A huge ovarian mucinous cystadenoma in a 14-year-old premenarchal girl: review on ovarian mucinous tumor in premenarchal girls

Superficial epithelial ovarian tumors are unusual in adolescent girls (when compared with adult women) and extremely rare before menarche. Mucinous cystadenoma (MCA) in children that is a rare form of epithelial tumor is a benign cystic ovarian neoplasm. To our knowledge, there are only eight cases of mucinous cystadenoma, three of borderline mucinous cystadenoma, and three of mucinous cystadenocarcinoma reported in the English-language literature. We present a 14-year-old premenarchal girl with a giant ovarian mucinous cystadenoma. This review is supported by the finding that epithelial ovarian neoplasms are extremely rare prior to puberty and that only 14 mucinous tumors have been reported prior to menarche.     

Saliva and serum CA 125 assays for detecting malignant ovarian tumors

The aim of this study was to determine whether CA 125 was present in saliva and, if it was present, to compare saliva and serum levels in patients with pelvic masses in order to determine whether saliva assays would be useful in identifying patients with ovarian malignancies. Saliva and serum CA 125 levels were assayed in specimens obtained from 55 normal healthy women, 92 patients with benign pelvic masses, and 41 patients with malignant pelvic tumors. We defined a serum CA 125 value greater than 65 U/mL and a saliva CA 125 value greater than 3000 U/mL as the positivity criteria. No serum or saliva assay was positive in the 55 normal women. The sensitivities of the saliva and serum CA 125 assays in 16 patients with epithelial ovarian cancer were 81.3 and 93.8%, respectively. A linear correlation was observed between serum and saliva CA 125 levels. The false-positive rates of serum CA 125 in patients with endometriomas and pelvic tuberculosis were 72.7 and 80%, respectively, but the false-positive rates for saliva CA 125 assays were only 13.6 and 10%, respectively. Therefore, the saliva CA 125 assay had a better diagnostic value than the serum CA 125 assay. In addition, collection of saliva is simple, noninvasive, and inexpensive, and samples could be obtained easily and repeatedly. For these reasons, assays of saliva CA 125 levels may be a new way of screening for malignant ovarian tumors.     

Ovarian surgery in premenarchal girls

Study ObjectiveThis study was undertaken to assess the indications, procedures, and pathology in premenarchal girls undergoing ovarian surgery.DesignRetrospective chart review.SettingUniversity of Michigan Medical Center 1980–1996.ParticipantsPremenarchal girls, who underwent ovarian surgery.InterventionsNone.Main Outcome MeasuresAll available charts (n = 52) had information extracted concerning age at time of surgery, presenting symptoms, preoperative and postoperative diagnosis, procedure, and pathology report.ResultsOf the 52 patients, 50% were less than 1 year old, 31% were between 1 and 8 years old, and 19% were between 8 and 12 years old. Presenting complaints in 31 patients included structural and or endocrinologic abnormalities, and the other 21 patients presented with abdominal or systemic complaints. The most common preoperative diagnosis was an abdominal/pelvic mass (n = 24). The postoperative diagnoses revealed 18 torsions and 16 ovarian masses without torsion, 8 chromosomal abnormalities, 5 hernias, and 5 malignancies. Procedures included 37 salpingo-oophorectomies (28 unilateral and 9 bilateral), 7 oophorectomies, and 7 cystectomies. One patient underwent a staging procedure. Pathology reports confirmed hemorrhagic infarctions (n = 19), dysgenic gonads (n = 8), simple cysts (n = 7), teratomas (n = 6), theca lutein cysts (n = 4), fibroma (n = 1), stromal tumor (n = 1), mucinous cystadenoma (n = 1), granulosa cell tumor (n = 1), uterine neuroblastoma (n = 1), mixed germ cell neoplasm (n = 1), metastatic Wilms' tumor (n = 1), and gonadoblastoma (n = 1).ConclusionsTorsion was the most common diagnosis in our study group and was usually unsuspected. Premenarchal ovarian surgery usually included removal of the entire ovary. However, because malignancies are uncommon in this population (9.6%), a cystectomy should be considered when appropriate and technically feasible.     

