The Use of Human Epididymis 4 and Cancer Antigen 125 Tumor Markers in the Benign or Malignant Differential Diagnosis of Pelvic or Adnexal Masses

Background: Ovarian cancer is one of the highest mortality cancers in gynaecology. Discrimination of benign masses from malignant ones may sometimes become a challenge for the clinician since there is not a reliable tumour marker, thus some unnecessary, highly morbid operations can be performed. Aims: To explore the efficacy of human epididymis 4 (HE 4) and cancer antigen 125 (CA 125) markers in differentiating malignant and benign pelvic masses of ovarian origin and to identify the cut-off points for those markers. Study Design: Prospective study. Methods: Fifty-one patients who were diagnosed and planned to undergo surgery for ovarian mass between June 2008 and December 2008 were enrolled into this study. Preoperative venous blood samples were taken and frozen for marker investigation and final diagnoses were concluded by histopathological examination. After recruitment of all cases CA 125 and HE 4 levels were evaluated. Results: The statistical analysis did not indicate any statistically significant difference between the CA 125 levels of the patients with malignant and benign adnexal masses (p=0.105). The HE 4 levels of the patients with malignant adnexal masses were higher at a statistically significant level compared to the patients with benign adnexal masses (p=0.002). For HE 4 tumour marker and at the cut-off point of >25 pM, sensitivity was 1, specificity 0.40, positive cut-off value 0.19, negative cut-off value 1, accuracy 0.47 and positive likelihood ratio 1.65. Conclusion: Human epididymis 4 is a better diagnostic tool than CA 125 in benign-malignant discrimination of adnexal masses. The cut-off value of 25 pmol/L for human epididymis 4 will contribute to providing proper guidance to patients with adnexal masses and applying the proper treatment method

Shotgun Proteomics Identifies Serum Fibronectin as a Candidate Diagnostic Biomarker for Inclusion in Future Multiplex Tests for Ectopic Pregnancy

Ectopic pregnancy (EP) is difficult to diagnose early and accurately. Women often present at emergency departments in early pregnancy with a 'pregnancy of unknown location' (PUL), and diagnosis and exclusion of EP is challenging due to a lack of reliable biomarkers. The objective of this study was to identify novel diagnostic biomarkers for EP. Shotgun proteomics, incorporating combinatorial-ligand library pre-fractionation, was used to interrogate pooled sera (n = 40) from women undergoing surgery for EP, termination of viable intrauterine pregnancy and management of non-viable intrauterine pregnancy. Western blot was used to validate results in individual sera. ELISAs were developed to interrogate sera from women with PUL (n = 120). Sera were collected at time of first symptomatic presentation and categorized according to pregnancy outcome. The main outcome measures were differences between groups and area under the receiver operating curve (ROC). Proteomics identified six biomarker candidates. Western blot detected significant differences in levels of two of these candidates. ELISA of sera from second cohort revealed that these differences were only significant for one of these candidates, fibronectin. ROC analysis of ability of fibronectin to discriminate EP from other pregnancy outcomes suggested that fibronectin has diagnostic potential (ROC 0.6439; 95% CI 0.5090 to 0.7788; P>0.05), becoming significant when 'ambiguous' medically managed PUL excluded from analysis (ROC 0.6538; 95% CI 0.5158 to 0.7918; P<0.05). Fibronectin may make a useful adjunct to future multiplex EP diagnostic tests

Simultaneous sex cord stromal tumor with annular tubules, adenocarcinoma of the cervix and intraductal papilloma of the breast in a patient with Peutz–Jeghers syndrome: a case report

Peutz–Jeghers syndrome was first described by a Dutch physician, Jan Peutz, in 1921. It is an inherited syndrome characterized by intestinal hamartomatous polyps, which can cause obstruction, and mucocutaneous hyperpigmentation. This rare syndrome brings a 15-fold increase in the risk of intestinal as well as gynecologic tumors, especially ovarian cancer. We present a 49-year-old women with a huge adnexal mass and already diagnosed Peutz–Jeghers syndrome. Although the sampling of the endometrium, which was done before the surgery, was normal, cervical adenocarcinoma (adenoma malignum) was diagnosed after the operation, and complementary radical trachelectomy was conducted to complete the therapy. In conclusion, Peutz–Jeghers syndrome patients are at an increased risk of genital tract tumors. It should be kept in mind that a clinical examination could be insufficient to diagnose all the tumoral components of the disease.Zespół Peutza–Jeghersa jako pierwszy opisał holenderski lekarz Jan Peutz w 1921 roku. Ten dziedziczny zespół charakteryzuje się obecnością polipów hamartomatycznych, które mogą powodować niedrożność jelit, oraz hiperpigmentacją skóry i błon śluzowych. To rzadkie schorzenie powoduje 15-krotny wzrost ryzyka wystąpienia guzów jelita oraz nowotworów ginekologicznych, szczególnie raka jajnika. Poniżej przedstawiamy przypadek 49-letniej pacjentki z olbrzymią zmianą w obrębie przydatków, u której wcześniej zdiagnozowano zespół Peutza–Jeghersa. Chociaż przeprowadzona przed operacją biopsja endometrium nie wykazała zmian wewnątrz macicy, po zabiegu zdiagnozowano gruczolakoraka szyjki macicy, a leczenie uzupełniono zabiegiem radykalnej trachelektomii. Podsumowując, pacjentki z zespołem Peutza–Jeghersa znajdują się w grupie zwiększonego ryzyka wystąpienia nowotworów narządów rodnych. Należy pamiętać, że badanie kliniczne może nie być wystarczające do wykrycia wszystkich guzowych elementów tej choroby

