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Solid tumor

• a tumor where the solid components comprise 80%


or more of the tumor when assessed in two-
dimensional section
• fibroma, fibrothecoma, granulosa cell tumor,
sclerosing stromal tumor, surface epithelial tumor
such as Brenner tumor, serous papillary carcinoma,
malignant germ cell tumor such as dysgerminoma,
endodermal sinus tumor, lymphoma, and metastatic
tumor
Jung IS. Ultrasonography of ovarian masses using a pattern recognition approach.
Ultrasonography 34(3), July 2015
Benign
• Fibroma, fibrothecoma: presence of a round,
oval, or lobulated hypoechoic mass with
minimal to moderate vascularity
• Brenner tumor; similar to those of fibroma
and fibrothecoma + multiple calcifications
• Sclerosing stromal tumor; young patients,
solid or multilocular solid mass with marked
peripheral vascularity
Jung IS. Ultrasonography of ovarian masses using a pattern recognition approach.
Ultrasonography 34(3), July 2015
Fibroma

Jung IS. Ultrasonography of ovarian masses using a pattern recognition approach.


Ultrasonography 34(3), July 2015
Fibroma vs Malignan
• a solid pelvic mass next to but without a clear
connection with the uterus,
• less vascularized tumor with low- speed flow
• primary ovarian carcinoma is less likely to be a
completely solid mass
• a secondary ovarian malignancy is typically a bilateral
instead of a unilateral disease
• CT: Most ovarian fibromas appear as a solid mass with
delayed accumulation of contrast medium
• marked T1 and T2 hypointensities on magnetic
resonance imaging

Leung SW, Yuen PM. Ovarian Fibroma: A Review on the Clinical Characteristics, Diagnostic
Difficulties, and Management Options of 23 Cases. Gynecol Obstet Invest 2006;62:1–6
CA-125
• Normal value:
– CA 125 <= 35 U/mL
– Ca 125 II < 20 U/mL
• Non-mucinous epithelial carcinoma

Ueland FR, Li AJ. Serum biomarkers for evaluation of an dnexal mass for epithelial carcinoma of
the ovary, fallopian tube, or peritoneum. UpTodate.2018
CEA
• Normaly found: fetal or embryonic tissue
• Small amount present in colon
• Maybe elevated in malignancy that produce the
protein; mucinous cancer (GI or Ovary) 
epithelial carcinoma
• Benign condition: mucinous cystadenoma of the
ovary
• LEVEL:
– Non smoker: < 3.8 mcg/L
– Smoker: < 5.5 mcg/L
Ueland FR, Li AJ. Serum biomarkers for evaluation of an dnexal mass for epithelial carcinoma of
the ovary, fallopian tube, or peritoneum. UpTodate.2018
CEA
• Normal cell product (protein polysavharidae)
 oncofetal glycoprotein
• Low sensitivity and specificity  not
recommended as a screening tool
• Primary use: colorectal cancer monitoring
Overexpress of CEA
Cancer/ malignan Benign
• Colon • IBD/ colitis
• Rectum • Pancreatitis
• Breast • COPD
• Lung • Renal disease
• Liver disease (hepatitis,
cirrosis)
• Smoker “healthy”

Levels exceding 10 ng/mL are rarely due to benign sign


Specificity of CEA
• Neither specific for colon cancer nor for
malignancy
• CEA is not useful in screening for colorectal
cancer or in the diagnostic evaluation of an
undefined illness.
Specificity of CEA
• Can be elevated in almost any advanced
adenocarcinoma (distant metastases)
• Never elevated in early malignancy
• Cancer which can produce elevated level of
CEA:
– Breast, lung, pancreas, stomach, esophagus,
cervix, bladder, prostate, kidney, thyroid, liver and
ovary
Main clinical application
• Surveillance following curative resection of
colorectal cancer
• Monitoring therapy in advanced colorectal
cancer
• Other GI malignancies as general purpose
marker for adenocarcinomas
• Rarely elevated in patients with any type of
local cancer
CEA in ovarian cancer
• CEA alone and CA125/CEA ratio demonstrated a
better performance than CA125 to discriminate
between ovarian neoplasms (including benign,
and malignant) from ovarian metastases, and
the best cut-off values of CEA and CA125/CEA
ratio were 2.3 and 11.9 respectively.
• CEA alone is enough to use for differentiating
between the ovarian neoplasms (including
benign and primary malignant) and ovarian
metastases
CEA in ovarian neoplasms versus patients with
ovarian metastases
LDH
• Lactate dehydrogenase (LDH) is a glycolytic enzyme which
catalyses the reversible conversion of pyruvate to lactate,
using NADH as a co-enzyme  tumor and progression
• Dysgerminoma and other solid germ cell tumors

Coquard IR. Ovarian germ-cell malignant tumors.orphanet encyclopedia. 2004

Konishi I, et.al. analysis of serum Ca 125, CEA, AFP, LDH Level in patients with ovarian tumorsNihon Sanka Fujinka
Gakkai Zasshi. 1986 Jun;38(6):827-36
RMI
RMI = U x M x CA125
ADNEX