A Case Report On Diagnosis of Malignancy with Serum-Ascites Cholesterol Gradient
LifeScience-Biochemistry
DOI:
https://doi.org/10.22376/ijlpr.2023.13.6.L32-L36Keywords:
Ovarian cancer, serum-ascites albumin gradient, serum-ascites cholesterol gradientAbstract
Ascites are the accumulation of fluid in the Abdomen. It happens due to clinical complications from various diseasesthat cause signs and symptoms. Cirrhosis, malignant ascites, and abdominal tuberculosis are the most common causes of ascites.The multiple etiologies of ascites make determining the cause difficult. Several techniques can aid in the differential diagnosis ofascites. However, the techniques are more expensive, invasive, and require more time. As a result, a less expensive and fastermethod of diagnosis, at least as a screening test, would greatly benefit clinicians. Albumin and Cholesterol in serum and ascitic fluidare parameters that would help screen and diagnose cancer. The serum-ascites albumin gradient or gap (SAAG) is a medicalcalculation that helps determine the cause of ascites. In addition, the serum ascites cholesterol gradient (SACG) aids in thedifferential diagnosis.The case study aims to evaluate the significance of serum-ascites cholesterol gradient (SACG) in diagnosingovarian carcinoma. This case report includes a 53-year-old woman who presented to the surgical department with anorexia,indigestion, heartburn, pain or discomfort in the abdominal and pelvic regions, nausea, early satiety, bloating, and weight loss for1 month. She was diagnosed with ovarian carcinoma. The gradients of serum-ascites albumin and serum-ascites Cholesterol werecalculated. Later, the results were compared to Ca-125, an ovarian cancer marker. SAAG showed low sensitivity but high specificityand poor diagnostic performance. Her diagnosis of ovarian carcinoma was confirmed and she was advised to follow up with theoncologist. The current case report will help understand the contribution of the ascitic fluid and serum parameters in a case ofovarian cancer with ascites of unknown etiology.
References
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225-49. doi: 10.3322/caac.20006, PMID 19474385.
Cannistra SA. Cancer of the ovary. N Engl J Med. 2004;351(24):2519-29. doi: 10.1056/NEJMra041842, PMID 15590954.
Hashimoto K, Honda K, Matsui H, Nagashima Y, Oda H. Flow cytometric analysis of ovarian cancer ascites: response of mesothelial cells and macrophages to cancer. Anticancer Res. Jul 2016;36(7):3579-84. PMID 27354626.
Vaz AM, Peixe B, Ornelas R, Guerreiro H. Peritoneal tuberculosis as a cause of ascites in a patient with cirrhosis. BMJ Case Rep. 2017 Jul 14;2017: bcr2017220500. doi: 10.1136/bcr-2017-220500, PMID 28710241.
Gogoi P, Debnath E, Serum CR/ascites albumin gradient (SAAG), a cost-effective and reliable first-line diagnostic parameter in the differential diagnosis of ascites - a study in a North-East Indian population. Int J Res Rev. 2018;5(12):215-9.
Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med. Aug 1992;117(3):215-20. doi: 10.7326/0003-4819-117-3-215, PMID 1616215.
Cervantes Pérez E, Cervantes Guevara G, Cervantes Pérez G, Cervantes Cardona GA, Fuentes Orozco C, Pintor Belmontes KJ et al. Diagnostic utility of the serum-ascites albumin gradient in Mexican patients with ascites related to portal hypertension. JGH Open. 2020 Aug 8;4(5):838-42. doi: 10.1002/jgh3.12404, PMID 33102752.
Bijoor AR, Venkatesh T. Value of ascitic fluid Cholesterol and serum-ascites albumin gradient in differentiating cirrhotic and malignancy-related ascites. Indian J Clin Biochem. 2001 Jan;16(1):106-9. doi: 10.1007/BF02867577, PMID 23105301.
Rana SV, Babu SGV, Kocchar R. Usefulness of ascitic fluid cholesterol as a marker for malignant ascites. Med Sci Monit. Mon 2005;11(3):CR136-42. PMID 15735567.
