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Question 30

A 9 yo female presents with a complex adnexal mass and precocious puberty. Which tumor marker is most likely to help with your pre-operative evaluation?

Answer Choices:

CA-125

HE-4 (human epididymis protein 4)

CEA (carcinoembryonic antigen)

Multivariate index assay for ovarian cancer

Inhibin B

Correct Answer:

Inhibin B

Explanation:

  • CA-125 is particularly helpful in postmenopausal women

  • CEA is often elevated with GI malignancies

  • The multivariate index assay combines menopausal status with 5 tumor markers to determine need for referral to GYN ONC (CA-125, prealbumin, apolipoprotein A-1, beta-2 microglobulin and transferrin). It is used for patients with an adnexal mass over age 18.

  • Need to look for sources of estrogen when there is precocious puberty.

  • Granulosa cell tumors often present like this, and inhibin B levels are elevated