Dear Editor,
The original article “Biomarkers of malignant ascites—a myth or reality” published in MJAFI in April 2011 (MJAFI 2011;67: 108–112) was interesting and we would like to offer these following comments:
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1
Elevated serum ferritin is detected in various malignancies. The high serum ferritin concentration has been attributed to either reticuloendothelial cell disturbance, release of ferritin from damaged cells or synthesis of ferritin by neoplastic cells.
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2
Patients with extensive tumours show the highest ferritin level associated with tumour progression. The ferritin levels are roughly correlated with tumour mass and behave as non-specific markers.
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3
In most cases of malignancy, even in cases not presenting as ascites, the serum ferritin level will be high; if at all the diagnosis turns out to be ascites then the ascitic fluid ferritin will also be high. The author has not commented on cases in which ascites is due to non-malignant causes in patients with known malignancy. Also when the ascites is of the mixed type, it bears no relevance.
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4
Patients with high protein non-cirrhotic ascites almost always have high ascitic fibronectin and cholesterol elevations despite the absence of malignancy.1
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5
In an earlier study, carcinoembryonic antigen (CEA), similar to this ascitic fluid, was proposed as a helpful marker for detecting malignant ascites; but then the proposal was flawed due to lack of evidence.2
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6
In our view low serum-ascites albumin gradient (SAAG) and cytological examination confirmation in case of peritoneal carcinomatosis, and high SAAG and serum alphafetoprotein (AFP) in case of hepatocellular carcinoma and metastasis would be the ideal screening method to rule out malignant ascites. The high serum ferritin and ascitic fluid ferritin will only give a clue for malignancy.
REFERENCES
- 1.Banerjee M, Singh R, Arora MM, Srinivas V, Basannar D, Patrikar S. Bio-markers of malignant ascites-a myth or reality. MJAFI. 2011;67:108–112. doi: 10.1016/S0377-1237(11)60005-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Runyon BA. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS, Brandt LJ, editors. 9th ed. Vol 2. Saunders Elsevier; Philadelphia, PA: 2010. pp. 1517–1542. (Sleisenger and Fordtran's Gastrointestinal and Liver Disease). 91. [Google Scholar]