Deep infiltrating endometriosis presenting as acute abdomen with extremely elevated tumor markers: a cancer-mimicking case

Xu Ma, Ma X, Ma Xu, Ye JS, Jinsheng Ye, Jin-Sheng Ye, Zhi Liu, Liu Z, Quan-Li Geng, Geng QL
BMC women's health · 2026 · vol. 26(1) · doi:10.1186/s12905-026-04590-0 · PMID:42277797 · PMC13483858 · W7164306230
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This case describes a severe deep infiltrating endometriosis presentation with acute abdomen and elevated tumor markers that mimicked ovarian carcinoma, ultimately diagnosed via postoperative histopathology.

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The paper reports a case of deep infiltrating endometriosis (DIE) in a 42-year-old woman who presented with sudden severe diffuse abdominal pain and imaging findings that, together with markedly elevated CA-125 and CA 19-9 (about 20-fold above normal), strongly mimicked a ruptured malignant ovarian tumor. At surgery, the lesions were indistinguishable from advanced ovarian cancer, and the definitive diagnosis of DIE (ASRM score 178, stage IV) was confirmed only after postoperative histopathology. The authors note rapid postoperative symptomatic relief and no recurrence during follow-up, but as a retrospective case report there is no broader evidence base beyond this single presentation. This paper is centrally about endometriosis — it describes DIE presenting as an acute abdomen that cancer-mimics ovarian malignancy.

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Abstract

BACKGROUND: Deep infiltrating endometriosis (DIE) is a rare and severe subtype of endometriosis that can cause marked distortion of pelvic anatomy. Diagnosis becomes particularly challenging when it presents as an acute abdomen with significantly elevated tumor marker levels. In this study, we describe a rare and deceptive presentation of acute abdomen caused by severe DIE that closely mimicked ovarian carcinoma. CASE PRESENTATION: A 42-year-old woman (gravida 1, para 1) was admitted with sudden-onset severe diffuse abdominal pain lasting 5 hours. Preoperative findings-including cancer antigen 125 and carbohydrate antigen 19-9 were both elevated to approximately 20-fold above the upper limit of normal, along with imaging results-strongly suggested a ruptured malignant ovarian tumor. Intraoperatively, the lesions were indistinguishable from advanced ovarian cancer, and a definitive diagnosis of deep infiltrating endometriosis (American Society for Reproductive Medicine score 178, Stage IV) was confirmed only through postoperative histopathological examination. Her postoperative recovery was unremarkable, with rapid symptomatic relief, and no recurrence was observed during follow-up. CONCLUSION(S): This case highlights that deep infiltrating endometriosis should be considered in patients presenting with acute abdomen, even when clinical and biochemical features strongly suggest pelvic malignancy. Furthermore, the emergency surgery for definitive diagnosis and radical resection also achieved excellent therapeutic outcomes.
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Abstract

Background Deep infiltrating endometriosis (DIE) is a rare and severe subtype of endometriosis that can cause marked distortion of pelvic anatomy. Diagnosis becomes particularly challenging when it presents as an acute abdomen with significantly elevated tumor marker levels. In this study, we describe a rare and deceptive presentation of acute abdomen caused by severe DIE that closely mimicked ovarian carcinoma. Case presentation A 42-year-old woman (gravida 1, para 1) was admitted with sudden-onset severe diffuse abdominal pain lasting 5 hours. Preoperative findings—including cancer antigen 125 and carbohydrate antigen 19-9 were both elevated to approximately 20-fold above the upper limit of normal, along with imaging results—strongly suggested a ruptured malignant ovarian tumor. Intraoperatively, the lesions were indistinguishable from advanced ovarian cancer, and a definitive diagnosis of deep infiltrating endometriosis (American Society for Reproductive Medicine score 178, Stage IV) was confirmed only through postoperative histopathological examination. Her postoperative recovery was unremarkable, with rapid symptomatic relief, and no recurrence was observed during follow-up. Conclusion(s) This case highlights that deep infiltrating endometriosis should be considered in patients presenting with acute abdomen, even when clinical and biochemical features strongly suggest pelvic malignancy. Furthermore, the emergency surgery for definitive diagnosis and radical resection also achieved excellent therapeutic outcomes. Similar content being viewed by others Abbreviations - ASRM: - American Society for Reproductive Medicine - CA-125: - Cancer antigen 125 - CA 19-9: - Carbohydrate antigen 19-9 - DIE: - Deep infiltrating endometriosis

Acknowledgements

Not applicable. Clinical trial number Not applicable. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was waived by the Institutional Review Board of Beijing Yanqing Hospital of Traditional Chinese Medicine, as this study was a retrospective case report with no experimental interventions. Consent for publication Written informed consent was obtained from the patient for the publication of this case report. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Ma, X., Ye, JS., Liu, Z. et al. Deep infiltrating endometriosis presenting as acute abdomen with extremely elevated tumor markers: a cancer-mimicking case. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04590-0 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04590-0

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MeSH descriptors

Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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