High CA-125 level in cirrhosis of the liver

This patient was 64 years old female who presented with abdominal swelling of 6 weeks duration. She had history of non-insulin dependent diabetes mellitus and hypertension and was taking Dibenclamide, Metformin and Amlodipin. Her physical examination showed distended abdomen with fluid thrill. Her vital signs were normal. Peripheral edema was present and she was moderately obese. Laboratory findings showed hemoglobin 16.5 g/dl, hematocrit 46.9% WBC count was 6500/ul, platelet 224000/ul, Fasting Blood Suger 119 mg/dl, total bilirubin 0.6 mg/dl, direct bilirubin 0.4 mg/dl, AST 46 U/l, ALT 26 U/l, alkaline phosphatase 221 [Normal 39 - 117 U/l] Serum albumin was 3.3 g/dl [Normal 3.5 - 5.0 g/dl], creatinine 0.6mg/dl. Hepatitis B surface Antigen was negative and so was anti HCV. Thyroid profile was normal. CA-125 level was 484 and after one week, repeat level was more than 500 U/ml [Normal 1.7 - 32 U/ ml]. Chest X-Ray was normal and abdominal sonography showed massive ascites and cholelithasis. CT scan of the abdomen and pelvis showed massive ascites and no abnormal masses were noted and pancreas and ovaries were found to be normal. Ascitic fluid was sent for examination and total leucocyte count was 200 cells/ul with 50% of lymphocytes and total protein of 2.4 g/dl. Ascitic fluid cytology was negative for malignant cells. She underwent exploratory laparotomy at which time no malignancy of the ovary or any other organs of the abdomen was found. Liver was noted to be small and shrunken and a biopsy was taken which was reported as cirrhosis of the liver. There were no changes of steatosis. On re-evaluation, her total core antibody [HB core total 1gG] was positive. She was treated with Diuretics and continued on other medical treatment