Thursday, June 30, 2011

Transgender

A 40 year old transgender male to female patient establishes care with you for the first time. She says she was healthy until five years ago when she was diagnosed with hepatitis C cirrhosis. She established care at that time and is compliant with a diuretic regimen. However, she's had refractory ascites and edema. Indeed, when you examine her today, you note a tense abdomen with dullness to percussion at the flanks and a positive fluid wave. When you review labs she brought from her previous care provider, you note that she has an elevated CA-125 of 300 U/mL (normal 0-35 U/mL). There is no indication of why this test was sent.

Challenge: What's your interpretation of this test result?

Image of transgender pride flag is in the public domain, from Wikipedia.

3 comments:

daisy said...

ca-125 can be elevated for lots of reasons, but with the hep c i would be concerned for hepatocellular carcinoma.

jimmy said...

maybe way off course?.. but maybe previous provider didn't have information that patient was transgender male to female. maybe thought pt. was a female?..CA-125 is for ovarian CA, maybe pt. has Hepatic CA, causing ^ed CA-125.. maybe a AFP/U/s of liver or CT of liver would be in order??..

Craig Chen said...

actually the whole gender thing is a red herring - this has to do with the hep c, but not necessary hcc.
-
Transgender

Almost all patients with ascites or pleural effusions from any cause have falsely elevated CA-125 levels (possibly from sheer forces on mesothelial cells). Thus, this finding is nonspecific and expected, and when ascites is controlled, the value may come down.

Source: UpToDate.