Preoperative Differentiation of Benign and Malignant Non-epithelial Ovarian Tumors: Clinical Features and Tumor Markers

Abstract

Objective To evaluate the role of clinical features and preoperative measurement of cancer antigen 125 (CA125), human epididymis protein (HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. Methods One hundred and nineteen consecutive women with germ cell, sex cord-stromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. Results Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, among malignant, four were immature teratomas. The most common tumors in the sex cord-stromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign and malignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. Conclusion Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant cases were diagnosed at initial stages with good prognosis. The measurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

Insights into the Clinico-Epidemiological Aspects of Non-Epithelial Ovarian Tumor Emphasizing Diagnosis and Tailored Surgical Approach; a Single Institutional Retrospective Study

“…In contrast, the study under discussion here, 90% of the non-epithelial ovarian cancer patients studied exhibited a unilateral ovarian tumor as their primary site, which agreement with 91% reported by In the current study, it was found that 54% of the patients were in a pre-menopausal state. This approximates the findings in the study by Gomes et al (2020) where pre-menopausal patients constituted 57% of the sample.…”

“…The most prevalent histological subtype of ovarian sex cord-stromal tumors (OSCTs) was adult granulosa cells, constituting approximately 72% of cases in this study. This observation is in line with the study conducted by Gomes et al (2020) who reported a similar distribution, with adult granulosa cell tumors representing around 71% of OSCT cases.…”

“…In the study conducted by Gomes et al in (2020) 85% of the ovarian patients had unilateral ovarian tumor as their primary site. In contrast, the study under discussion here, 90% of the non-epithelial ovarian cancer patients studied exhibited a unilateral ovarian tumor as their primary site, which agreement with 91% reported by In the current study, it was found that 54% of the patients were in a pre-menopausal state.…”

Diagnostic value of combination of exfoliative cytology with CA125, CEA, NSE, CYFRA21-1 and CA15-3 for lung cancer

“…Carcinoembryonic antigen (CEA) is present in endoderm-derived digestive system cancer and normal digestive tract tissues, and also present in a trace amount in normal human serum, which can be used as a diagnostic marker for breast cancer, lung cancer, and colorectal cancer, but its specificity and sensitivity are not high (4). Carbohydrate antigen 125 (CA125), a glycoprotein that can be bound by the monoclonal antibody OC125, is most commonly found in the serum of patients with epithelial ovarian tumors, but does not exist in normal ovarian tissues, which has high diagnostic sensitivity, but low specificity (5). Neuron-specific enolase (NSE) is an acid protease unique to neuroendocrine cells and neurons, which is a specific marker for neuroendocrine tumors such as medullary thyroid carcinoma and small cell carcinoma (6).…”

May human epididymis 4 protein play a role in the etiopathogenesis of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome?

“…Human epididymis protein 4 (HE4) is a protein that was first shown to be secreted from distal epithelial cells of human epididymal ducts 8 . It is known that there is a relationship between the serum levels of the HE4 protein, which is a protease inhibitor, and many malignancies, especially of ovarian origin 9–12 . It is also known that this protein has roles in regulation of cell migration, adhesion, and invasion, and in autoimmune diseases 13,14 .…”