Q. My mom with fallopian tube cancer has positive ANA for the past five years. Kindly help.

Answered by
Dr. Divya Agarwal
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Oct 09, 2020

Hello doctor,

My mother was diagnosed with a fallopian tube carcinoma five years ago and is in remission since treatment ended. Since that time, her doctor has routinely followed very comprehensive labs to check for overall wellness. One of those lab tests has always been her ANA (antinuclear antibody), and it has always been positive at every check for the last five years, but no real autoimmune symptoms over these past five years. The only new symptom she experiences some redness near her nail beds, ears, the tip of the nose (that has already started to resolve after a couple of weeks and her doctor said was an allergic reaction).

Here is her ANA history, specifically, starting with the oldest:

1:40 (homogenous).

1:160 (homogenous).

1:160 (homogenous).

1:160 (speckled).

1:80 (speckled).

1:80 (speckled).

1:160 (speckled).

1:160 (speckled).

Most recent, 1:320 (nuclear, speckled) AC 2, 4, 5, 29.

1:40 (cytoplasmic) - AC 15 through AC 23.

As you can see, we had just requested a traditional ANA test as we normally do. However, it seems as if two staining patterns were reported. And this time, they gave us AC (codes), which they have never done before. We are not sure why the same lab has reported so differently on the same test. Can you help us understand the meaning of her results? I will attach them as well.

Specifically, why were two ANA titers reported? 1:320 and 1:40. What are the meaning of them and AC (codes)? I was especially concerned with AC 29. When I googled, it is mentioned being very specific for systemic sclerosis or scleroderma? Can anything else cause this result? Anything else we should be aware of? I am hoping this could just be an allergic reaction of some kind.

#

Hi,

Welcome to icliniq.com.

This test has been repeated several times with variable results. It does not seem to hold much significance in your mother's case, as she never had symptoms related to any disease associated with ANA. ANA is not a screening test. It should be done only if there is suspicion of a related disease.

The recent reports are slightly different because the reporting and classification have changed slightly now. And the codes are largely based on the patterns on the staining seen under the microscope. So I do not think there is anything to worry regarding the skin rash.

Thank you doctor,

For all of her previous tests, there would have been AC codes as well. The lab just did not report them, is that correct? You mentioned the reporting and classification as having changed recently. How recent has that been? She was tested six months ago, and it was not reported so thoroughly then?

I find it so unusual that we asked for the same test through quest labs, ANA with reflex, and this time, two patterns were listed (nuclear, speckled) and (cytoplasm). Is this unusual? How is it possible to get two patterns from one blood sample? Is this also a result of more recent advances in reporting?

Can you speak about AC 29 specifically? This is especially concerning to me because my research points to it being tied to systemic sclerosis or scleroderma. Is there anything else that can cause this pattern of staining seen besides systemic sclerosis or scleroderma? Could this be an allergic skin reaction?

#

Hi,

Welcome back to icliniq.com.

Yes, it is pretty recent. Some labs are still not following this system. Two patterns may sometimes be reported. However, it is not the norm. The pattern you are indicating is associated with scleroderma. However, as I stated, this is not a diagnostic test. Without any symptoms of scleroderma, it has no significance.

Thank you doctor,

I have attached her comprehensive lab spreadsheet so you can easily see her full lab picture, and I would appreciate you reviewing in full. Her ANA levels are the last parameter at the bottom of page 2, and the most recent test results are the left column.

Any further interpretation here would be appreciated. For example, her inflammation markers are low. I am assuming this bodes well when it comes to autoimmunity? But again, I would appreciate you having a look at the whole picture.

You say two ANA patterns may be reported, but it is not the norm. What does this mean clinically? Is it a more concerning finding when two patterns are listed, or is this just another example of the new/recent way of reporting ANAs? And is there anything notable about her two patterns in combination (nuclear, speckled + cytoplasm)?

I am confused about your statement. The pattern (AC 29) indicated is associated with scleroderma. However, it is not a diagnostic test. Does that mean that people without disease or scleroderma can test positive for AC 29 (i.e., a false positive)? And can anything else cause this elevation (such as an infection or allergic reaction)?

As I mentioned, redness near her fingernails, earlobes, and nose (resolving after a couple of weeks) are the only odd symptom. No pain symptoms or otherwise, which led her doctor to mention an allergic reaction. I have attached a picture of this as well. Bottom line what is your recommendation for her? Do you feel there is no need for follow-up testing if no symptoms present themselves?

#

Hi,

Welcome back to icliniq.com.

The other tests seem to be fine. However, her WBC counts were low. Is she still on any medicines for her cancer? I would not say there is anything concerning about testing positive for two patterns. Yes, the test for scleroderma may come out positive, even in normal persons.


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