Anastasi Emanuela, Porpora Maria Grazia, Pecorella Irene, Bernardo Silvia, Frati Luigi, Benedetti Panici Pierluigi, Manganaro Lucia
Department of Molecular Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy,
Tumour Biol. 2014 Jul;35(7):6969-71. doi: 10.1007/s13277-014-1898-9. Epub 2014 Apr 17.
We present a case of a 58-year-old menopausal woman referred to our hospital for the presence of large pelvic masses diagnosed by clinical examination and pelvic ultrasound. MRI examination showed voluminous bilateral capsulated multilocular ovarian cysts slightly hyperintense on T1-weighted images with thick septa and small papillary projections. CT scan confirmed the MRI findings. Among the ovarian tumor markers analyzed (CA125, HE4, and CA72.4), only Ca125 was slightly increased (48 U/ml). These data were suggestive of mucinous ovarian tumor. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy, appendectomy, and multiple peritoneal biopsies. Pathological examination revealed bilateral borderline mucinous ovarian tumor with superficial atypical implants. Nine months later, the patient complained of left coxofemoral pain and underwent a PET/TC total body that suggested pubic bone metastases. Ovarian tumor markers were analyzed, and a second PET/TC was performed. CA125 was 252 U/ml, HE4 62 pM/L, and CA72.4 > 100 U/Ml. PET/TC was suggestive of peritoneal carcinosis. The patient was readmitted to the hospital. Clinical examination revealed small vaginal nodules. All nodules were excised. Microscopic analysis of all specimens revealed metastatic mucinous adenocarcinoma of intestinal type.The case shows that even a slight CA125 increase in the presence of a borderline ovarian tumor should not be overlooked since it can be indicative of a progressive disease. This case also highlights its additional diagnostic value when serum CA125 analysis is used in conjunction with MRI and CT imaging for the prognosis of mucinous borderline ovarian tumors (mBOTs).
我们报告一例58岁的绝经后女性，因临床检查及盆腔超声诊断出盆腔有巨大肿块而转诊至我院。MRI检查显示双侧有大量包膜的多房性卵巢囊肿，在T1加权图像上呈轻度高信号，伴有厚分隔和小乳头样突起。CT扫描证实了MRI的结果。在所分析的卵巢肿瘤标志物（CA125、HE4和CA72.4）中，只有Ca125略有升高（48 U/ml）。这些数据提示为黏液性卵巢肿瘤。患者接受了全子宫切除术、双侧输卵管卵巢切除术、阑尾切除术及多次腹膜活检。病理检查显示双侧交界性黏液性卵巢肿瘤伴浅表非典型种植。9个月后，患者主诉左髋股部疼痛，接受了PET/TC全身检查，提示耻骨骨转移。分析了卵巢肿瘤标志物，并进行了第二次PET/TC检查。CA125为252 U/ml，HE4为62 pM/L，CA72.4>100 U/Ml。PET/TC提示腹膜癌。患者再次入院。临床检查发现阴道有小结节。所有结节均被切除。对所有标本的显微镜分析显示为肠型转移性黏液腺癌。该病例表明，即使在交界性卵巢肿瘤存在时CA125略有升高也不应被忽视，因为它可能提示疾病进展。该病例还突出了血清CA125分析与MRI和CT成像联合用于黏液性交界性卵巢肿瘤（mBOTs）预后评估时的额外诊断价值。
