Extremely elevated serum CA125 due to endometriosis

Endometriosis can mimic cancer in a pre-menopausal woman (1). In this case an ultrasound showed a complex ovarian cyst with a low resistance blood flow and the serum CA 125 level was 6,114 iu/mL (normal <35), more than twice the highest level previously reported due to benign disease.     

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.     

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。     

CA 125 in peritoneal fluid and serum of patients with endometriosis

Serum and peritoneal fluid collected from 48 patients at laparoscopy was assayed for CA 125. Geometric mean serum CA 125 was similar in 21 patients with predominantly early stage endometriosis (13.4 U/ml; confidence intervals (C.I.) 10.8-16.7) and 27 patients without endometriosis (12.9 U/ml; C.I. 9.7-17.2). Mean peritoneal fluid CA 125 was higher in the endometriosis patients (mean 44.4 U/ml; C.I. 34.5-57.2) than controls (35.7 U/ml; C.I. 30.0-42.2), but the difference was not significant. Peritoneal fluid volume was increased in endometriosis patients (p = 0.013), and only after correction for peritoneal fluid volume did total antigenic concentration in aspirated peritoneal fluid show significant elevation (p = 0.0015) in endometriosis patients (mean 340 U/ml; C.I. 212-547) compared with controls (125 U/ml; C.I. 85-184). These results suggest that although CA 125 may be expressed in peritoneal fluid in endometriosis, it is unlikely to be of use as a marker of disease activity in peritoneal fluid obtained by culdocentesis.     

What is the source of elevated serum levels of CA 125 in patients with endometriosis?

The presence of CA 125 was investigated in endometriotic tissue and endometrial mucosa using two different immunohistochemical methods, indirect immunofluorescence and the avidin-biotin immunoperoxidase technique. Neither of the methods revealed the antigen in the 12 endometriotic fragments studied. The endometrial mucosa both of patients with endometriosis and of the control subjects was positive with indirect immunoperoxidase staining in all cases, whereas with indirect immunofluorescence it was positive in 75 and 67%, respectively. Thus the mechanism(s) responsible for distribution of the antigen in different tissues and its reported high serum levels in advanced endometriosis is still unclear.     

Plasma and peritoneal fluid levels of CA 125 in women with endometriosis

Determined by a sandwich, solid-phase radioimmunoassay with mouse monoclonal antibody, OC 125, plasma CA 125 levels were significantly elevated in stage III (mean +/- SEM = 32.7 +/- 5.2 U/ml, n = 17, p = less than 0.01) and stage IV endometriosis (37.2 +/- 10.5 U/ml, n = 6, p = less than 0.005) compared with levels during the follicular (15.9 +/- 1.5 U/ml, n = 12) and secretory phases (15.8 +/- 1.3 U/ml, n = 15) of control women and users of oral contraceptives (15.5 +/- 1.2 U/ml n = 10). However, CA 125 levels were not significantly elevated in women with stage I (16.6 +/- 2.0 U/ml, n = 28) or stage II endometriosis (17.9 +/- 2.1 U/ml, n = 13). Peritoneal fluid levels of CA 125 (n = 14) were significantly higher (2 to 9.3 times) than the corresponding paired plasma levels in participants with stage I, II, or III endometriosis. In patients treated with danazol (n = 10) or buserelin (n = 17), plasma CA 125 levels decreased significantly by midtherapy, remained suppressed at the end of therapy, but rebounded to near pretreatment levels 6 months after treatment was completed. With gestrinone therapy a similar decline was observed but became significant only at the end of therapy. Our findings indicate that elevated plasma CA 125 levels may prove useful in the management of endometriosis.     

对子宫腺肌病患者血清CA125及EMAb的临床评价

目的：探讨血清CA125及子宫内膜抗体（EMAb)测定，对子宫腺肌病的诊断及疗效评估的临床价值。方法：经术后病理学检查确诊子宫腺肌病患者63例和子宫肌瘤患者45例，均于术前及术后测定两组血清CA125水平和EMAb。结果：子宫腺肌病组术前血清CA125平均水平及EMAb阳性率均高于子宫肌瘤组，两者相比差异有显著性（P＜0．001及P＜0．01）。联合测定血清CA125水平和EMAb，以两者均阳性为诊断标准，诊断子宫腺肌病的敏感性为54．63％，特异性为100％。子宫腺肌病组术后血清CA125水平和EMAb阳性率均较术前下降，差异有显著性（P＜0．01及P＜0．05）。结论：测定血清CA125及EMAb对子宫腺肌病有较好的辅助诊断价值，联合检测更能提高诊断的正确性，并可作为评价子宫腺肌病疗效的敏感指标。     

Prognostic potential of serum CA 125 levels in danazol-treated patients with external endometriosis: a preliminary study

Serum levels of CA 125 in 33 patients with progressive external endometriosis who were treated with 400 mg/day of Danazol for 16 weeks were assayed for an extended period (24-40 weeks), and changes in the CA 125 pattern were analyzed. Patterns of hormonal response were classified into four types. Prognosis for one type was good, whereas that for the other three types was poor. By making use of these patterns, we were able to determine more accurately the proper dose of Danazol, to alter the duration of treatment, and to predict relapse.     

