 (Ⅰ、Ⅱ期 ) (6 1 90 % ) (P <0 0 1 ) ,且强阳性表达率 (5 2 0 0 % )也显著高于早期癌 (1 4 2 9% ) (P <0 0 5 ) ;有腹水组VEGF阳性表达率 (87 5 0 % )显著高于无腹水组 (5 7 1 4 % ) (P <0 0 5 ) ;②上皮性卵巢癌患者血清VEGF水平也明显高于良性囊腺瘤患者和交界性肿瘤患者 (P <0 0 1 ) ,卵巢癌中 ,低分化患者血清VEGF水平高于高、中分化患者 (P <0 0 1 ) ,血清VEGF水平在临床Ⅲ、Ⅳ期患者明显高于Ⅰ、Ⅱ期患者 (P <0 0 5 ) ,有明显腹水者比无腹水者高 (P <0 0 1 )。结论　VEGF在上皮性卵巢癌肿瘤组织中表达的增加以及血     

血浆溶血磷脂酸诊断早期卵巢恶性上皮性肿瘤价值初探

目的:初步探讨血浆溶血磷脂酸(LPA)诊断早期卵巢恶性上皮性肿瘤的潜在价值.方法:分别测定31例早期卵巢恶性上皮性肿瘤(Ⅰ～Ⅱ期),20例卵巢良性肿瘤,20例卵巢巧克力囊肿及20例正常妇女血浆LPA和血清癌抗原125(CA125)水平.结果:早期卵巢恶性上皮性肿瘤组、卵巢良性肿瘤、卵巢巧克力囊肿组、正常妇女组血浆LPA水平分别为4.12±1.36 μmol/L、1.74±0.71μmol/L、2.99±1.28μmol/L.、1.85±0.35μmol/L,早期卵巢恶性上皮性肿瘤组血浆LPA水平高于卵巢良性肿瘤组及卵巢巧克力囊肿组及正常妇女组(P均＜0.05).血浆LPA和血清CA125诊断早期卵巢恶性上皮性肿瘤的敏感性分别为80.65%和54.84%,血浆LPA水平在诊断早期卵巢恶性上皮性肿瘤的敏感性方面要优于CA125(P＜0.05);但两者的特异性分别为85.00%、76.67%,差异无统计学意义(P＞0.05).结论:早期卵巢恶性上皮性肿瘤组血浆LPA水平高于卵巢良性肿瘤组及卵巢巧克力囊肿组及正常妇女组,敏感性优于CA125,血浆LPA检测对诊断早期卵巢恶性上皮性肿瘤可能具有一定的积极意义.     

Is there a correlation between tumor marker panel and tumor size and histopathology in well staged patients with borderline ovarian tumors?

AIMS: To investigate whether there is a correlation between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well staged patients with borderline ovarian tumors (BOTs). METHODS: Four tumor markers (CA 125, CA 19-9, CA 15-3, and CEA) were analysed clinically in 60 well staged patients with borderline ovarian tumor, for this retrospective observational study. RESULTS: Most patients had serous histology and early stage disease, and the mean age at the time of diagnosis was 40.70 years (range: 19-73). Twenty-nine patients (48.3%) had high CA 125 levels (>35 U/l), 15 patients (25%) had high levels of CEA (>4 ng/ml), 12 patients (20%) had high levels of CA 19-9 (>37 U/ml), and 9 patients (15%) had high levels of CA 15-3 (>30 ng/ml) at the time of initial surgery. The positive rate of CA 125, CA 19-9, CA 15-3, and CEA in serous tumor were 57.9, 7.9, 7.9 and 15.8%, respectively. These figures were 31.8, 40.9, 27.3 and 40.9% in mucinous tumor. The positive rate of CA 125 in the serous group was statistically significantly higher than that in the mucinous group, while the positive rates for CA 19-9 and CEA in mucinous histology was significantly higher than those in serous tumors. In case of grouping the tumor size as <4, 4.1-10 and >10 cm, the mean serum levels of tumor markers had significantly increased by increasing tumor size (p<0.05 for CA 125, and CA 19-9, p>0.05 for CA 15-3, and CEA). CONCLUSION: The high levels of tumor markers, especially for CA 125 and CA 19-9, may indicate the larger tumor size. The elevation of serum CA 125 may suggest serous tumors, while the high level of serum CA 19-9 and CEA may indicate mucinous BOTs.     

