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Objetivo: Describir las características clínicas de las pacientes con cáncer de ovario epitelial en el Instituto Oncológico Nacional de PanamáÌ. Métodos: Se realizó un estudio descriptivo en el Instituto Oncológico Nacional. Se revisaron todos los expedientes de las pacientes con cáncer de ovario epitelial desde enero 2012 a diciembre 2021. Aquellas con diagnóstico histopatológico confirmado de cáncer de ovario epitelial primario fueron incluidas en el estudio. Entre las variables evaluadas, se encontraban edad, lugar de procedencia, grupo histológico, etapa al diagnóstico, tratamiento y recidivas. Resultados: Se incluyeron 547 pacientes. El 49% (266) de las pacientes residían en la provincia de Panamá. La edad media fue de 56 años (DE:13.2). El 71% (386) estaban aseguradas. El 80% (439) presentaron síntomas relacionados al cáncer. El 80% (442) presentaron valores de CA-125 elevados. El 59% (321) eran de tipo seroso. El 62% (338) fueron tratadas con una combinación de cirugía y quimioterapia. En etapa I, el 19% (27) recayeron mientras que en etapa III, el 39% (103). El 80% (138) de las recidivas recibieron sólo quimioterapia. Conclusiones: En general, el cáncer epitelial se presentó en etapas avanzadas en mujeres mayores de 40 años asociado a sintomatología y valores de CA-125 elevados. El tipo histológico más frecuente fue el seroso y el tratamiento habitual fue una combinación de cirugía y quimioterapia. El porcentaje de muerte fue directamente proporcional con la etapa al diagnóstico. (provisto por Infomedic International)
Objetivo: Describir las características clínicas de las pacientes con cáncer de ovario epitelial en el Instituto Oncológico Nacional de PanamáÌ. Métodos: Se realizó un estudio descriptivo en el Instituto Oncológico Nacional. Se revisaron todos los expedientes de las pacientes con cáncer de ovario epitelial desde enero 2012 a diciembre 2021. Aquellas con diagnóstico histopatológico confirmado de cáncer de ovario epitelial primario fueron incluidas en el estudio. Entre las variables evaluadas, se encontraban edad, lugar de procedencia, grupo histológico, etapa al diagnóstico, tratamiento y recidivas. Resultados: Se incluyeron 547 pacientes. El 49% (266) de las pacientes residían en la provincia de Panamá. La edad media fue de 56 años (DE:13.2). El 71% (386) estaban aseguradas. El 80% (439) presentaron síntomas relacionados al cáncer. El 80% (442) presentaron valores de CA-125 elevados. El 59% (321) eran de tipo seroso. El 62% (338) fueron tratadas con una combinación de cirugía y quimioterapia. En etapa I, el 19% (27) recayeron mientras que en etapa III, el 39% (103). El 80% (138) de las recidivas recibieron sólo quimioterapia. Conclusiones: En general, el cáncer epitelial se presentó en etapas avanzadas en mujeres mayores de 40 años asociado a sintomatología y valores de CA-125 elevados. El tipo histológico más frecuente fue el seroso y el tratamiento habitual fue una combinación de cirugía y quimioterapia. El porcentaje de muerte fue directamente proporcional con la etapa al diagnóstico. (provided by Infomedic International)
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SUMMARY OBJECTIVE: Endometrial cancer is the most common gynecological cancer in developed countries, with a majority of cases being low-grade endometrioid endometrial cancer. Identifying risk factors for disease recurrence and poor prognosis is critical. This study aimed to assess the correlation between preoperative cancer antigen-125 levels and disease recurrence in early-stage endometrioid endometrial cancer patients. METHODS: The study was a retrospective analysis of 217 patients diagnosed with endometrioid endometrial cancer who underwent surgical treatment at a university-affiliated tertiary hospital between 2016 and 2022. Patients were divided into two groups based on their preoperative cancer antigen-125 levels and compared with clinicopathological findings and disease recurrence. Disease-free survival rates were calculated, and logistic regression analysis was performed to determine independent factors affecting disease-free survival. RESULTS: The mean age of patients was 61.59±0.75 years, and the mean follow-up time was 36.95±1.18 months. The mean cancer antigen-125 level was 27.80±37.81 IU/mL. The recurrence rate was significantly higher in the group with elevated cancer antigen-125 levels (p=0.025). Disease-free survival was lower in patients with elevated cancer antigen-125 compared with those with normal levels (p=0.005). Logistic regression analysis revealed that elevated cancer antigen-125 levels were associated with disease recurrence (OR: 3.43, 95%CI 1.13-10.37, p=0.029). CONCLUSION: The findings of this study suggest that preoperative cancer antigen-125 levels can be used as a predictor of disease recurrence in early-stage endometrioid endometrial cancer patients. cancer antigen-125 levels may be a useful tool for risk stratification and patient management in endometrial cancer.
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The national burden of HCV has significantly mounted over the period of last few decades placing Pakistan at the worst placement of second largest burden of HCV globally. Herein for the first time from Pakistan, we examined clinical correlation of potential biomarkers with HCV. Nation-wide study was conducted on 13,348 suspected HCV patients during 2018-2022. During pre-COVID-19 era of 2018-2019, prevalence of HCV remained 30%. During 2018, among HCV positive patients, 91% of ALT, 63% of AST, 67% of GGT, 28% of Bili T, 62% of HB, 15% of HBA1C, 25% of CREAT, 15% of PT, 15% of aPTT and 64% of AFP were abnormal. During 2019, among HCV infected 74.47% of ALT, 63.54% of AST, 70.24% of GGT, 24.71% of Bili T, 8.77% of HB and 75% of AFP were raised. CT/CAT scan revealed 4.65% liver complications (mild 13.04%, moderate 30.43% and severe 56.52%). During 2020, HCV prevalence remained 25%. 65.17% of ALT, 64.20% of AST, 68.75% of GGT, 31.25% of Bili T, 20.97% of HB, 4.65% of CREAT and 73.68% of AFP levels were raised. CAT analysis revealed liver complications among 4.41% (14.81% mild, 40.74% moderate, and 44.44% sever). 85.71% of participants diabetes was out of control. During 2021, HCV prevalence remained 27.1%. ALT (73.86%), AST (50.6%), GGT (67.95%), Bili T (28.21%), HB (20%), CREAT (5.8%) and AFP (82.14%) levels were abnormal. During 2022, the levels of ALT (56.06%), AST (56.36%), GGT (56.6%), Bili T (19.23%), HB (43.48%), HBA1C (14.81), CREAT (18.92%), AFP (93.75%) were abnormal. CAT analysis revealed 7.46% liver complications (25% mild, 30.36% moderate, and 42.86% sever). During 2021-2022, 83.33% of subject's diabetes was not controlled.
