Aim: To analyze the use of serum cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA-125) and carcinoembryogenic antigen (CEA) in predicting the malignant potential of mucinous ovarian tumor, and to assess the clinical factors associated with these tumors. Methods: This retrospective study collected the data from 314 patients who were diagnosed with mucinous ovarian tumor. These patients had preoperative serum CA19-9, CA-125, CEA available and underwent surgery at Ramathibodi Hospital between January 2010 and December 2016. The diagnostic performance of CA19-9, CA-125 and CEA was analyzed using the receiver operator characteristic curve. The associations between clinicopathological factors and serum CA19-9, CA-125 and CEA level were also analyzed. Results: A total of 314 patients were recruited in this study. They consisted of 221 patients with benign mucinous ovarian tumor (70.38%), 65 patients with borderline mucinous ovarian tumor (20.70%) and 28 patients with mucinous ovarian carcinoma (8.92%). Multivariate analysis revealed that the tumor size, elevated serum CA19-9, CA-125 and CEA influenced the tumor pathology. The mucinous ovarian tumor with large tumor size, elevated serum CA19-9, CA-125 and CEA more than the cut off values showed a positive correlation with the risk ratio of 1.60 (95% CI = 1.13-2.28; P = 0.005), 1.74 (95% CI = 1.22-2.47; P = 0.002), 1.90 (95% CI = 1.34-2.70; P < 0.001), 1.58 (95% CI = 1.10-2.29; P = 0.020), respectively. CA-125 provided the highest diagnostic performance, with an area under receiver operator characteristic curve of 0.745, to differentiate between borderline, malignant or benign mucinous ovarian tumor. Conclusion: Preoperative elevation of the serum CA19-9, CA-125, CEA and tumor size are useful predictors to differentiate between benign, borderline and malignant mucinous ovarian tumor. The best predictor is CA-125, followed by CA19-9 and CEA.
Retroperitoneal tumors can pose a diagnostic and therapeutic challenge to gynecologists because of their rarity, late presentation, and complex anatomical location in the retroperitoneum. This article reviews the diagnosis and management of retroperitoneal tumors in the pelvis, and highlights the potential pitfalls that may be faced by gynecologists.
Endometriosis is characterized by the presence of endometrial tissues outside the uterus. It affects females in their reproductive years as it is believed to be an oestrogen dependent condition. The estimated prevalences of endometriosis in the general population are as high as 10%, and are increased in females with subfertility.The diagnosis of endometriosis is usually suspected clinically, and confirmed by transvaginal ultrasound or magnetic resonance imaging of the pelvis. The gold standard of diagnosis is surgical visual inspection of the pelvic organs by an experienced surgeon during laparoscopy.Positive histology will confirm the diagnosis; but negative histology does not exclude it. Serum CA 125 levels may be increased in endometriosis, but is a poor diagnostic tool as compared to laparoscopy.The management of endometriosis is dependent on whether the primary problem is pain or subfertility. The primary objectives of the interventions include the removal of endometriotic implants, nodules or cysts, restoration of normal anatomy, reduction of disease progression and symptomatic relief. Treatment must be individualized, taking into consideration the impact of the condition on the quality of life. This may require a multidisciplinary approach involving the pain clinic and counselling services.
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