Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Editorial Volume 4 Issue 7

All that Glitters is Not Gold: Non-Oncological Elevation of CA-125

Hakim Rahmoune1,2*, Nada Boutrid1,2, Soumia Satta3,4, Hala Boutrid5 and Naouel Lemdaoui3,4

1LMCVGN Research Laboratory, Setif-1 University, Algeria
2Department of Pediatrics, University Hospital of Setif, Setif-1 University, Algeria
3General Surgery “B” Department, Ben Badis University Hospital of Constantine, Algeria
4Faculty of Medicine, Constantine-3 University, Algeria
5Department of Obstetrics-Gynecology, University Hospital of Babeloued, Algiers-1 University, Algeria

*Corresponding Author: Hakim Rahmoune, LMCVGN Research Laboratory, and Department of Pediatrics, University Hospital of Setif, Setif-1 University, Algeria.

Received: July 01, 2020; Published: June 01, 2021

Genital, and particularly adnexal lesions are not uncommon, and may masquerade different diagnoses, sometimes unexpected.

  A sharp approach of this condition should lead to a step-wised assessment, especially for adolescent patients, keeping in mind the socio-epidemiological context of the local population.

We present a very ludic and peculiar case of an ovarian cyst with ascites in a teenager.

We admitted a girl aged 13 with a previous history of a prolonged, 6-month secondary amenorrhea associated with fever and subacute pain at the right lumbar region.

A prompt and complete investigation reveals a mid-size ovarian cyst at right with localized, (reactive) ascites.

  Concomitant biology depicts highly elevated inflammatory biomarkers (C Reactive Protein, CRP and Erythrocyte Sedimentation Rate, ESR) along with a dramatic increase of the Cancer Antigen-125 (CA-125).

Finally, TB-Interferon is positive, and Tuberculin skin test is as high as 19 mm of diameter.

Assessment by pelvic Magnetic resonance imaging (MRI) shows, in addition to the ovarian cyst, diffuse uterine and trabecular synechiae.

A confirmatory puncture of the peritoneal liquid confirms the presence of mycobacterium tuberculosis.

According to our national guidelines, the patient is put under 3 anti-tuberculosis antibiotics for 18 months and oral steroids for 6 weeks.

Regular clinical, serological and sonographic controls denote a complete remission within 9 months.

After completion of her 18-month regimen, the teen is free from any clinical, biological or radiological (ultra-sonography) abnormality.

She is progressively transferred to the adult gynecology ward for follow-up.

  In sum, symptoms of a pelvic tuberculosis are nonspecific encompassing abdominal pain or distention and gynecological signs; while imaging studies and serum CA-125 may help diagnosis [1].

  Specifically, the MRI is a medical imaging technique that allows precise lesion diagnosis and better-quality follow-up of the tuberculous genital disease. In fact, the presence of uterine synechiae (also known as Asherman syndrome) is a serious condition where the formation of intrauterine adhesions (sequela from the endometrium injury) is often associated with infertility [2].

  In the other hand, tumor biomarker Ca-125 is secreted by different celomic epitheliums. It may be increased in malignant diseases like ovarian cancer but also in other conditions including pulmonary and extra-pulmonary tuberculosis [3,4]. The CA-125 has even been suggested as a parameter evaluate the tuberculosis activity and the patient’s response to treatment [5,6].

  The high risk of organic and functional complications after a pelvic tuberculosis, mainly related to subsequent subfertility, deserve a great attention in endemic areas. In all forms of genital tuberculosis, a long-term adult monitoring is mandatory.

Acknowledgements

H. Rahmoune, N. Boutrid and N. Lemdaoui are supported by the Directorate General for Scientific Research and Technological Development (DGRSDT), MESRS, Algeria.

  1. Fahmi MN and Harti AP. “A diagnostic approach for differentiating abdominal tuberculosis from ovarian malignancy: a case series and literature review”. BMC Proceedings 11 (2019): 13.
  2. Abreu N., et al. “Pelvic tuberculosis: a forgotten diagnosis - case report”. Radiology Case Reports 5 (2018): 993-998.
  3. Fortún J., et al. “Ca-125: a useful marker to distinguish pulmonary tuberculosis from other pulmonary infections”. The Open Respiratory Medicine Journal 3 (2009): 123.
  4. Seo BS., et al. “A patient with tuberculous peritonitis with very high serum CA 125”. BMJ Case Reports (2012): bcr2012006382.
  5. Yates JA., et al. “Red Snappers and Red Herrings: Pelvic Tuberculosis Causing Elevated CA 125 and Mimicking Advanced Ovarian Cancer. A Case Report and Literature Review”. Hawai'i Journal of Medicine and Public Health8 (2017): 220.
  6. Mas MR., et al. “CA-125 a new marker for diagnosis and follow-up of patients with tuberculous peritonitis”. Digestive and Liver Disease7 (2000): 595-597.

Citation

Citation: Hakim Rahmoune., et al. “All that Glitters is Not Gold: Non-Oncological Elevation of CA-125”. Acta Scientific Gastrointestinal Disorders 4.7 (2021): 01-02.

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Copyright

Copyright: © 2021 Hakim Rahmoune., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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