Relationship between serum levels and immunohistological tissue levels of CA 125 and CEA in epithelial ovarian cancers: its implications for tumor cell type specificity

Tissue localization and serum levels of CA125 and CEA in patients with epithelial ovarian tumors were examined. In patients with serous cystadenocarcinoma, "high CA125 and low CEA" was a characteristic feature in the serum, while in patients with mucinous cystadenocarcinoma, "low CA125 and high CEA" was generally found in the serum. Tissue localization of CA125 was strongly positive in serous cystadenocarcinoma associated with high serum CA125 levels, and negative in serous tumors showing normal serum CA125 levels. In mucinous cystadenocarcinoma, CA125 staining was positive with a minimum intensity. Immunostaining of CEA was strongly positive in mucinous cystadenocarcinoma associated with high serum CEA levels and was negative in mucinous tumors showing normal serum CEA levels. Tissue localization of CEA in serous cystadenocarcinoma was negative. There was a good correlation between serum CA125 and immunohistochemical tissue levels of CA125 in serous cystadenocarcinoma, and the same between serum CEA and immunohistochemical tissue levels of CEA in mucinous cystadenocarcinoma. These results demonstrate that in epithelial ovarian tumors CA125 has a relatively higher tumor cell type specificity for serous cystadenocarcinoma, whereas CEA does for mucinous cystadenocarcinoma.     

Clinical evaluation of MRI in the diagnosis of borderline ovarian tumors

OBJECTIVE: To evaluate the clinical potential of contrast-enhanced MRI with Gd-DTPA (gadopentetate dimeglumine) in the diagnosis of borderline ovarian tumors. METHODS: Thirteen patients with 14 borderline ovarian tumors were evaluated with serum levels of four tumor markers (CA125, CA19-9, SLX and CEA) and contrast-enhanced MRI. RESULTS: Among the 13 patients, five had normal serum levels of all four tumor markers, and five had high serum levels of plural tumor markers. The positive rates of CA125, CA19-9, SLX, and CEA were 46.2% (6/13), 38.5% (5/13), 30.8% (4/13), and 7.7% (1/13), respectively. With contrast-enhanced MRI, all 13 patients were diagnosed as having malignant tumors using the widely accepted criteria of MRI findings for the diagnosis of malignant ovarian tumors. CONCLUSIONS: In the present study, all 14 borderline tumors had similar MRI findings to those of malignant tumors and were diagnosed as ovarian cancers with contrast-enhanced MRI, unrelated to the serum levels of tumor markers.     

CA125 expression pattern, prognosis and correlation with serum CA125 in ovarian tumor patients. From The Danish "MALOVA" Ovarian Cancer Study

OBJECTIVES: To determine the CA125 tissue expression levels in borderline and invasive epithelial ovarian tumor tissues. Secondly, to evaluate whether CA125 tissue expression levels correlate with clinico-pathological parameters and serum CA125 levels and finally to investigate the prognostic value of tissue CA125 expression levels in ovarian cancer (OC) patients. METHODS: We designed tissue arrays (TA) and analyzed the CA125 expression in tissues from 778 Danish women with an ovarian tumor. Furthermore, corresponding preoperative blood samples obtained before surgery were collected from 382 women with OC. RESULTS: Significantly more CA125 expression positive tumors (no expression vs. expression) were found in the serous subtype compared to the percentage of positive tumors in mucinous, endometroid and other subtypes for patients both with borderline ovarian tumors and with OC (p<0.00001, p<0.00001). Similarly, a positive significant correlation was found between elevated serum CA125 levels and elevated levels of CA125 tissue expression (N=382 stage I-IV OC, Spearman rho=0.31, p<0.0001) (N=206 stage III OC, Spearman rho=0.30, p<0.0001). We found a significantly shorter survival for stage III/IV OC patients with no CA125 tissue expression compared to stage III/IV OC patients with positive CA125 tissue expression (p=0.0003). CONCLUSION: Our finding that tissue CA125 expression was lacking in late stage primary OC tumor of Danish women with poor survival may be of value in selecting patients as eligible candidates for individually based treatments.     

