Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
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Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : QD01 - QD02 Full Version

CA 19-9 in Ovarian Immature Teratoma- A Potential Tumour Marker or A Masquerade?


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53781.16543
Julie H John, R Sanghamita, Ajay Halder, Sramana Mukhopadhyay, Shweta Patel

1. Junior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. 2. Junior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. 3. Associate Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. 4. Associate Professor, Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. 5. Assistant Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

Correspondence Address :
Dr. Shweta Patel,
Assistant Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal-462026, Madhya Pradesh, India.
E-mail: drshwetaaiims@gmail.com

Abstract

Carbohydrate antigen 19-9, also known as Cancer Antigen (CA 19-9) is a tumour marker found elevated in certain ovarian tumours. Although, reports of its association with mature teratoma are considerable, little is mentioned about its association with immature teratoma. This could be attributed to immature teratoma being a rare tumour with only a few studies on its tumour markers. Authors present the case of a 24-year-old female presenting with ovarian immature teratoma who also showed unusually high serum levels of CA 19-9 which reduced drastically after surgery. This association therefore may warrant further investigations to establish the clinical relevance and its importance in future.

Keywords

Abdominopelvic mass, Adjuvant chemotherapy, Carbohydrate antigen 19-9, Multiloculated solid-cystic lesion

Case Report

A 24-year-old P0A1 married for the past seven months, presented with rapidly increasing abdominopelvic mass over the past three months. Her menstrual cycles were normal with a history of first trimester pregnancy loss two months earlier. On per abdominal examination, the mass was 25×20 cm in size, firm in consistency, and non tender. On vaginal examination, uterus was not separated from the mass. Her Magnetic Resonance Imaging (MRI) suggested right sided well defined multiloculated solid cystic lesion measuring 20×11×18 cm with right ovary not seen separate from the mass (Table/Fig 1). Tumour markers were significantly increased. The β-Human Chorionic Gonadotropin (β-HCG) was 4.03 mIU/mL, Carcinoembryonic Antigen (CEA) was 3.82 ng/mL, Lactate Dehydrogenase (LDH) was 200 U/mL, Cancer Antigen 125 (CA-125) was 222 U/mL, Alpha Fetoprotein (AFP) was 16.9 IU/mL and CA-19.9 was 1336 U/mL. Upper abdominal imaging and colonoscopy was done to rule out gastrointestinal pathology and was found to be normal.

Intraoperatively, a 22×11×18 cm, irregular, bosselated surfaced right ovarian mass with an intact capsule and dilated blood vessels on the surface was seen, which was adherent to the anterior surface of uterus, pushing it inferiorly. Left fallopian tube and ovary were grossly normal, while the right fallopian tube was stretched over the mass (Table/Fig 2). Systematic survey of peritoneal cavity revealed no other organ involvement or metastasis. Operative team proceeded with fertility preserving ipsilateral salpingo-oophorectomy assisted by frozen section histopathology of the specimen. Postoperative period was uneventful. Final histopathology report revealed immature teratoma grade 3 and pathological stage was T1aN0Mx (Table/Fig 3), (Table/Fig 4). On postoperative day 14, CA-19.9 was reported as 109 U/mL. Patient is currently in remission after having received adjuvant chemotherapy with Bleomycin, Etoposide and Platinum (BEP) based regimen for two cycles and is on regular follow-up.

Discussion

Sialylated Lewis A antigen or cancer antigen 19-9 is structurally a carbohydrate moiety which is widely employed as a tumour marker (1). An ideal tumour marker should be highly sensitive and organ-specific, correlate well with the tumour size, should be epidemiologically homogenous, with minimal interobserver variability. Among the tumour markers, CA 19-9 stands out as a predictable marker for the diagnosis of solid organ tumours of abdominopelvic origin. It is made up of transmembrane proteinaceous moieties with glycosylated assimilation of oligosaccharides. It is a member of the mucinous epicellular marker’s league (2). Physiologically, the ductal cells of pancreas and epithelial lining of biliary tracts, gastric, colonic, endometrial structures all synthesize CA19-9 antigen as a part of its normal immunological homeostasis. As an established tumour marker of hepatobiliary and pancreatic malignancies, its concentration level correlates with the size of the mass. However, not only in malignant masses, but the serum levels also spike in multiple benign and inflammatory conditions in source organs of gynaecological, pulmonary, urological and thyroid system (3).

It has been shown that statistically significant relationship exists between ovarian mature cystic teratoma and CA19-9 levels with mean level being 71±17 U/mL (4). There are case reports describing the elevated CA19-9 levels in mucinous cystadenoma and mature cystic teratoma of the ovaries (5),(6),(7),(8). Steinberg W, concluded that high levels of CA19-9 are associated with malignant tumours (9). While the study by Cho HY et al., suggested high levels are seen in mucinous borderline and malignant tumours (10). However, study by Lahdenne P et al., found reporting immature teratoma in association with CA19-9 marker (11). Although, it has been stated that 50% immature teratoma can have raised CA19-9 (6),(12).

Immature teratoma is a less prevalent (1% of all ovarian cancers) germ cell tumour accustomed to present either as an isolated pure form or as a component of mixed germ cell growth affecting individuals in early 30s (13).