A carga nacional de HCV aumentou significativamente ao longo das últimas décadas, colocando o Paquistão na pior colocação da segunda maior carga de HCV globalmente. Pela primeira vez no Paquistão, examinamos a correlação clínica de potenciais biomarcadores com HCV. Um estudo nacional foi realizado com 13.348 pacientes suspeitos de HCV de 2018 a 2022. Durante a era pré-COVID-19 de 2018 a 2019, a prevalência do HCV permaneceu em 30%. Durante 2018, entre pacientes positivos para HCV, 91% de ALT, 63% de AST, 67% de GGT, 28% de Bili T, 62% de HB, 15% de HBA1C, 25% de CREAT, 15% de PT, 15% de aPTT e 64% de AFP eram anormais. Durante 2019, entre os infectados pelo HCV, 74,47% de ALT, 63,54% de AST, 70,24% de GGT, 24,71% de Bili T, 8,77% de HB e 75% de AFP foram elevados. A TC/TAC revelou 4,65% de complicações hepáticas (leve 13,04%, moderada 30,43% e grave 56,52%). Durante 2020, a prevalência do HCV permaneceu em 25%. 65,17% de ALT, 64,20% de AST, 68,75% de GGT, 31,25% de Bili T, 20,97% de HB, 4,65% de CREAT e 73,68% de AFP estavam elevados. A análise de TAC revelou complicações hepáticas em 4,41% (14,81% leves, 40,74% moderadas e 44,44% graves). 85,71% dos participantes o diabetes estava fora de controle. Durante 2021, a prevalência de HCV permaneceu em 27,1%. Os níveis de ALT (73,86%), AST (50,6%), GGT (67,95%), Bili T (28,21%), HB (20%), CREAT (5,8%) e AFP (82,14%) estavam anormais. Durante 2022, os níveis de ALT (56,06%), AST (56,36%), GGT (56,6%), Bili T (19,23%), HB (43,48%), HBA1C (14,81), CREAT (18,92%), AFP (93,75%) eram anormais. A análise de TAC revelou 7,46% de complicações hepáticas (25% leves, 30,36% moderadas e 42,86% severas). Durante 2021 e 2022, 83,33% do diabetes do sujeito não foi controlado.
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Biomarcadores Tumorais , Tomografia Computadorizada por Raios X , Hepacivirus , COVID-19 , PaquistãoRESUMO
El cáncer de ovario es un problema de salud pública para el cual no se cuenta con métodos de tamizaje estandarizados, no obstante, los marcadores Ca125, He4 y el índice de Roma tiene un gran valor en el diagnóstico y pronóstico de esta patología. Objetivo. Analizar el comportamiento de los marcadores tumorales Ca125 y He4 e índice de Roma en la predicción de malignidad en pacientes con masas ováricas. Materiales y Métodos. Se tomaron los resultados de laboratorio de 112 mujeres atendidas en el Hospital General Ambato de los valores séricos de Ca125, He4 y su correspondiente cálculo del índice de Roma. Se los dividió en el grupo pre y postmenopáusico, maligno y benigno. Resultados. El análisis de los resultados definió la relación de Ca 125 y He4 con el diagnóstico de cáncer de ovario con un nivel de confianza del 95% y valor de p<0,05. La probabilidad de diferenciar cáncer de ovario de procesos benigno para Ca125, He4 e índice de Roma fue del 93,33%, 84,4 y 99,7, respectivamente. Conclusiones. El mejor predictor de malignidad es el índice de Roma. Se encontraron valores séricos elevados de He4 mayores para pacientes postmenopáusicas. Se requieren más estudios que avalen un método de tamizaje estandarizado para el cáncer de ovario.
Ovarian cancer is a public health problem for which there are no standardized screening methods; however, Ca125, He4 and Rome index markers are of great value in the diagnosis and prognosis of this pathology. Objective. To analyze the behavior of tumor markers Ca125 and He4 and Rome index in the prediction of malignancy in patients with ovarian masses. Materials and Methods. The laboratory results of 112 women attended at Hospital General Ambato were taken for serum Ca125, He4 and their corresponding calculation of the Rome index. They were divided into premenopausal and postmenopausal, malignant and benign groups. Results. Analysis of the results defined the relationship of Ca 125 and He4 with the diagnosis of ovarian cancer with a confidence level of 95% and value of p<0.05. The probability of differentiating ovarian cancer from benign processes for Ca125, He4 and Rome index was 93.33%, 84.4 and 99.7, respectively. Conclusions. The best predictor of malignancy is the Rome index. Elevated serum He4 values were found to be higher for postmenopausal patients. Further studies are needed to support a standardized screening method for ovarian cancer.