Tissue expression of CA 125 in benign and malignant lesions of ovary and fallopian tube: A comparison with CA 19-9 and CEA

Sections of formalin-fixed and paraffin-embedded tissue specimens of 11 normal ovaries and tubes, 13 tubo-ovarian abscesses, 3 tubal carcinomas, and 115 ovarian tumors were investigated by immunohistochemistry. CA 125 and CA 19-9 were demonstrated with monoclonal antibodies, CEA with polyclonal antibodies. The tissue expression was visualized by the avidin-biotin method. In the germinal epithelium of all ovaries no tumor marker was confirmed. In 4 out of 11 tubes the epithelium was CA 125 positive, in 2 out of 11 cases CA 19-9 positive. Nine out of 13 tubo-ovarian abscesses were CA 125 and 5 out of 13 were CA 19-9 positive in their epithelium. Elevated serum levels of these markers might be due to expression via the epithelial cell of the inflamed tube. All normal and inflammatory adnexal tissues were CEA negative. In serous tumors and undifferentiated carcinomas, CA 125 was most frequently confirmed (85 and 70%, respectively). All mucinous tumors were CA 125 negative. The most frequently confirmed tumor marker was CA 19-9 (77%). In endometrioid tumors, CEA was most frequent (44%). In 42% of the borderline tumors and carcinomas only one marker was demonstrated, in 7% none. Here, immunohistochemistry may indicate the most adequate marker. Tumor marker expression was markedly heterogenous: tumor areas with strong, weak, and no reaction were adjacent. The tumor markers revealed no specificity for malignancy or disease.     

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.     

Serous and mucinous borderline tumors of the ovary: a clinicopathologic and DNA-ploidy study of 102 cases

One-hundred and two patients with epithelial borderline ovarian tumors treated at Tampere University Hospital between January 1965 and September 1991 were evaluated. There were 48 patients with serous tumors and 54 with mucinous tumors. Ninety-three (91%) patients had clinical stage I and nine had stage III disease. Abdominal hysterectomy and bilateral salpingo-oophorectomy were performed in 70% of the patients. Forty percent of those with serous and 20% with mucinous tumors were operated conservatively. After conservative surgery six patients had a total of 10 deliveries and none of these had a recurrence. Seven patients received chemotherapy, none had radiation therapy. An aneuploid DNA pattern was identified in 8.2% of 85 specimens studied and a high S-phase fraction was found in 8.6% of 81 specimens studied. DNA measurement failed to identify the malignantly behaving tumors. Elevated preoperative serum levels of CA125 were found in 10 (63%) out of 16 cases studied. All of them dropped postoperatively to normal. During the follow-up period (mean 11.6 years, range 4.5–29.7 years) 22 patients died but in 17 of them death was unrelated to ovarian tumor. The corrected (borderline malignancies related) 5-year survival rate was 100% in patients with serous tumor and 96% with mucinous tumor, 25-year survival rate was 97% and 91%, respectively. There was no difference between the serous and mucinous groups. Our results show that ovarian borderline tumors have a good prognosis. Quite conservative therapy is often enough, especially in low-stage disease in young women who want to retain their fertility.     

