Giant splenic cyst with expectant management in pregnancy: A case report and review of the literature.

A 22-year-old primigravida was diagnosed with an 18-cm splenic cyst during routine third-trimester routine ultrasound examination. She was referred to a tertiary obstetric hospital and after multidisciplinary consultation, expectant management was decided on. Induction of labour was performed at term and she delivered vaginally with vacuum extractor application without complications. Percutaneous aspiration and sclerotherapy of the cyst was performed one week after delivery. She was hemodynamically stable throughout.

The role of HE4 in ovarian cancer follow-up: a review.

OBJECTIVE: The aim of this review was to analyze the state of the art about HE4 and follow-up in patients treated for ovarian cancer. METHODS: A literature search was conducted in the MEDLINE database using the key words "HE4" and "ovarian cancer" and "recurrence" or "relapse" or "follow up." RESULTS: Seven of 28 clinical studies were selected. Four studies were prospective, and all of them were based on a small number of patients (8-73 women). A failure of HE4 levels to normalize at completion of standard therapy may indicate a poor prognosis, thus suggesting the need of a closer follow-up. Moreover, HE4 showed better sensibility and specificity in the diagnosis of ovarian cancer recurrence with respect to CA-125, being also an earlier indicator of the relapse with a lead time of 5 to 8 months. HE4 showed a better performance in this setting if performed in association with other markers (CA-125, CA-72.4). HE4 seems to be an independent predictive factor for the surgical outcome at secondary cytoreductive surgery and to maintain its prognostic role even after the recurrence. CONCLUSIONS: These preliminary data start to suggest a superiority of HE4 over CA-125 in the detection of ovarian cancer recurrence. Moreover, the prognostic role of HE4 could help clinicians to personalize the follow-up program, whereas its predictive role could be useful to plan the treatment of the relapse. The role of HE4 in ovarian cancer follow-up deserves to be further investigated in prospective randomized multicentric studies.