O câncer do ovário é um problema de saúde pública para o qual não existem métodos de triagem padronizados. No entanto, os marcadores índice Ca125, He4 e Roma são de grande valor no diagnóstico e prognóstico desta patologia. Objetivo. Analisar o comportamento dos marcadores tumorais Ca125 e He4 e o índice de Roma na previsão de malignidade em pacientes com massas ovarianas. Materiais e métodos. Os resultados laboratoriais de 112 mulheres tratadas no Hospital Geral Ambato foram tomados para o soro Ca125, He4 e seu correspondente cálculo do índice de Roma. Eles foram divididos em grupos pré e pós-menopausa, malignos e benignos. Resultados. A análise dos resultados definiu a associação de Ca125 e He4 com o diagnóstico de câncer de ovário a um nível de confiança de 95% e valor de p<0,05. A probabilidade de diferenciar o câncer de ovário dos processos benignos para Ca125, He4 e índice de Roma foi de 93,33%, 84,4 e 99,7, respectivamente. Conclusões. O melhor preditor de malignidade é o índice de Roma. Os valores elevados de soro He4 foram considerados mais altos para pacientes na pós-menopausa. São necessários mais estudos para apoiar um método padronizado de triagem para o câncer de ovário.
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Neoplasias Ovarianas , Saúde PúblicaRESUMO
Abstract Introduction: Diagnosing extra-pulmonary tuberculosis (EPTB) is a challenge for physicians. It has been suggested that cancer antigen 125 (CA-125), which is produced by mesothelial cells, may be an EPTB diagnostic biomarker. Objective: To describe serum CA-125 levels behavior in patients with TB treated in a referral university hospital located in Cali, Colombia. Materials and methods: A cross-sectional study was conducted in 99 TB patients treated at Fundación Valle del Lili between 2007 and 2016 with CA-125 measurements (U/mL) made before TB treatment was started. Cases were classified as pulmonary TB (PTB) (n=33) or EPTB (n=66). A bivariate analysis was performed to compare the variables of interest (sociodemographic, clinical, and laboratory findings data) between EPTB and PTB groups, and to determine differences between patients with CA-125 positive results and those with negative results in relation to mortality. Results: Elevated CA-125 levels were reported in 55 patients (55.56%), and positive CA-125 results (>35 U/mL) were more frequent in the EPTB group (59.09% vs. 48.48%). In the EPTB group, results were positive in tuberculous serositis cases (100% pericardial TB, 68.42% peritoneal TB, and 66.66% pleural TB), and in 66.66% of miliary TB and spinal TB cases, respectively. Also, 15 TB infection-related deaths were reported in the follow-up period (n=66), of which 13 had a CA-125 positive result, finding a significant difference with those with negative results (p=0.021); however, 47.05% of the surviving patients also had a positive result. Conclusions: Most of tuberculous serositis, miliary TB, and spinal TB cases showed elevated CA-125 levels before starting TB treatment. Therefore, CA-125 may be useful for prognostic purposes in these patients.
Resumen Introducción. El diagnóstico de la tuberculosis extrapulmonar (TBEP) es un reto para los médicos. Se ha sugerido que el antígeno del cáncer 125 (CA-125), producido por las células mesoteliales, puede ser un biomarcador diagnóstico de TBEP. Objetivo. Describir el comportamiento de los niveles séricos del CA-125 en pacientes con tuberculosis (TB) atendidos en un hospital de referencia de Cali, Colombia. Materiales y métodos. Estudio transversal realizado en 99 pacientes con TB y mediciones de CA-125 (U/mL) antes de iniciar tratamiento para TB atendidos en la Fundación Valle del Lili entre 2007 y 2016. Los casos se clasificaron como TB pulmonar (TBP) (n=33) o TBEP (n=66). Se realizó un análisis bivariado para comparar las variables de interés (datos sociodemográficos, clínicos y de laboratorio) entre los grupos TBEP y TBP, y para determinar diferencias entre pacientes con resultados positivos y negativos para CA-125 en relación con la mortalidad. Resultados. Se reportaron niveles elevados de CA-125 en 55 pacientes (55.56%). Los resultados positivos para CA-125 (>35 U/mL) fueron más frecuentes en el grupo TBEP (59.0% vs. 48.48%). En el grupo TBEP se encontraron resultados positivos en los casos de serositis tuberculosa (100% TB pericárdica, 68.42% TB peritoneal y 66.66% TB pleural), y en 66.66% de los casos de TB miliar y vertebral, respectivamente. Además, se reportaron 15 muertes relacionadas con la infección por TB en el período de seguimiento (n=66), de las cuales 13 tuvieron un resultado positivo para CA-125, encontrando una diferencia significativa con aquellas con resultados negativos (p=0.021); sin embargo, el 47.05% de los pacientes supervivientes también tuvo un resultado positivo. Conclusiones: La mayoría de los casos de serositis tuberculosa, TB miliar y vertebral tuvieron niveles elevados de CA-125 antes de iniciar el tratamiento de la TB. El CA-125 puede resultar útil para fines de pronóstico en estos pacientes.
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Resumen El síndrome de Meigs (SM) es la asociación de ascitis, derrame pleural y neoplasias ovárica benigna, en el pseudo-Meigs se agrega CA-125 elevado. Presentamos el caso de una mujer de 67 años con masa anexial derecha, marcadores tumorales negativos. Se realiza ooforectomía, reportan cistoadenofibroma seroso. Doce semanas posteriores con distensión abdominal, pérdida de peso, tomografía abdominal con carcinomatosis peritoneal, antígeno CA-125 de 1,063.4 U/l. Segunda visión laparoscopia, sin neoplasia, corroborada por histopatología. Realizar un diagnóstico de SM es sencillo, no así cuando se presenta un caso atípico de pseudo-Meigs. Los artículos mencionan mejoría significativa posterior al manejo quirúrgico.