Cancer antigen CA 125 in ovarian cancer

AIM: To estimate the diagnostic and prognostic value, pathological and clinical correlation of cancer antigen 125 (CA125) in ovarian cancer (OC). Retrospective analysis was done of 350 patients who were operated for OC in years 1990-2001 in Gynecology Clinic MU of Gdansk. We analyzed those before primary operation (PO) and second look laparotomy (SLL). Chi 2 and t-Student tests were used. RESULTS: Before PO 18% OC patients had CA125 less than 35 and 43.8% more than 600 U/ml, for benign tumors it was 59.9 and 1.1 respectively (p < 0.001). 56.2% with complete remission and 43.8% with progress disease in SLL had normal values of antigen before the operation. There were 32 patients who had CA125 > 600 before SLL and all of those had progress disease. The positive and negative predictive value of CA125 before SLL were 0.94 and 0.56 respectively. Cytoreduction with no macroscopic disease was achieved in 45% of patients with CA125 < 600 U/ml before PO, and it was 19.2% for those with antigen > 600 (p = 0.001). We looked for differences of CA125 levels depending on clinical and pathological data. According to our results only histology (p = 0.02) and clinical stage (p = 0.02) influenced CA 125 levels. CONCLUSIONS: There is a good correlation between elevated levels of CA125 and state of the disease in SLL, and we consider SLL as obligatory to perform as there is a low negative predictive value of CA125. The CA125 before primary operation has prognostic significance to possibility of optimal cytoreduction.     

CA 125 and vascular endothelial growth factor in the differential diagnosis of epithelial ovarian tumors

Tumor markers have been investigated in differentiation of benign and malignant tumors. We analyzed CA 125 and vascular endothelial growth factor (VEGF) levels in serum and cyst fluid in patients with epithelial ovarian tumors. Serum and tumor cyst fluid of 50 patients with ovarian epithelial tumors (7 malignant, 3 bordeline and 40 benign) were assayed for VEGF by ELISA and CA 125 levels by chemoluminescence. CA 125 serum levels were significantly higher in patients with malignant and borderline tumors than in patients with benign cysts (p = 0.0005). CA 125 cyst fluid contents were comparable for malignant, borderline and benign ovarian tumors (p = 0.39). Significantly higher levels of VEGF were present in cyst fluid for malignant and borderline tumors compared with benign cysts (p < 0.0001); however, serum levels of VEGF were similar among all patients (p = 0.25). The CA 125 serum levels correlated with matched VEGF cyst fluid levels (r = 0.44, p = 0.0015). Serum CA 125 and cystic VEGF were good methods to differentiate benign and malignant epithelial ovarian tumors. Patients with elevated intracystic VEGF levels presented significantly higher CA 125 serum levels, although the CA 125 intracystic content overlapped. The angiogenesis and enhancement of vascular permeability induced by VEGF represents a new hypothesis for the release of the CA 125 antigen into the circulation in patients with ovarian epithelial neoplasm.     

Primary research on saliva and serum CA125 assays for detecting malignant ovarian tumors

Saliva and serum CA125 levels were assayed in specimens obtained from 55 normal healthy women, 92 patients with benign pelvic masses and 41 patients with malignant pelvic tumors. A saliva CA125 value greater than 3,000 kU/ml and serum CA125 value greater than 65 kU/ml were defined as positive. Only one saliva assay was positive in 55 normal women. The sensitivity of saliva and serum CA125 assays in 16 patients with epithelial ovarian cancer was 81% and 94% respectively. A linear correlation was observed between serum and saliva CA125 levels in 32 patients with malignant ovarian cancer. The false positive rate of saliva and serum CA125 assays in patients with endometriomas and pelvic tuberculosis was 13.6%, 10% and 72.7%, 80% respectively. Therefore, the saliva CA125 assay had better diagnostic value than the serum CA125 assay. In addition, collection of saliva is simple, noninvasive, and inexpensive and could be obtained repeatedly. For these reasons, assays of saliva CA125 levels may provide a new way of screening for malignant ovarian tumors.     

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.     

CA 125 surveillance and second-look laparotomy in ovarian carcinoma

CA 125 was evaluated as a tumor marker in 31 patients undergoing treatment for ovarian carcinoma, 17 of whom had second-look laparotomies. At the time of second-look laparotomy, 14 patients had CA 125 values in the normal range. Six of these patients had a positive second-look laparotomy. Although normal CA 125 values do not obviate the need for second-look laparotomy in treatment planning, rising or falling trends reflected clinical disease progression or regression in 80% of the cases.     

Vaginal bleeding in premenarchal girls: a review

Vaginal bleeding in childhood is not a common complaint. Serious medical or sociological problems can underly this irregular symptom in young girls. Therefore it requires careful medical investigation followed by appropriate sociologic and psychologic support. The variable etiologies of vulvovaginitis are the most common causes of vaginal bleeding during the prepubertal period. External blood loss can be related to trauma or urologic factors. It can be the presenting sign of relatively rare benign and malignant neoplasms of the genital tract. Precocious menstruation in itself or as a part of precocious puberty must be suspected in these cases. Vaginal bleeding in prepubertal girls is uncommon but warrants careful evaluation because of the special status of the young patient.     

