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      Ovarian fibroma/fibrothecoma with elevated serum CA125 level : A cohort of 66 cases

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          Abstract

          Ovarian fibroma/fibrothecoma with elevated serum OC125 antigen (CA125) is rarely encountered in clinical practice, and also easily misdiagnosed as epithelial ovarian carcinoma (EOC). The aim of this study was to investigate the clinicopathological features of ovarian fibroma/fibrothecoma with elevated serum CA125.

          In total, 580 patients who underwent primary surgery and pathologically diagnosed as ovarian fibroma/fibrothecoma were retrospectively analyzed. The clinicopathological parameters were collected and compared between the patients with elevated serum CA125 (>35 U/mL) and without. The immunoreactivity for CA125 in ovarian fibroma/fibrothecoma and epithelial cancer tissues was detected and compared by immunohistochemistry. Univariate and multivariate analyses were performed to identify factors associated with elevated serum CA125 level. The correlation between the immunoreactivity of CA125 in tissue and serum CA125 level was examined by Pearson correlation analysis.

          Elevated serum CA125 level (range 36.7–1848 u/m) was found in 66 of 580 (11.3%) ovarian fibroma/fibrothecoma patients. Univariate analysis showed that the elevated serum CA125 level was significantly correlated with tumor diameter ≥10 cm ( P < .001), ascites ( P < .001), and hydrothorax ( P < .001). Multivariate analysis revealed that tumor diameter ≥10 cm and ascites were independently associated factors ( P < .001 and < .001 respectively). Immunohistochemical staining showed that the expression of CA125 was negative in all fibroma/fibrothecoma tissues, but positive in all EOC tissues, and the immunoreactivity for CA125 was positively correlated with serum CA125 level in the EOC patients ( P = .005).

          The elevated serum CA125 level in ovarian fibroma/fibrothecoma is nontumor originated and occurs more frequently in those with larger size tumor or Meigs syndrome.

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          Incidence, clinical analysis, and management of ovarian fibromas and fibrothecomas.

          Nabil T. Makhlouf, Riadh Ben Temime, Abdelhamid Koubaa … (2008)
          The objective of the study was to identify the incidence, diagnosis, and therapeutic and histological particularities of ovarian fibromas and fibrothecomas. This was a retrospective study of 24 patients who underwent surgical treatment for ovarian fibromas and fibrothecomas between January 1994 and December 2006. Clinical, ultrasonographic, tumor marker, therapeutic, and histologic data were analyzed. The mean age of patients was 49 years. Thirteen patients were menopausal. Ultrasonographic findings were ovarian echogenic tumor in 6 cases, hypoechogenic tumor in 12 cases, mixed tumor in 6 cases, and anechogenic tumor in 1 case. Cancer antigen-125 level measured in 21 cases was abnormal in 3 cases. Twenty-one patients underwent laparotomy. Three patients underwent laparoscopy; however, 1 was converted to laparotomy because of a suspected tumor. Histological findings were 16 fibromas and 9 fibrothecomas. Ovarian fibromas and fibrothecomas are uncommon, accounting for 3.3% of ovarian tumors. These lesions often occur in perimenopausal and menopausal patients. Clinical, ultrasonographic, and tumor marker data remain the best preoperative approach currently available for ovarian tumors. However, the diagnosis remains histological.
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            Meigs' syndrome with elevated serum CA 125 levels: two case reports and review of the literature.

            D Timmerman, I B Vergote, P Moerman (1995)
            Two cases of Meigs' syndrome in association with elevated serum CA 125 levels are reported. The significance of Meigs' syndrome lies in the fact that neither ascites nor pleural effusion is necessarily an ominous sign in women with a pelvic tumor. Although there is a strong correlation between ovarian malignancy and elevated serum CA 125 levels, several benign conditions have been found to cause a rise in CA 125 levels. It is important to remember that a pelvic neoplasm in a woman presenting with hydrothorax, ascites, and elevated CA 125 levels might be benign and that this condition can rapidly be resolved with surgical removal. Neither ultrasound examination nor computed tomography can reliably offer a preoperative diagnosis.
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              Elevated CA125 level associated with Meigs' syndrome: case report and review of the literature.

              A. J. Morán Mendoza, G Alvarado-Luna, G Calderillo-Ruiz … (2016)
              Meigs' syndrome is the association of ovarian fibroma, pleural effusion, and ascites. Meigs' syndrome with marked elevation of CA125 is an unusual clinical condition reported in 27 cases in the literature. The patient was a 46-year-old woman with right pleural effusion, ascites, ovarian tumor, and CA125 level of 1808 U/mL. Tomography revealed ascites and bilobate pelvic tumor of approximately 25 cm. The diagnosis of advanced epithelial ovarian cancer was considered, and the patient was treated with chemotherapy. Three chemotherapy schemes were applied due to the total lack of response in tumor volume; however, CA125 decreased to 90 U/mL. Thus, surgery was performed with resection of 25 cm of the left ovarian tumor, with intact capsule and without implants; the result of histopathologic analysis was fibroma. Postoperative CA125 was 11 U/mL. Patients with elevated CA125 and ascites cytology positive for malignancy must be cautiously treated due to the possibility of false positives, even if the probability is low. Therefore, minimally invasive surgery for biopsy collection must be considered. Although the association between ovarian tumor, pleural effusion, ascites, and marked elevation of CA125 is highly indicative of epithelial ovarian cancer, Meigs' syndrome must be considered in the differential diagnosis.
              Article 0 comments Cited 10 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: August 2018
                Publication date (Electronic): 24 August 2018
                Volume: 97
                Issue: 34
                Electronic Location Identifier: e11926
                Affiliations
                [a ]Women's Reproductive Health Laboratory of Zhejiang Province
                [b ]Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
                Author notes
                [∗ ]Correspondence: Yuanming Shen, Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China (e-mail: 13588193832@ 123456163.com ).
                Article
                Publisher ID: MD-D-17-08240 Accession ID: 11926
                DOI: 10.1097/MD.0000000000011926
                PMC ID: 6112998
                PubMed ID: 30142807
                SO-VID: 01f800d4-4a8a-41db-85bb-870d7fa078b6
                Copyright © Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                Date received : 5 January 2018
                Date accepted : 26 July 2018
                Categories
                Subject: 5600
                Subject: Research Article
                Subject: Observational Study
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: clinicopathological characteristics,epithelial ovarian carcinoma (eoc),ovarian fibroma/fibrothecoma,serum ca125
                Data availability:
                Keywords: clinicopathological characteristics, epithelial ovarian carcinoma (eoc), ovarian fibroma/fibrothecoma, serum ca125

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