Abstract Meigs syndrome (MS) is the association of ascites, pleural effusion and benign ovarian neoplasms, the pseudo-Meigs (PMS) adds elevated CA-125. We present the case of a 67-year-old female with a right adnexal mass, negative tumor markers, performed ororectomy reported serous cystadenofibroma. 12 weeks later with abdominal distension, weight loss, abdominal tomography with peritoneal carcinomatosis, CA -125 antigen of 1063.4U/L. Second laparoscopic view, without neoplasia, corroborated by histopathology. Making a diagnosis of MS is simple, but not when an atypical case of Pseudo-Meigs is presented. The articles mention significant improvement after surgical management.
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Resumen OBJETIVO: Evaluar el rendimiento diagnóstico de cuatro índices de riesgo de malignidad (IRM) en la predicción de riesgo de cáncer de ovario. MATERIALES Y MÉTODOS: Estudio comparativo y retrospectivo efectuado en pacientes mayores de 18 años con tumor anexial atendidas en el Hospital Christus Muguerza Conchita y Alta Especialidad del 2016 al 2021. Para evaluar el rendimiento diagnóstico de cada índice se utilizó la curva ROC y el índice de Youden para la obtención de sensibilidad y especificidad. RESULTADOS: Se incluyeron 330 pacientes con media de edad de 38 años. Para el IRM1 una S 73.9% y E de 85.3% con punto de corte en 126; IRM2 el mejor punto de corte se estableció en 210, con una S 72.5% y E de 89.3%; IRM3 el mejor punto de corte se estableció en 125, con una S 73.9% y E 85.8%; y para el IRM4 el punto de corte fue 436, con una S 68.1% y E 89.7%. CONCLUSIONES: El IRM es un método fácil, de bajo costo y accesible para la discriminación de pacientes con probable masa anexial maligna. En la población mexicana del noreste de México puede recomendarse la aplicación de cualquiera de los índices.
Abstract OBJECTIVE: Compare the diagnostic performance of four malignancy risk indices in predicting ovarian risk at Hospital Christus Muguerza Conchita and Alta Especialidad. MATERIALS AND METHODS: Retrospective study including clinical records of patients older than 18 years with adnexal tumor treated at the Christus Muguerza Conchita and Alta Especialidad Hospital from 2016 to 2021. The ROC curve was used to evaluate the diagnostic performance of each index, through the obtaining the best cut-off point with the highest sensitivity and specificity from the Youden index. RESULTS: A total of 330 patients were included for the adnexal tumor assessment approach. The mean age of the patients was 38.8 years. For IRM1 an S 81.2% and E of 69.3% with a cut-off point at 126; IRM2 the best cut-off point was established at 210, with an S 72.5% and E of 89.3%; IRM3 the best cut-off point was established at 125, with an S 73.9% and E 85.8%; and for IRM4 the cut-off point was 436, with an S 68.1% and E 89.7%. CONCLUSIONS: MRI is an easy, low-cost and accessible method for the discrimination of patients with probable malignant adnexal mass. The use of any of the indices can be recommended in the Mexican population of northeastern Mexico.
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Resumen ANTECEDENTES: Una masa anexial es una prominencia de localización cercana, o relacionada con los órganos reproductores femeninos y sus tejidos circundantes. En la práctica clínica, las masas anexiales representan un dilema en cuanto a su diagnóstico y tratamiento. El diagnóstico suele ser fortuito, luego de un hallazgo en el examen ginecológico o en estudios de imagen. CASO CLÍNICO: Paciente de 29 años, con antecedentes de tres embarazos, dos partos y un aborto, sin comorbilidades asociadas. El último parto se registró en enero del 2021. Acudió a consulta debido a un cuadro de dolor en la parte inferior del abdomen, tipo cólico, de intensidad progresiva 7/10 en la escala visual análoga, irradiado a la zona lumbar, asociado con episodios eméticos, sin ningún otro síntoma, de una semana de evolución. Al ingreso a Urgencias sus condiciones generales se estimaron aceptables: hidratada, álgica, sin alteraciones cardiacas ni pulmonares, sin afectación neurológica ni adenopatías. CONCLUSIONES: Es importante individualizar cada caso, determinar las características ecográficas y llevar a cabo un tratamiento escalonado conforme a la respuesta clínica de las pacientes. La bibliografía y este reporte comprueban la utilidad de los nuevos índices propuestos por la IOTA para el cálculo del riesgo de malignidad de masas complejas anexiales. En este reporte de caso se logra observar una correcta relación entre la sospecha preoperatoria y el desenlace histológico final.
Abstract BACKGROUND: An adnexal mass is a prominence of location close to, or related to, the female reproductive organs and their surrounding tissues. In clinical practice, adnexal masses represent a diagnostic and treatment dilemma. Diagnosis is usually fortuitous, following a finding on gynecological examination or imaging studies. CLINICAL CASE: 29-year-old patient, with a history of three pregnancies, two deliveries and one miscarriage, with no associated comorbidities. The last delivery was recorded in January 2021. She came for consultation due to a picture of pain in the lower abdomen, colic type, of progressive intensity 7/10 on the visual analog scale, radiating to the lumbar area, associated with emetic episodes, without any other symptoms, of one week of evolution. On admission to the emergency department, her general condition was considered acceptable: hydrated, energetic, without no cardiac or pulmonary alterations, without neurological involvement or lymphadenopathies. CONCLUSIONS: It is important to individualize each case, determine the ultrasound characteristics and carry out a stepwise treatment according to the clinical response of the patients. The literature and this report prove the usefulness of the new indexes proposed by IOTA for the calculation of the risk of malignancy of complex adnexal masses. In this case report a correct relationship between preoperative suspicion and final histologic outcome is observed.
