Treatment and Long-term outcome of acute cerebral infarction in a patient with high CA125 and endometriosis. Stroke with high CA125 and endometriosis
Main Article Content
Abstract
Summary: This report describes a novel association between stroke and endometriosis in a patient with extremely high serum levels of CA-125.
ABSTRACT
Background: Cancer antigen 125 is a cell surface glycoprotein present in elevated serum levels with certain types of cancer, especially non-mucinous epithelial ovarian cancers. Still, such elevations can also be seen in benign gynecologic conditions such as severe adenomyosis, uterine myomas, and advanced endometriosis. Recently, high serum levels of cancer antigen 125 have also been associated with an increased risk of stroke.
Case: This report describes the case of a 48 years-old woman that presented a novel association between ischemic stroke and endometriosis in a patient with extremely high serum levels of cancer antigen 125 and illustrates the long-term management strategy utilized for secondary prevention of ischemic stroke.
Conclusion: The role of the cancer antigen 125 level on the pathogenesis of ischemic stroke is yet to be determined. High serum cancer antigen 125 can be seen in ischemic stroke in women of reproductive age. Cancer antigen 125 levels might have some implications on the election of the long-term secondary prevention of IS.
Teaching Points:
- Elevated serum levels of CA-125 are associated with an increased risk of stroke.
- Raised serum levels of CA-125 can be seen in benign gynecologic conditions.
- The finding of high CA-125 might have some implications on the election of the long-term management strategy for the secondary prevention of ischemic stroke.
Article Details
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References
2. Jovin TG, Boosupalli V, Zivkovic SA, Wechsler LR, Gebel JM. High titers of CA-125 may be associated with recurrent ischemic strokes in patients with cancer. Neurology 2005;64:1944-1945.
3. Xie X, Chen L, Zeng J, et al. Clinical features and biological markers of lung cancer-associated stroke. J Int Med Res 2016;44:1483-1491.
4. Ghaemmaghami F, Karimi Zarchi M, Hamedi B. High levels of CA125 (over 1,000 IU/ml) in patients with gynecologic disease and no malignant conditions: three cases and literature review. Arch Gynecol Obstet 2007;276:559-561.
5. Yin X, Wu J, Song S, Zhang B, Chen Y. Cerebral infarcts associated with adenomyosis: a rare risk factor for stroke in middle-aged women: a case series. BMC Neurol 2018;18:213.
6. Shen A, Xu S, Ma Y, et al. Diagnostic value of serum CA125, CA19-9 and CA15-3 in endometriosis: a meta-analysis. Journal of International Medical Research 2015;43:599-609.
7. Dai X, Jin C, Hu Y, et al. High CA-125 and CA19-9 levels in spontaneous ruptured ovarian endometriomas. Clin Chim Acta 2015;450:362-365.
8. Kristjansdottir B, Partheen K, Fung ET, et al. Ovarian cyst fluid is a rich proteome resource for detection of new tumor biomarkers. Clin Proteomics 2012;9:14.
9. Kurata H, Sasaki M, Kase H, Yamamoto Y, Aoki Y, Tanaka K. Elevated serum CA125 and CA19-9 due to the spontaneous rupture of ovarian endometrioma. Eur J Obstet Gynecol Reprod Biol 2002;105:75-76.
10. Okoth K, Wang J, Zemedikun D, Thomas GN, Nirantharakumar K, Adderley NJ. Risk of cardiovascular outcomes among women with endometriosis in the United Kingdom: A retrospective matched cohort study. BJOG 2021.
11. Korenaga TK, Tewari KS. Gynecologic cancer in pregnancy. Gynecol Oncol 2020;157:799-809.
12. Charkhchi P, Cybulski C, Gronwald J, Wong FO, Narod SA, Akbari MR. CA125 and Ovarian Cancer: A Comprehensive Review. Cancers (Basel) 2020;12.
13. Okada S, Miyagawa-Hayashino A, Fujinami J, et al. Trousseau's syndrome associated with pulmonary pleomorphic carcinoma exhibiting aggressive features: A case report. Mol Clin Oncol 2020;12:36-40.
14. Tachihara M, Nikaido T, Wang X, et al. Four cases of Trousseau's syndrome associated with lung adenocarcinoma. Intern Med 2012;51:1099-1102.
15. Maezono-Kandori K, Ohara T, Fujinami J, Makita N, Tanaka E, Mizuno T. Elevated CA125 is Related to Stroke Due to Cancer- Associated Hypercoagulation. J Stroke Cerebrovasc Dis 2021;30:106126.
16. Abdelazim IA, AbuFaza M, Hamed MES, Bekmukhambetov Y, Zhurabekova G, Shikanova S. Severe adenomyosis with unexpectedly high CA-125: report of a rare case. Prz Menopauzalny 2020;19:144-146.
17. Yamashiro K, Furuya T, Noda K, Urabe T, Hattori N, Okuma Y. Cerebral infarction developing in a patient without cancer with a markedly elevated level of mucinous tumor marker. Journal of stroke and cerebrovascular diseases 2012;21:619. e611-619. e612.
18. Lacheta J. Uterine adenomyosis: pathogenesis, diagnostics, symptomatology and treatment. Ceska Gynekol 2019;84:240-246.
19. Benagiano G, Habiba M, Brosens I. The pathophysiology of uterine adenomyosis: an update. Fertil Steril 2012;98:572-579.
20. Zhao Y, Zhang Y, Yang Y. Acute cerebral infarction with adenomyosis in a patient with fever: a case report. BMC Neurol 2020;20:210.
21. Navi BB, Singer S, Merkler AE, et al. Recurrent thromboembolic events after ischemic stroke in patients with cancer. Neurology 2014;83:26-33.
22. Naito H, Nezu T, Hosomi N, et al. Antithrombotic Therapy Strategy for Cancer-Associated Ischemic Stroke: A Case Series of 26 Patients. J Stroke Cerebrovasc Dis 2018;27:e206-e211.