Jüngst D, Xie Y, Gerbes AL. Pathophysiology of elevated ascites fluid Cholesterol in malignant ascites. Increased ascites to serum relation of proteins and lipoproteins in patients with peritoneal carcinomatosis compared to patients with liver cirrhosis. J Hepatol. 1992;14(2-3):244-8. doi: 10.1016/0168-8278(92)90165-l, PMID 1500688.
Vyakaranam S, Nori S et al. Serum – ascites albumin and cholesterol gradients in the differential diagnosis of ascites. NJIRM. 2011;2(3). July- September.22-28.
Sood A, Garg R, Kumar R, Chhina RS, Arora S, Gupta R, et al. Ascitic fluid cholesterol in malignant and tubercular ascites. J Assoc Physicians India. 1995;43(11):745-7. PMID 8773030.
Feldman GB, Knapp RC. Lymphatic drainage of the peritoneal cavity and its significance in ovarian cancer. Am J Obstet Gynecol. 1974;119(7):991-4. doi: 10.1016/0002-9378(74)90021-0, PMID 4276313.
Coates G, Bush RS, Aspin N. A study of ascites using lymphoscintigraphy with 99m Tc-sulfur colloid. Radiology. 1973;107(3):577-83. doi: 10.1148/107.3.577, PMID 4702536.
Prabhu M, Gangula RS, Stanley W. Diagnostic utility of serum ascites lipid and protein gradients in differentiating ascites. Int J Hepatol. 2019;2019:8546010. doi: 10.1155/2019/8546010, PMID 31275659.
Vyakaranam S, Nori S, Sastry M, Vyakaranam BS, Bhongir AV. 'Serum – ascites albumin and cholesterol gradients in the differential diagnosis of ascites,' NJIRM. Vol. 2; 2011. p. 22-8.
Dharwadkar K, Bijoor A. Usefulness of serum ascites cholesterol gradient (SACG), total protein (TP) ratio and serum ascites albumin gradient (SAAG) in differentiating tuberculous ascites and cirrhotic ascites. Int J Med Sci Public Health. 2013;2(4):1068-72. doi: 10.5455/ijmsph.2013.010920134.
Sastry AS, Mahapatra SC, Dumpula V. Ascitic fluid analysis with special reference to serum ascites cholesterol gradient and serum ascites albumin gradient. Int J Res Med Sci. 2017;5(2):429. doi: 10.18203/2320-6012.ijrms20170059.
Rana SV, Babu SG, Kocchar R. Usefulness of ascetic fluid Cholesterol as a marker for malignant ascites. Med Sci Monit. 2005;11:136-42.
Gupta R, Misra SP, Dwivedi M, Misra V, Kumar S, Gupta SC. Diagnosing ascites: the value of ascitic fluid total protein, albumin, Cholesterol, their ratios, serum‐ascites albumin, and cholesterol gradient. J Gastroenterol Hepatol. 1995;10(3):295-9. doi 10.1111/j.1440-1746.1995.tb01096.x, PMID 7548806.
Sahithya, Pani, Suseela, Ayesha, Qamar, Srinivasulu, et al. Pasha, MD & Kumar, B & Macherla, Ramana & Reddy. J Clin Diagn Res. 2020. Biochemical Markers of Ascitic Fluid to Differentiate Ovarian Cancer from Liver Cirrhosis Patients;14(3):125-8.
Hirabayashi K, Graham J. Genesis of ascites in ovarian cancer. Am J Obstet Gynecol. 1970;106(4):492-97. doi: 10.1016/0002-9378(70)90031-1, PMID 5412843.
Cretu AM, Aschie M, Preda G, Rosoiu N. Diagnostic limitations of biochemical evaluation of peritoneal effusions in differentiating malignant and non-malignant pathologies. Ovidius Univ Ann Chem. 2010;21(2):139-46.
Mortensen PB, Kristensen SD, Bloch A, Jacobsen BA, Rasmussen SN. Diagnostic value of ascitic fluid cholesterol levels in the prediction of malignancy. Scand J Gastroenterol. 1988;23(9):1085-8. doi 10.3109/00365528809090173. PMID 3247589.
Published
How to Cite
Issue
Section
Copyright (c) 2023 Dr. K. Sumathi, Ms. V.P. Nivedhini, Dr. Jainulavudeen Mohamed Rabeek

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.