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Abstract Introduction: Progressive structural changes in the peritoneal membrane occur over the course of treatment in peritoneal dialysis (PD), resulting in an increase in cytokines such as CCL2 and structural changes in peritoneal membrane triggering an increase in CA-125 in dialysate, which reflects a probable local inflammatory process, with possible loss of mesothelial cells. Thus, the current study aimed to evaluate the association between plasma and CCL2 and CA-125 dialysate levels in patients undergoing PD. Methods: Cross-sectional study was conducted with 41 patients undergoing PD. The assessments of CA-125 and CCL2 levels were performed using a capture ELISA. Correlations were estimated using Spearman's correlation and the investigation of the association between the explanatory variables (CCL2) and response variable (CA-125) was done for crude ratio of arithmetic means and adjusted utilizing generalized linear models. Results: A moderate positive correlation was observed between the levels of CA-125 and CCL2 in the dialysate (rho = 0.696). A statistically significant association was found between the levels in the CCL2 and CA-125 dialysate (RoM=1.31; CI = 1.20-1.43), which remained after adjustment for age (RoM = 1.31; CI=1.19-1.44) and for time in months of PD (RoM=1.34, CI=1.22-1.48). Conclusion: The association of CA-125 levels with CCL2 in the dialysate may indicate that the local inflammatory process leads to temporary or definitive changes in peritoneal membrane. A better understanding of this pathogenesis could contribute to the discovery of new inflammatory biomarkers.
Resumo Introdução: Alterações estruturais progressivas na membrana peritoneal ocorrem no decorrer do tratamento em diálise peritoneal (DP), resultando em um aumento de citocinas como CCL2 e alterações estruturais na membrana peritoneal desencadeando um aumento de CA-125 no dialisato, o que reflete um provável processo inflamatório local, com possível perda de células mesoteliais. Assim, o presente estudo teve como objetivo avaliar a associação entre CCL2 e CA-125 no plasma e no dialisato de pacientes submetidos à DP. Métodos: Foi realizado um estudo transversal com 41 pacientes submetidos à DP. As avaliações dos níveis de CA-125 e CCL2 foram realizadas utilizando ELISA de captura. As correlações foram estimadas usando a correlação de Spearman, e a investigação da associação entre as variáveis explicativas (CCL2) e a variável resposta (CA-125) foi feita pela razão bruta das médias aritméticas e ajustada utilizando modelos lineares generalizados. Resultados: Foi observada uma correlação positiva moderada entre os níveis de CA-125 e CCL2 no dialisato (rho = 0,696). Foi encontrada uma associação estatisticamente significativa entre os níveis no dialisato de CCL2 e CA-125 (RoM=1,31; IC = 1,20-1,43), que permaneceu após ajuste por idade (RoM = 1,31; IC=1,19-1,44) e pelo tempo de DP em meses (RoM=1,34, IC=1,22-1,48). Conclusão: A associação dos níveis de CA-125 com CCL2 no dialisato pode indicar que o processo inflamatório local leva a alterações temporárias ou definitivas na membrana peritoneal. Uma melhor compreensão desta patogênese pode contribuir para a descoberta de novos biomarcadores inflamatórios.
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Humanos , Lactente , Diálise Peritoneal , Antígeno Ca-125/sangue , Quimiocina CCL2/sangue , Peritônio , Soluções para Diálise , Estudos Transversais , Inflamação , Proteínas de MembranaRESUMO
Introducción: Los tumores benignos de ovario corresponden a un 60-95% de las lesiones anexiales, en edad fértil los más frecuentes corresponden a quistes foliculares y endometriomas. Sin embargo, alrededor del 15% son patología maligna de ovario. Por lo que se debe evaluar aspectos como edad, características ecográficas y la presencia de marcadores tumorales específicos como CA 125. Objetivo general: Describir un reporte de caso y caracterizar la evidencia disponible sobre el abordaje de tumores benignos de ovario. Caso Clínico: Se presenta el caso clínico de una paciente en edad fértil de 43 años, cursando con dolor abdominal asociado a masa anexial, donde destaca la elevación del marcador CA 125 en rango de malignidad, por lo que se solicita valoración por oncología y manejo quirúrgico, confirmándose una masa anexial benigna de características quísticas, sugerente de endometrioma, al descartar patología maligna se realiza quistectomía total. Discusión: La patología anexial es una entidad clínica que puede abarcar características tumorales, ya sean benignas como malignas, por ello frente a lesiones ováricas, siempre se deben descartar estas últimas. Las características ecográficas de la paciente hacían sospechar de un endometrioma, el CA 125 elevado en ella hizo que se optara por un manejo quirúrgico oncológico con biopsia rápida para descartar o confirmar malignidad. Conclusión: Ante la presencia de endometriomas, el tratamiento debe discutirse caso a caso, teniendo en cuenta la sintomatología, deseos de fertilidad futura y tamaño de las lesiones.