Accuracy of CA 125 in the diagnosis of ovarian tumors: a quantitative systematic review

A quantitative systematic review was performed to estimate the accuracy of CA 125 assay in the diagnosis of ovarian tumors. Studies that evaluated CA 125 levels for the diagnosis of ovarian tumors and compared them with paraffin-embedded sections as the diagnostic standard were included. Seventeen studies were analyzed, which included 2374 women. The pooled sensitivity for the diagnosis of borderline tumors or ovarian cancer was 0.80 (I.C. 95% 0.76-0.82) and the specificity was 0.75 (I.C. 95% 0.73-0.77). The diagnostic odds ratio for ovarian cancer and borderline lesions vs. benign lesions was 21.2 (95% C.I., 12-37). Summary receiver operating characteristic curves were constructed due to heterogeneity in the diagnostic odds ratio. For malignant and borderline ovarian tumors vs. benign lesions the area under the curve was 0.8877. A CA 125 level of >or= 35 U/ml is a useful preoperative test for predicting the benign or malignant nature of pelvic masses. The accuracy of CA 125 in the diagnosis of ovarian tumors is high and very important in helping the surgeon to decide what kind of surgery should be performed.     

CA125 Serum Levels and Secondary Laparotomy in Epithelial Ovarian Tumours

CA125 serum levels were assayed prior to 57 secondary laparotomies for ovarian epithelial tumours. Tumour was present in all 16 patients with an elevated level greater than 35 U/ml but the absence of tumour was incorrectly predicted in 15 of the 33 (45.5%) patients with CA125 levels less than 35 U/ml. For these patients the CA125 level was elevated in 14 of 20 (70%) with tumour greater than 1.5 cm, 1 of 7 (14.3%) with macroscopic tumour less than or equal to 1.5 cm and 1 of 4 (25%) with microscopic tumour. Tumour was resectable to less than or equal to 0.5 cm in 7 of 12 (58.3%) patients with CA125 less than 35 U/ml, 2 of 4 (50%) with CA125 in the range 35-100 U/ml and only 1 of 11 (9.1%) with CA125 greater than 100 U/ml (p less than .05). The CA125 level was elevated in 1 of 13 (7.7%) patients with less than 15 cm3 of tumour compared with 16 of 18 (88.9%) patients with 15 cm3 of tumour or more (p less than .0001). The correlation between the CA125 serum level and the tumour volume was almost statistically significant (r = +0.31, p = .053). The level of CA125 was normal in all 8 patients with mucinous tumours--4 of whom were found to have tumour at secondary surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison between tissue and serum content of CA 125, CA 19-9, and carcinoembryonic antigen in ovarian tumors

Tumor markers CA 125, CA 19-9, and carcinoembryonic antigen (CEA) were detected by immunohistochemistry in paraffin embedded tissue samples obtained from two different locations in 35 ovarian tumors. In addition, serum concentrations of these tumor markers were measured before cytoreductive surgery. The staining reaction was heterogeneous in different parts of the tumor as well as within the parenchyma. Of the marker positive tumors, a staining reaction was observed in both tissue samples in only 10 of 22 cases for CA 125, in eight of 13 cases for CEA, and in three of eight cases for CA 19-9. Eighty-one percent of the patients whose tumor was positive for CA 125 also showed elevated serum levels of this marker. A poor correlation was found between tissue and circulating CA 19-9 levels. CEA was detected in 28% of the tumors and seemed to be valuable only for monitoring in rare cases of ovarian cancer. For purposes of selecting a marker for monitoring of patients with ovarian carcinoma, immunohistochemistry has a predictive value for CA 125 only. In order to better define the marker expressed in a tumor, it is necessary to examine at least two samples of different parts of the malignant tissue.     

Epithelial ovarian tumors of borderline malignancy

Between January 1975 and January 1987, 80 patients underwent primary surgery at Brigham and Women's Hospital for epithelial ovarian tumors of borderline malignancy. Surgical staging revealed 52 (65%) patients with stage IA, 2 (2.5%) with stage IB, 10 (12.5%) with stage IC, 4 (5%) with stage II, 11 (13.8%) with stage III, and 1 (1.2%) with stage IV. All 37 patients with mucinous tumors had stage I disease, whereas 13 (33%) of 39 patients with serous tumors had stage II-IV disease. The mean sizes of mucinous and serous ovarian tumors were 18.7 and 10 cm, respectively. At initial surgery, 48 (60%) patients had a total abdominal hysterectomy with bilateral salpingo-oophorectomy and 16 (20%) had an oophorectomy. Sixteen (20%) patients underwent cystectomy, 6 (37.5%) of whom subsequently had an oophorectomy. All 10 patients treated by cystectomy alone have remained disease free. CA-125 levels were normal in 5 patients with stage I disease, but were elevated in 6 of 8 patients with more advanced tumors. Current disease status was determined in 72 patients (90%); 69 (95.8%) are alive and disease free, 1 (1.4%) patient is alive with tumor, and 2 (2.8%) patients died, free of disease.     