Although, the marker most commonly linked to immature teratoma is alpha-fetoprotein (14). The combined estimation of CA 125, CA 19.9, CEA and AFP accentuate the sensitivity of diagnosis and severity of progression. In terms of specificity, none is superior. Having the knowledge of widely used cut-off values of the serum CA-125 (>35 U/mL), CA 19-9 (>39 U/mL) and CEA (>3.8 U/mL) aids in suggesting the possibility of malignancy, however, not organ-specific. In the present case, authors found increased values of both CA 125 and CA 19-9. The up scaling of CA 19-9 was much higher i.e., 1336 U/mL. Its elevation is well associated with mature teratomas and size progression, pertaining to the secretion from the apical cytoplasm of the epithelial lining (15). The utility of CA 19-9 as a follow-up marker for recurrence after radical removal can be culminated as observed in the present case. The carbohydrate markers i.e, CA 125 and CA 19-9, although less studied can be used as an adjunct in the follow-up of immature teratoma (11).

Conclusion

The CA 19-9 has been found elevated in various ovarian malignancies- both benign and malignant. The use of CA19-9 as a diagnostic modality may be difficult due to its lack of specificity. However, if employed as a prognostic marker and for follow-up of ovarian neoplasms, it may succor the smooth management of these neoplasms. The limited literature available on immature teratoma and tumour markers associated with it, however, obligates the need for further studies on it.

References

1.
Duffy MJ, Sturgeon C, Lamerz R, Haglund C, Holubec VL, Klapdor R, et al. Tumor markers in pancreatic cancer: A European Group on Tumor Markers (EGTM) status report. Ann Oncol. 2010;21(3):441-47. [crossref] [PubMed]
2.
Magnani JL, Brockhaus M, Smith DF, Ginsburg V, Blaszczyk M, Mitchell KF, et al. A monosialoganglioside is a monoclonal antibody-defined antigen of colon carcinoma. Science. 1981;212(4490):55-56. [crossref] [PubMed]
3.
Dyckhoff G, Warta R, Gonnermann A, Plinkert PK, Flechtenmacher C, Volkmann M. Carbohydrate antigen 19-9 in saliva: Possible preoperative marker of malignancy in parotid tumors. Otolaryngology-Head and Neck Surgery. 2011;145(5):772-77. [crossref] [PubMed]
4.
Abide ÇY, Ergen EB. Retrospective analysis of mature cystic teratomas in a single center and review of the literature. Turk J Obstet Gynecol. 2018;15(2):95. [crossref] [PubMed]
5.
Pandey D, Sharma R, Sharma S, Salhan S. Unusually high serum levels of CA 19-9 in an ovarian tumour: Malignant or benign? J Clin Diagn Res. 2017;11(3):QD08. [crossref] [PubMed]
6.
Singh A, Srivastava A, Chauhan D, Guatam RG. CA-19-9 as an Emerging Marker of Ovarian Tumour: A Rare Entity. J Clin Diag Res. 2019;13(5):QD01-03. [crossref]
7.
Madaan M, Puri M, Sharma R, Kaur H, Trivedi SS. Unusually high levels of CA19-9 associated with mature cystic teratoma of the ovary. Obstet Gynecol Sci. 2014;2014. [crossref] [PubMed]
8.
Prodromidou A, Pandraklakis A, Loutradis D, Haidopoulos D. Is There a Role of Elevated CA 19-9 Levels in the Evaluation of Clinical Characteristics of Mature Cystic Ovarian Teratomas? A Systematic Review and Meta-analysis. Cureus. 2019;11(12):e6342. [crossref] [PubMed]
9.
Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. Am J Gastroenterol. 1990;85(4):350-55.
10.
Cho HY, Kyung MS. Serum CA19-9 as a predictor of malignancy in primary ovarian mucinous tumors: A matched case-control study. Med Sci Monit. 2014;20:1334-39. [crossref] [PubMed]
11.
Lahdenne P, Pitkanen S, Rajantie J, Kuusela P, Shmes MA, Lanning M, Heikinheimo M. Tumor markers CA 125 and CA 19-9 in cord blood and during infancy: Developmental changes and use in pediatric germ cell tumors. Pediatr Res. 1995;38(5):797-01. [crossref] [PubMed]
12.
Novaković S. Tumor markers in clinical oncology. Radiology and Oncology. 2004;38(2):73-83.
13.
Smith HO, Berwick M, Verschraegen CF, Wiggins C, Lansing L, Muller CY, et al. Incidence and survival rates for female malignant germ cell tumors. Obstet Gynecol. 2006;107(5):1075-85. [crossref] [PubMed]
14.
Saba L, Guerriero S, Sulcis R, Virgilio B, Melis G, Mallarini G. Mature and immature ovarian teratomas: CT, US and MR imaging characteristics. Eur J Radiol. 2009;72(3):454-63. [crossref] [PubMed]
15.
Coskun A, Kiran G, Ozdemir O. CA 19-9 can be a useful tumor marker in ovarian dermoid cysts. Clin Exp Obstet Gynecol. 2008;35(2):137-39.

DOI and Others

DOI: 10.7860/JCDR/2022/53781.16543

Date of Submission: Jan 06, 2022
Date of Peer Review: Feb 07, 2022
Date of Acceptance: May 02, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 07, 2022
• Manual Googling: Apr 29, 2022
• iThenticate Software: May 30, 2022 (20%)

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