Introduction: Benign ovarian tumors correspond to 60-95% of adnexal lesions, in childbearing years the most frequent correspond to follicular cysts and endometriomas. However, about 15% are malignant ovarian pathology. Therefore, aspects such as age, ultrasound characteristics and the presence of specific tumor markers such as CA 125 must be evaluated. General objective: Describe a case report and characterize the available evidence on benign ovarian tumors. Case report: A case of a 43 year old female of childbearing age, presents abdominal pain associated with an adnexal mass, where CA 125 elevations are found in the range of malignancy, for which an oncology evaluation and surgical management. A benign adnexal mass with cystic characteristics is confirmed, suggestive of endometrioma, when malignant pathology is ruled out, a total cystectomy is performed. Discussion: Adnexal pathology is a clinical entity that can include tumor characteristicas, whether benign or malignant, therefore, in the face of ovarian lesions, these should always be ruled out. The sonographic characteristics of the patient made one suspect an endometrioma, the elevated CA 125 in it led to an oncological surgical management with rapid biopsy to rule out or confirm malignancy. Conclusions: In the presence of endometriomas, treatmentshould be discussed individually, taking into account the symptoms, wishes for future fertility, and size of the lesions. Keywords: Ca-125 antigen, Endometriosis, Ovarian neoplasms
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Humanos , Feminino , Adulto , Neoplasias Ovarianas/diagnóstico por imagem , Antígeno Ca-125/sangue , Endometriose/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Espectroscopia de Ressonância Magnética , Doenças dos Anexos , UltrassonografiaRESUMO
Resumen La tuberculosis (TBC) peritoneal es una entidad poco frecuente y representa un 25 %-50 % de los casos de tuberculosis abdominal, y 0,1 %-0,7 % de todos los casos de tuberculosis. La mortalidad alcanza un 35 % cuando hay un retraso en el tratamiento, y un 73 % en pacientes con cirrosis. Además, tiene un gran espectro clínico, por lo que su diagnóstico diferencial abarca a nivel clínico patologías como cirrosis, malignidad, síndrome nefrótico, desnutrición; a nivel imagenológico enfermedad metastásica peritoneal, carcinomatosis de origen gástrico, pancreático, vesical, ovárico, colónico y enfermedades infecciosas como actinomicosis, coccidioidomicosis, histoplasmosis o micobacterias no tuberculosas. El diagnóstico se apoya inicialmente con química sanguínea, función hepática y renal, ultrasonido, tomografía computarizada (TC), paracentesis con citoquímico de líquido peritoneal, medición de adenosina-desaminasa (ADA) y reacción en cadena de polimerasa (PCR); no obstante, la laparoscopia con biopsia peritoneal y confirmación patológica o microbiológica siguen siendo el estándar de oro. Se han descrito casos de falsos negativos de la prueba ADA en situaciones de inmunosupresión o uso de antituberculosos. Se ha planteado el seguimiento de la actividad de la enfermedad midiendo los niveles de antígeno del cáncer 125 (CA-125). A continuación, presentamos un caso inusual de un paciente con TBC peritoneal con un síndrome de Sweet secundario, en quien inicialmente el reporte para ADA fue negativo, posiblemente debido a la administración de meropenem y en quien, además, se hizo el seguimiento de la actividad de la enfermedad con CA-125. Son muy excepcionales los reportes de falsos negativos de ADA y Sweet secundario a tuberculosis, por lo cual aportamos a la literatura con el reporte de nuestro caso.
Abstract Peritoneal tuberculosis is a rare disease that accounts for 25-50% of abdominal tuberculosis cases and 0.1-0.7% of all cases of tuberculosis. Mortality is 35% when treatment is delayed, and 73% in patients with cirrhosis. It also has a wide clinical spectrum, so its differential diagnosis covers conditions such as cirrhosis, malignancy, nephrotic syndrome, and malnutrition. Moreover, imaging studies may reveal peritoneal metastases; carcinomatosis of gastric, pancreatic, bladder, ovarian, colonic origin; and infectious diseases such as actinomycosis, coccidioidomycosis, histoplasmosis or non-tuberculous mycobacteria. Diagnosis is initially supported by blood chemistry, liver and renal function tests, ultrasound, CT scans, paracentesis with peritoneal fluid cytochemistry, and ADA and PCR measurement. The gold standard is laparoscopy with peritoneal biopsy and pathological or microbiological confirmation. Cases of false negatives of the ADA test have been described in immunosuppression or use of antituberculosis drugs. Monitoring of disease activity by measuring CA-125 levels has been considered. The following is the report of an unusual case of peritoneal TB with secondary Sweet's syndrome, in which the ADA report was initially negative, possibly due to meropenem administration, and in whom disease activity was monitored through Ca125. False negative reports of ADA and Sweet's secondary to TB are very rare, so this case contributes to the literature on these conditions.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose , Peritonite Tuberculosa , Síndrome de Sweet , Preparações Farmacêuticas , Adenosina , Reação em Cadeia da Polimerase , Laparoscopia , DiagnósticoRESUMO
BACKGROUND: Ovarian cancer (OC) is considered the most lethal gynecological cancer, of which more than 65% cases are diagnosed in advanced stages, requiring platinum-based neoadjuvant chemotherapy (NACT). METHODS: A prospective-longitudinal study was conducted among women with advanced epithelial ovarian cancer (AEOC), III and IV stages, and treated with NACT, at the National Cancer Institute - Mexico, from July 2017 to July 2018. Serum samples were obtained for quantification of CA125 and HE4 using ELISA at the first and in each of the three NACT cycles. The therapeutic response was evaluated through standard tomography. We determined whether CA125 and HE4, alone or in combination, were associated with TR to NACT during follow up. RESULTS: 53 patients aged 38 to 79 years were included, 92.4% presented papillary serous subtype OC. Higher serum HE4 levels were observed in patients with non-tomographic response (6.89 vs 5.19 pmol/mL; p = 0.031), specially during the second (p = 0.039) and third cycle of NACT (p = 0.031). Multivariate-adjusted models showed an association between HE4 levels and TR, from the second treatment cycle (p = 0.042) to the third cycle (p = 0.033). Changes from baseline HE4 levels during the first cycle was negative associated with TR. No associations were found between CA125 and TR. CONCLUSIONS: Serum HE4 levels were independently associated with TR among patients with AOEC treated with NACT, also a reduction between baseline HE4 and first chemotherapy levels was also independently associated with the TR. These findings might be relevant for predicting a lack of response to treatment.