Placental site trophoblastic tumor: Report of a tertiary center experience

PubMedID: 26775357Objective: To analyze the clinical and pathological characteristics of placental site trophoblastic tumor (PSTT) cases and to discuss the diagnosis, treatment, and prognosis of PSTT. Materials and Methods: The clinical and pathological data of eight patients with PSTT at Istanbul Medical Faculty Hospital from 1988 to 2010 were analyzed retrospectively. Results: The mean age of the patients was 31 years. The antecedent pregnancy was full-term delivery in most of the patients (6/8, 75%). The mean interval from last pregnancy to diagnosis of PSTT was 35 months (range, six to 192). Serum human chorionic gonadotropin (hCG) levels at the time of diagnosis ranged from 0.1 to 2280 mIU/ml (mean, 614). All patients had Stage 1 disease and ultimately underwent hysterectomy. None of the patients received adjuvant chemotherapy. One patient died of an unknown reason, one month after the surgery. The rest of the patients were alive and without evidence of disease after an average of 3.5 years (range, one to 11) of follow-up. Conclusion: Hysterectomy alone can provide long-term survival in early-stage disease

UTERINE MYOMA WITH CYSTIC DEGENERATION MIMICKING OVARIAN NEOPLASM: A CASE REPORT

WOS: 000408442000008Objective: Myomas are the most common uterine neoplasms. They usually have a characteristic appearance on ultrasound but the myomas that have undergone degeneration may have variable patterns. We are presenting a patient with the histologic diagnosis of uterine myoma with cystic degeneration, but preoperatively, we strongly suspected that the tumor was a primary ovarian tumor. Case report: A 41-year-old woman, presented with a history of abdominal distention and pelvic pain. Abdominal sonogram showed a large, complex and predominantly cystic mass, approximately 20 cm x 30 cm in size, occupying the whole abdomen and suggestive of a suspicious ovarian neoplasm. Magnetic Resonance Imaging scan showed a large, thin-walled and predominantly cystic mass. The tumor was in general cystic but solid components showed contrast enhancement after contrast injection. Tumor markers were slightly elevated. Primary ovarian tumor was the most likely diagnosis, because of its size, cystic nature and thin walls. At laparotomy, we found an enlarged, complex and predominantly cystic tumor arising from the uterus that filled the entire abdominal cavity. Total hysterectomy and bilateral salpingectomy was done. Frozen section diagnosis was degenerated uterine myoma. Postoperative period was uneventful and the patient was discharged 5 days after the operation. The final histologic diagnosis was uterine myoma with cystic and myxoid degeneration, no mitosis nor necrosis was present. Conclusion: An uterine myoma with extensive cystic degeneration may mimic an ovarian tumor on imaging modalities and should be considered in the differential diagnosis of an adnexial / pelvic mass

Conservative management of a patient with endometrial carcinoma desiring fertility: how to inform?

Conservative management of patients with endometrial cancer who desire fertility is becoming widespread in certain circumstances. A 36-year-old women desiring fertility with early-stage endometroid type adenocarcinoma of the endometrium was treated with 160 mg/d megestrol acetate for six months. After confirmation of a normal endometrial biopsy she became pregnant spontaneously. Following an uneventful pregnancy a healthy baby at term was delivered by cesarean section. Definitive surgery was Performed. The risks and benefits of this thereupeutic approach are discussed and informing style of the patients emphasized

UTERINE MYOMA WITH CYSTIC DEGENERATION MIMICKING OVARIAN NEOPLASM: A CASE REPORT

Objective: Myomas are the most common uterine neoplasms. They usually have a characteristic appearance on ultrasound but the myomas that have undergone degeneration may have variable patterns. We are presenting a patient with the histologic diagnosis of uterine myoma with cystic degeneration, but preoperatively, we strongly suspected that the tumor was a primary ovarian tumor

EPITHELIAL OVARIAN CANCER WITH CENTRAL NERVOUS SYSTEM METASTASIS - CASE REPORT

Epithelial ovarian cancer rarely metastasizes to central nervous system (CNS). We present a case of ovarian cancer with CNS metastasis

Placental site trophoblastic tumor: report of a tertiary center experience

Objective: To analyze the clinical and pathological characteristics of placental site trophoblastic tumor (PSTT) cases and to discuss the diagnosis, treatment, and prognosis of PSTT. Materials and Methods: The clinical and pathological data of eight patients with PSTT at Istanbul Medical Faculty Hospital from 1988 to 2010 were analyzed retrospectively. Results: The mean age of the patients was 31 years. The antecedent pregnancy was full-term delivery in most of the patients (6/8, 75%). The mean interval from last pregnancy to diagnosis of Pm was 35 months (range, six to 192). Serum human chorionic gonadotropin (hCG) levels at the time of diagnosis ranged from 0.1 to 2280 mIU/ml (mean, 614). All patients had Stage 1 disease and ultimately underwent hysterectomy. None of the patients received adjuvant chemotherapy. One patient died of an unknown reason, one month after the surgery. The rest of the patients were alive and without evidence of disease after an average of 3.5 years (range, one to 11) of follow-up. Conclusion: Hysterectomy alone can provide long-term survival in early-stage disease