HE4, Ca125 and ROMA algorithm for differential diagnosis between benign gynaecological diseases and ovarian cancer.

The aim of this study is to evaluate the diagnostic performance of human epididymis protein 4 (HE4), cancer antigen 125 (Ca125) and the risk of ovarian malignancy algorithm (ROMA) in discriminating ovarian cancer from other benign gynaecological diseases. Serum levels of HE4 and Ca125 were measured in 119 women with benign gynaecological diseases, 29 patients with primary ovarian cancer, 32 patients with ovarian cancer on chemotherapy treatment (18 of them with progressive disease), 6 patients treated and free of disease and 32 healthy women. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios (LR ±) were calculated. Receiver operator characteristic (ROC) curves were constructed, and the areas under the curve (AUC) were calculated. High serum levels for HE4, Ca125 and ROMA were observed in cancer patients. HE4 was elevated in 12.6 %, Ca125 in 21 % and ROMA in 9.2 % in the benign group, but HE4 was not elevated in endometriosis. The AUC values for HE4, Ca125 and ROMA were 0.92, 0.911 and 0.945 respectively. The sensitivity for discriminating ovarian cancer from benign gynaecological diseases was 86.2 % for HE4 and Ca125 and 93.1 % for ROMA. The specificity was 87.4, 78.9 and 90.7 % for HE4, Ca125 and ROMA. The overall positive likelihood ratio (LR+) was 6.84 for HE4, 4.1 for Ca125 and 10.01 for ROMA. In premenopausal women, LR + was 11.86 for HE4, 5.11 for ROMA and 2.02 for Ca125. HE4 might be significant in the differential diagnosis of ovarian cancer. HE4 seems to be superior to Ca125 in terms of diagnostic performance of all premenopausal women. ROMA could help to discriminate in cases with any doubt with a high diagnostic accuracy.

Paniculitis pancreática como forma de presentación inicial de adenocarcinoma gástrico con metástasis hepáticas / Gastric adenocarcinoma with hepatic metastases presenting as pancreatic panniculitis

El interés del caso reportado surge a raíz de la obtención de un valor de lipasa superior a 7.000 U/l en una paciente con una paniculitis en miembros inferiores de 10 meses de evolución. Se estableció el diagnóstico de paniculitis pancreática, y adenocarcinoma gástrico con metástasis hepáticas, con la peculiaridad de no encontrar afectación clínica ni radiológica del páncreas. Las paniculitis pancreáticas de origen tumoral no pancreático constituyen una rareza, y son un hecho excepcional en la literatura médica consultada. Este es el primer caso de paniculitis pancreática como signo inicial de un cáncer gástrico, con metástasis hepáticas y con mayor supervivencia reportado en la literatura, lo cual hace que su revisión clínica e histológica sea de extraordinario interés(AU)

A patient presenting with a ten month history of progressive lower limb panniculitis was found to have more than 7,000 lipase U/L. Pancreatic panniculitis and gastric adenocarcinoma with liver metastases was diagnosed, despite no clinical or radiological findings of pancreatic disease. Pancreatic panniculitis arising from a non pancreatic primary is extremely rare. To our knowledge, this is the first time pancreatic panniculitis has been reported as the presenting sign of gastric carcinoma with hepatic metastases. It is also the longest survival to be reported to date(AU)