Assuntos
Antígeno Ca-125/metabolismo , Carcinoma Epitelial do Ovário/tratamento farmacológico , Carcinoma Epitelial do Ovário/metabolismo , Proteínas de Membrana/metabolismo , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/metabolismo , Proteína 2 do Domínio Central WAP de Quatro Dissulfetos/metabolismo , Biomarcadores Tumorais/metabolismo , Quimioterapia Adjuvante , Feminino , Humanos , Cinética , Estudos Longitudinais , Pessoa de Meia-Idade , PrognósticoRESUMO
OBJETIVO: Evaluar la exactitud diagnóstica del Índice de Riesgo de Malignidad II (IRM II) en 100 pacientes con diagnóstico de masa anexial. MÉTODO: En una muestra de 100 pacientes con diagnóstico de masa anexial se cuantificaron variables demográficas y se aplicó el IRM II. Mediante una tabla 2 × 2 se obtuvieron la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la exactitud diagnóstica, y se compararon con el resultado histopatológico. RESULTADOS: El IRM II con resultado positivo se presentó en el 73.1% (52 pacientes) de los casos con resultado histopatológico maligno y en el 26.9% de aquellos con resultado histopatológico benigno. Presenta una sensibilidad en la prueba del 73.1%, una especificidad del 70.8%, un valor predictivo positivo del 73.2% y un valor predictivo negativo del 70.8%. La exactitud diagnóstica es del 72%. CONCLUSIONES: El IRM II es una herramienta de cribaje con aceptable desempeño diagnóstico para normar la conducta, como referir a un centro especializado o solicitar estudios más específicos en pacientes con diagnóstico de masa anexial por sospecha de malignidad. OBJECTIVE: Evaluate the usefulness of the Malignancy Risk Index II (MRI II) using diagnostic accuracy variables in 100 patients diagnosed with adnexal mass. METHOD: In a sample of 100 patients with a diagnosis of adnexal mass, demographic variables were quantified and MRI II was applied. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were obtained using a 2 × 2 table and compared with the histopathological result. RESULTS: MRI II with positive result was presented in 73.1% (52 patients) with malignant histopathological result and in 26.9% of patients with benign histopathological result. It presents a sensitivity in the test of 73.1%, a specificity of 70.8%, positive and negative predictive value of 73.2 and 70.8%, respectively. Diagnostic accuracy of 72%. CONCLUSIONS: MRI II is a screening tool with acceptable diagnostic performance to regulate behavior, such as referring to a specialized center or requesting more specific studies in patients diagnosed with adnexal mass due to suspected malignancy.
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Hospitais , Humanos , Estudos RetrospectivosRESUMO
Early diagnosis of ovarian carcinoma is bound to boost the long-term endurance rate of the patients. Most ovarian tumors happen post menopause when the ovaries have no vital operation and therefore irregular ovarian role causes no signs. According to Muinao T. et al. (Heliyon. 5(12):e02826, 2019), if we consider the frequency of ovarian carcinoma to be moderate, a screening technique must accomplish a base specificity of 99.6% and sensitivity of over 75%. The classification and approval of early diagnostic biomarkers explicit to ovarian carcinoma are essentially required. Prevailing methods for early diagnosis of ovarian carcinoma incorporate TVS, biological marker examination, or a blend of the two or other. In recent years, it has been revealed that a combination of at least two biomarkers has beaten single biomarkers in measures for early diagnosis of the illness. In the present document, we survey the ongoing exploration of innovative characteristic methodologies and possible panels of carcinoma biological markers for the early diagnosis of ovarian carcinoma and discuss biomarkers as the plausible apparatus for model improvement and other progressed approaches as an effective alternative to the prevailing methods for early diagnosis of this dreadful disease to evade bogus analysis and inordinate expense.
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Biomarcadores Tumorais/sangue , Detecção Precoce de Câncer/métodos , Neoplasias Ovarianas/diagnóstico , Área Sob a Curva , Autoanticorpos/sangue , Teorema de Bayes , Antígeno Ca-125/sangue , Carcinoma Epitelial do Ovário/sangue , Carcinoma Epitelial do Ovário/diagnóstico , Carcinoma Epitelial do Ovário/patologia , Metilação de DNA , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Proteínas de Membrana/sangue , MicroRNAs/sangue , Pessoa de Meia-Idade , Método de Monte Carlo , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/patologia , Sensibilidade e Especificidade , Análise Espectral Raman , Ultrassonografia , Proteína 2 do Domínio Central WAP de Quatro Dissulfetos/análiseRESUMO
Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease of variable presentation. Massive ascites in the context of SLE is infrequent. Even so, it has been reported that ascites may be the first manifestation of SLE. It is difficult to diagnose due to the multiple possible aetiological causes of ascites. There is a rare entity called Pseudo-Pseudo Meigs Syndrome (PPMS) in patients with SLE who have ascites, pleural effusion, and CA-125 elevation unrelated to malignancy. We present two cases of massive ascites, pleural effusion and elevation of CA-125 with a history of SLE diagnosis. One of these cases was diagnosed with PPMS and another associated with neoplasm of ovarian origin.
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Ascite , Antígeno Ca-125 , Lúpus Eritematoso Sistêmico , Ascite/complicações , Antígeno Ca-125/sangue , Humanos , Lúpus Eritematoso Sistêmico/diagnósticoRESUMO
PURPOSE: To evaluate the utilisation of CA-125, CA-15.3 and CA-19.9 in differentiating between ovarian neoplasms and endometriomas, and the best cut-off value for these tumour markers in this differentiation. MATERIALS AND METHODS: Preoperative serum values of CA-125, CA-15.3 and CA-19.9 were evaluated in 265 patients undergoing surgery for adnexal masses, being 32 non-neoplastic lesions, 134 benign neoplasms, 19 borderline tumours, 36 malignant neoplasms, and 44 endometriomas. ROC curves and Univariate and multivariate analyses were performed. RESULTS: Only CA-19.9 was useful in differentiating between endometriomas and ovarian neoplasms (benign and malignant tumours), being this marker found at higher levels in endometriomas. In multivariate analyses, CA-19.9 greater than 22.3 U/mL was considered an independent factor for the diagnosis of endometrioma, comparing endometrioma and ovarian cancer. Comparing endometrioma and all other groups, the clustering analysis using the combination CA-125 > 34.28 U/mL and CA-19.9 > 19.12 U/mL demonstrated that this association was considered an independent factor for the diagnosis of endometrioma. CONCLUSION: CA-9.9 is useful in distinguishing between endometriomas and ovarian cancer, and its combination with CA-125 is useful in differentiating endometrioma from other ovarian lesions.