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。     

Studies on serum CA125 levels in pregnant women

To confirm the change in serum CA 125 levels in cases of pregnancy, we measured serum CA 125 levels in 234 normal pregnant women, 40 postpartum women and 14 abnormal pregnant women (12 of IUFD and 2 of H. mole), using an RIA kit. The mean CA 125 level (+/- S.D.) and positive ratio (greater than 34U/ml) for pregnant women at 4-11 weeks of gestation were 65.0 +/- 77.3 U/ml and 64.6%, respectively, being the highest values in all the groups. On the contrary, those for pregnant women at 12-23 weeks of gestation were 22.3 +/- 10.6 U/ml and 12.7%, respectively, the lowest in all gestational groups. Changes in serum CA 125 levels in normal pregnant women showed a trend toward decrease, as gestation advanced. But the CA 125 levels for women at postpartum showed a slight trend toward increase. The mean CA 125 level (+/- S.D.) for 12 patients with IUFD was 392.5 +/- 275.8 U/ml and that for 2 patients with H. mole was 65.0 +/- 15.0 U/ml. Serum CA 125 levels for patients with IUFD were higher than that in cases of normal pregnancy. When utilizing CA 125 as a marker for ovarian cancer, the influence of pregnancy must be considered. And it indicates that CA 125 can be used as an aid to the diagnosis of IUFD in serous cases.     

Laparoscopy in diagnosing and treating endometriosis]

Clinical study in 98 women with genital endometriosis was performed. In 33 patient endometriosis was treated by operative laparoscopy-electrocauterization of foci in 20 women, ovarian cyst resection in 9 and cyst extrication in 4. In 10 cases laparoscopy was followed by laparotomy. Very high correlation between endometriosis and infertility was found (71.4%). Very few patients conceived till now (28.57%). Searching in the time of laparoscopy very subtle foci of endometriosis was stressed.     

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.     

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)     

Maternal serum CA125 levels in early intrauterine and tubal pregnancies

Summary Using an immunoradiometric assay, serum CA125 levels were measured in 13 women with a normal pregnancy, 9 with a spontaneous abortion, 3 with a hydatidiform mole, and 15 with a tubal pregnancy. Serum CA125 levels were high in patients with a normal pregnancy (154±169 U/ml; mean±S.D.), a spontaneous abortion (244±258 U/ml), or a hydatidiform mole (54±16 U/ml). In contrast, CA125 levels in patients with a tubal pregnancy (33±25 U/ml) were low, and almost all of those without uterine bleeding (25±9 U/ml) were within the normal range for non-pregnant women (<35 U/ml). The difference between serum CA125 levels with intrauterine pregnancy and with tubal pregnancy may be ascribed to the difference of the amount of decidual tissues at the site of trophoblastic invasion.     

Factors influencing serum CA 125 levels in normal women.

Serum CA 125 levels were studied in 2544 healthy women. Menopausal status and a history of hysterectomy were both highly significant influences on the CA 125 level (P less than .0001 for both factors). A history of hormone replacement therapy was also highly significant in reducing CA 125 levels (P = .002) in postmenopausal women. Other factors such as parity, history of unilateral oophorectomy or oral contraceptive usage, or family history of ovarian cancer were not significant influences when analysis of covariance was performed. When premenopausal women were assessed separately, age was significant (P = .04). The number of years since menopause did not influence CA 125 levels. Both hysterectomy and menopausal status have a clear effect on serum CA 125 levels and must be considered if serum CA 125 is to be used as a screening test.     

CA-125 levels in endometriosis

CA-125 is a cellular antigen detected in many patients with ovarian cancer, but it has also been detected in patients with endometriosis. Preoperative CA-125 levels were drawn from 113 patients before they underwent laparoscopy. Patients were categorized into diagnostic groups on the basis of pathologic findings. CA-125 levels in patients with evidence of intraabdominal adhesions were not statistically different from those in patients with normal pelvic anatomy. However, patients with advanced endometriosis had significantly elevated levels of CA-125 when compared with patients with normal pelvic anatomy (P less than 0.05). The clinical and immunologic implications of elevated CA-125 levels in patients with advanced endometriosis are discussed.     

Ovarian thecoma with ascites and high serum levels of CA125

We report a 34-year-old woman with an ovarian thecoma and ascites who exhibited high serum levels of CA125. Measuring serum tumor markers and imaging are two important diagnostic tools for malignant ovarian tumors. In the present case, a preoperative diagnosis of benign ovarian tumor could not be made due to the elevation of CA125 (895 U/ml) and nonspecific MRI findings. Received: 8 June 1999 / Accepted: 30 August 1999     

Elevated CA125 serum levels in a patient with tuberculous peritonitis

Summary We report a case of tuberculous peritonitis in a 59-year-old postmenopausal woman. Her serum CA125 level was raised and fell in response to antituberculous therapy.