Normal serum CA125 half-life and normal serum nadir CA125 level in patients with ovarian cancers

The normal serum CA125 half-life and distribution of the normal serum nadir CA125 value in patients with epithelial ovarian carcinoma (EOC) have not been determined yet. Among patients with EOC, 41 patients met the inclusion criteria of the present study: the patients that underwent complete cytoreductive surgery and six cycles of platinum-containing chemotherapy, and who had no recurrent disease more than five years. Serum CA125 half-life (T1/2) during primary surgery and primary chemotherapy was calculated and serum nadir CA125 level was evaluated by logarithmic-transformed serum CA125. Median value of nadir CA125 was 7 U/ml (range 3-20 U/ml), and the mean ln (serum nadir CA125) was 1.96 +/- 0.45. Mean T1/2 was 10.4 days in all patients, and T1/2 value was associated with the preoperative serum levels of CA125. Predicted slope of CA125 regression curve was also influenced by the preoperative CA125 value. The present study provides fundamental information with regard to normal half-life time and normal nadir of CA125 in EOC patients.     

Tumor marker CA 125 in diagnosis, monitoring management and follow-up of patients with ovarian tumors.

The concentration of CA 125 was defined in the blood serum of 151 patients with ovarian tumors: benign--49, borderline--5 and malignant--97. In 75.7% of benign tumors CA 125 concentrations did not exceed the normal level. In two from five patients with borderline tumors CA 125 concentration varied from 47 to 130 U/ml. High levels of CA 125 (from 125 to 10.000 U/ml and higher) were revealed in 54 from 57 patients (94.7%) with malignant ovarian tumors. If in Stages I and II elevated CA 125 levels (from 125 to 430 U/ml) were discovered in 71.4% and 80.0% of the cases, respectively, then in Stages III and IV CA 125 levels rose from 300 to 10.000 U/ml and higher in all cases. High CA 125 concentrations were noticed in 95.7% of patients with clinical signs of recurrences of the disease, and it was proved at "second-look" surgery. Thus, it was expedient to use CA 125 widely for an early detection of ovarian cancer, as a control on the efficiency of therapy and in diagnosis of subclinical recurrences of the disease.     

Conservative management of adnexal torsion in premenarchal girls

STUDY OBJECTIVE: To evaluate treatment of premenarchal girls with torsion of the adnexa. DESIGN: Retrospective review of medical records (Canadian Task Force classification II-2). SETTING: Tertiary care, university-affiliated hospital. PATIENTS: Eight premenarchal girls (age range 3-12 yrs) with twisted adnexa. INTERVENTION: Laparoscopic detorsion and follow-up with B scan and Doppler ultrasound imaging. MEASUREMENTS AND MAIN RESULTS: Duration of complaints ranged from 8 to 72 hours (mean 34.6 hrs) and the interval from admission to surgery ranged from 6 to 24 hours (mean 18.7 hrs). Four patients had torsion of normal-appearing adnexa. The other four had ovarian neoplasms. Two had cystic mature teratomas (dermoid cysts) and one a serous cystadenoma that required additional operation. The fourth girl had a simple ovarian cyst that was aspirated laparoscopically. Seven girls (87%) had normal-appearing ovaries on follow-up ultrasound. In one patient, a small ovary was seen, with no intraovarian blood flow on color Doppler. CONCLUSION: Although the diagnosis of torsion of the adnexa in premenarchal girls is difficult and usually delayed, laparoscopic detorsion seems to be an effective adnexa-sparing approach. We suggest that laparoscopy should be the treatment of choice and that detorsion, rather than adnexectomy, be performed more often in these patients.     

CA125 and radioimmunoimaging in monitoring of epithelial ovarian carcinoma

Serum CA125 was measured by monoclonal antibody-OC125 in 50 primary and 29 suspected recurrent ovarian cancer patients. Among the later, RII examination by using 131I labelled polyclonal antibody-OCOV3 was carried out in 16 cases at the same time. For the suspected recurrent cases, the results, as checked by surgico-pathological findings, revealed a corroborative rate of 79.3% for CA125 assay and 87.5% for RII technique. The positive predictive value of both CA125 assay and RII were 100%, while the negative predictive value was only 25% for CA125 assay and 50% for RII technique. However, for each individual case if the results of the two tests were combined, the negative predictive value was also 100%. Preoperative CA125 level had no significant relationship with the prognosis in primary cases. But the two year survival rate for recurrent cases with a preoperative CA125 less than or equal to 35,000 U/L was much higher than those with CA125 greater than 35,000 U/L.     

Serum CA 125 levels and survival in advanced ovarian cancer

We made a retrospective analysis of 85 patients with elevated serum CA 125 after surgery for ovarian cancer. Absolute CA 125 serum levels were a poor guide to prognosis. However, the ratio between the serum CA 125 after the first, second, or third course of treatment and the postoperative value was an excellent guide to prognosis. These were also independent and stable in the Cox Regression analysis.