Assuntos
Antígenos Glicosídicos Associados a Tumores/sangue , Antígeno Ca-125/sangue , Endometriose/sangue , Proteínas de Membrana/sangue , Mucina-1/sangue , Neoplasias Ovarianas/sangue , Adolescente , Adulto , Idoso , Criança , Diagnóstico Diferencial , Endometriose/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Adulto JovemRESUMO
SUMMARY OBJECTIVE: The aim of this retrospective study was to investigate the correlation of transiently elevated postoperative serum cancer antigen 125 levels and prognosis in patients with non-small cell lung cancer. METHODS: A total of 181 non-small cell lung cancer patients with normal levels of preoperative serum cancer antigen 125 were statistically summarized in this study. RESULTS: Out of the analyzed patients, 22 (12.2%) showed elevation of serum cancer antigen 125 within one month after surgery. Serum cancer antigen 125 level decreased to normal at three months postoperation. Serum cancer antigen 125 was positively correlated with pro-brain natriuretic peptide in non-small cell lung cancer postoperative patients (p=0.00035). Univariate analysis did not find significant difference in disease progression survival between those who experienced cancer antigen 125 elevation in the early postoperation and those who did not (p=0.646). CONCLUSIONS: In conclusion, transient elevation of cancer antigen 125 is associated to pro-brain natriuretic peptide increase after pulmonary surgery in non-small cell lung cancer patients.
Assuntos
Humanos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Prognóstico , Antígeno Carcinoembrionário , Estudos Retrospectivos , Antígeno Ca-125RESUMO
RESUMEN Definimos síndrome de Meigs como la triada de tumor ovárico benigno, derrame pleural y ascitis, una condición clínica rara que se resuelve con la resección del tumor. Estas mismas características pueden presentarse en el síndrome de pseudoMeigs que se asocia a tumores malignos, que agregan un aumento importante de los niveles del marcador CA-125. Es conocido por muchos años, pero su fisiopatología aún no está clara. Se presenta un caso de síndrome pseudo-Meigs y se hace una breve revisión bibliográfica de sus características más importantes.
ABSTRACT Meigs' syndrome is defined as the triad of benign ovarian tumor, pleural effusion and ascites, a rare clinical condition that is treated with tumor resection. Same characteristics may occur in cases of malignant tumors, that add a notable increase in antigen CA-125 serum levels, constituting the pseudo-Meigs syndrome. They have been known for many years, but their pathophysiology remains unclear. We report the case of a pseudo-Meigs syndrome, and a brief bibliography review of the most important characteristics of these syndromes is performed.
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Detection of circulating tumor DNA is a new noninvasive technique with potential roles in diagnostic, follow-up, and prognostic evaluation of patients with many types of solid tumors. We aimed to evaluate the role of circulating tumor DNA in the setting of metastatic ovarian carcinoma. A prospective cohort of patients with metastatic ovarian cancer who were referred to systemic therapy was enrolled. Blood samples were collected before the start of treatment and monthly thereafter for 6 months. Circulating tumor DNA was quantified by real-time quantitative reverse transcription polymerase chain reaction of different lengths of Arthrobacter luteus elements as described by Umetani et al. A total of 11 patients were included, 2 for primary disease and 9 for recurrent disease. After the first cycle of chemotherapy, patients whose circulating tumor DNA levels increased from baseline were more likely to respond to chemotherapy than those whose circulating tumor DNA levels did not increase (p = 0.035). Furthermore, patients whose circulating tumor DNA levels rose after the first cycle of chemotherapy also had improved disease-free survival compared to those whose circulating tumor DNA levels did not increase (p = 0.0074). We conclude that the increase in circulating tumor DNA values collected in peripheral blood after the first cycle of systemic treatment in patients with advanced ovarian cancer is associated with an early response to systemic treatment and correlates with superior disease-free survival in this population. Circulating tumor DNA might be a specific, noninvasive, and cost-effective new biomarker of early response to systemic treatment in these patients.
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Biomarcadores Tumorais , DNA Tumoral Circulante , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/genética , Idoso , Gerenciamento Clínico , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/terapia , Projetos Piloto , Prognóstico , Tempo para o Tratamento , Resultado do TratamentoRESUMO
Objectives: The aims of the study were to correlate endometriosis-associated pain, evaluated by visual analogue scale (VAS) scores, with serum levels of etonogestrel (ENG), levonorgestrel (LNG), CA-125 and soluble CD23 in users of the ENG implant or the 52-mg LNG-releasing intrauterine system (52 mg LNG-IUS) for up to 2 years after device placement.Methods: A randomised trial was conducted at the University of Campinas Medical School, Brazil. All participants (n = 103) had had endometriosis-associated chronic pelvic pain or dysmenorrhoea, or both, for more than 6 months. Participants were randomly assigned to use an ENG implant (experimental treatment) or a 52-mg LNG-IUS (active comparator). Follow-up was conducted 6 monthly for up to 24 months after device placement. Dysmenorrhoea and chronic pelvic pain were evaluated using a VAS and the scores were correlated with serum levels of ENG, LNG, CA-125 and soluble CD23.Results: Both progestin-only contraceptives significantly reduced VAS scores for dysmenorrhoea and chronic pelvic pain and reduced serum levels of soluble CD23 (p < 0.001). Serum levels of CA-125 decreased only in the ENG implant group after 24 months' use of the device (p < 0.001). No correlation was found between pain scores and ENG or LNG serum levels over time (p > 0.005).Conclusion: Both contraceptives improved dysmenorrhoea and chronic pelvic pain scores in women with endometriosis-associated pain and they reduced serum levels of soluble CD23; however, serum levels of CA-125 were reduced only in ENG implant users over the 24-month study period.