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

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

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

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

Laparoscopic management of a spontaneous 12th week heterotopic tubal pregnancy: a case report

Here we present a spontaneously-developed case involving 12th week heterotopic tubal pregnancy. In the preoperative period, the diagnosis was confirmed both by ultrasonographic examination and magnetic resonance imaging (MRI). The patient was treated successfully using a laparoscopic salpingectomy technique without jeopardizing the intrauterine pregnancy

NF-k(1)B and COX-2 Relation Between Endometrial Cancer and the Clinicopathological Parameters

Objective: Our study examines nuclear factor kappa B (NF-.B) and cyclooxygenase-2 (COX-2) polymorphisms in the most common gynecological cancer type, endometrial cancer, and the relationship between disease parameters and these polymorphisms. Methods: In our patient group; while 109 endometrial cancer patients were examined and treated in the Department of Gynecology and Obstetrics, Istanbul Medical Faculty, and 106 healthy women without the disease were included in the control group. DNA of blood samples taken from all groups were isolated; COX-2 765C> G and COX-2 1195A> G polymorphisms were studied with NF-.B-94 ins / delATTG. Genotypes analyzed using the PCR-based restriction fragment length polymorphisms (RFLP) method were investigated in terms of the relationship between endometrial cancer susceptibility and endometrial cancer disease parameters. Results in SPSS 17 program; Student's t-tests were analyzed using Anova, Fisher's exact, and Chi-square tests. Results: NF-.B D + and DD genotype, COX-2 765 G + and GG genotype, and COX-2 1195 AA genotype were found to be significantly more common in the endometrial cancer group compared to the control group (p <0.05). However, no significant relationship was found between polymorphisms and disease parameters. Conclusion: NF-.B and COX-2 polymorphisms are more common in women with endometrial cancer. However, the absence of a link between these polymorphisms and the prevalence or violence of the disease suggests that they often trigger cancer development