Analysis of serum CA125, CEA, AFP, LDH levels and LDH isoenzymes in patients with ovarian tumors--correlation between tumor markers and histological types of ovarian tumors

Serum CA125, CEA, AFP, LDH levels and LDH isoenzymes were analyzed in ovarian tumor patients, who were treated at Kyoto University Hospital. CA125 was positive in 10/16 (62.5%) cases of common epithelial carcinoma, especially 100% positive in serous carcinoma, but was negative in mucinous tumors. CA125 was also negative in patients with germ cell and sex cord stromal tumors. CEA was positive in 13/32 (40.6%) cases of epithelial carcinoma, most frequently elevated in patients with mucinous carcinoma, pseudomyxoma peritonei, and Krukenberg tumor. AFP was positive only in those with endodermal sinus tumors. LDH was elevated in 16/39 (41%) cases of epithelial carcinoma, but was not specific for histological types. In contrast, all 8 cases of dysgerminoma, 1 of immature teratoma and 2 of endodermal sinus tumor showed extremely elevated LDH levels. Moreover, the normal pattern or deviation to H subunit of LDH isoenzymes was seen in such cases of germ cell tumor, while deviation to M subunit was noted in epithelial and metastatic tumor patients. These data indicate that each parameter is useful as a tumor marker for the specific histological type of ovarian tumor; CA125 for non-mucinous epithelial carcinoma, CEA for mucinous tumor and Krukenberg tumor, AFP for yolk sac tumor, LDH and LDH isoenzymes for dysgerminoma and other solid germ cell tumors. In addition, preoperative diagnosis of histological types of ovarian tumors may be possible by combining these tumor markers.     

Relation between serum levels of tissue polypeptide antigen (TPA) and cancer antigen 125 (CA125) and their immunohistochemical identification in benign and malignant gynecological disease

Summary We studied immunohistochemical stains for TPA and CA125 in patients with benign and malignant gynecologic diseases. The results were as follows: (1) CA125 was not found in ovarian mucinous cystadenocarcinoma but was demonstrated immunohistochemically in 82% of ovarian serous cystadenocarcinomas and 83% of Krukenberg's tumors. (2) TPA was demonstrated in 65% of ovarian serous and 75% of ovarian mucinous cystadenocarcinomas, and in 58% of endometrial carcinomas. (3) TPA was found in all trophoblastic tumors examined, while CA125 was found in none. Eighty-three percent of patients with trophoblastic diseases had raised serum TPA levels. (4) When serum CA125 levels were raised, CA125 was demonstrated immunohistochemically in 71% of patients with ovarian serous cystadenocarcinomas, 67% of patients with Krukenberg's tumors and 100% of patients with tubal carcinomas. (5) Despite elevated serum levels, CA125 and TPA were not identified by immunohistochemistry in 64% cases of benign ovarian disease and in 80% of patients with uterine myomata. (6) It would seem that CA125 was more easily released from tumor cells than TPA.     

Immunohistochemical differentiation between ovarian granulosa cell tumors and ovarian carcinomas

Summary Differential diagnosis is a major problem in histopathology of ovarian tumors. Difficulties may arise if the tumor is a poorly differentiated carcinoma or a granulosa cell tumor of the sarcomatoid type. It was the aim of the present study to evaluate the usefulness of immunohistochemistry in differentiating between granulosa cell tumors of the ovary and ovarian carcinomas. We investigated 56 ovarian malignancies (13 granulosa cell tumors, 17 serous, 14 mucinous and 12 poorly differentiated carcinomas) and performed immunohistochemical detection of Vimentin, Keratin, CA125, CA19-9, CEA, S100 and Ber-EP4. Expression of Vimentin was highest and expression of Keratin was lowest in granulosa cell tumors in contrast to carcinomas. CA125 and CA19-9 were not expressed in granulosa cell tumors, whereas the detection rate in carcinomas (except for CA125 in mucinous carcinomas) was high. CEA, S100 and Ber-EP4 do not seem to be useful markers in differential diagnosis. A marker profile of Vimentin, Keratin, CA125 and CA19-9 allows a quite strict differentiation between poorly differentiated ovarian carcinomas and granulosa cell tumors of the ovary.