Unusual presentation of a case of ovarian endometrioma

R. Sutaria, Meena Satia, V. R. Badhwar
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2018 · vol. 7(8) , pp. 3403 · doi:10.18203/2320-1770.ijrcog20183355 · W2883140481
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This case report describes an ovarian endometrioma with markedly elevated CA-125 levels, ascites, and a large ovarian mass, initially misdiagnosed as ovarian malignancy.

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This paper reports an unusual case of a very large ovarian endometrioma (about 20×20 cm) that presented with ascites and markedly elevated CA-125 levels, leading to an initial diagnosis of ovarian malignancy. The authors describe how CA-125, while often discussed as a tumor-associated biomarker, can also be increased in several benign conditions including endometriosis, though marked elevations are rarely reported in benign disease. A key caveat is that the findings are based on a single case report, limiting generalizability to broader populations or diagnostic accuracy. This paper is centrally about endometriosis — it specifically documents ovarian endometrioma causing a cancer-mimicking presentation with markedly elevated CA-125.

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Abstract

Ca-125 is a cell surface glycoprotein present in epithelial ovarian tumors. It is called as a biomarker because it provides information about the biological state of a disease. It is also considered a “tumor associated protein” because elevated CA 125 levels do not always indicate ovarian cancer. Pelvic inflammatory disease irritable bowel disease, tuberculosis pancreatitis and endometriosis can also increase the Ca125 levels in these benign conditions the Ca 125 levels are rarely markedly. Here authors report a case of ovarian endometrioma with markedly elevated levels of Ca 125 who was diagnosed as a case of ovarian malignancy due to presence of ascites and a large ovarian mass of 20x20 cm size arising from the pelvis.
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Unusual presentation of a case of ovarian endometrioma DOI: https://doi.org/10.18203/2320-1770.ijrcog20183355Keywords: CA 125, Endometriosis, Pelvic inflammatory diseaseAbstract Ca-125 is a cell surface glycoprotein present in epithelial ovarian tumors. It is called as a biomarker because it provides information about the biological state of a disease. It is also considered a “tumor associated protein” because elevated CA 125 levels do not always indicate ovarian cancer. Pelvic inflammatory disease irritable bowel disease, tuberculosis pancreatitis and endometriosis can also increase the Ca125 levels in these benign conditions the Ca 125 levels are rarely markedly. Here authors report a case of ovarian endometrioma with markedly elevated levels of Ca 125 who was diagnosed as a case of ovarian malignancy due to presence of ascites and a large ovarian mass of 20x20 cm size arising from the pelvis. Metrics References Graham L. ACOG releases guidelines on management of adnexal masses. Am Fam Physician. 2008;77(9):1320-3. Understanding CA 125 Levels A guide for ovarian cancer patients. Available at http://www.foundationforwomenscancer.org/wp-content/uploads/CA125levels.pdf Keyhan S, Hughes C, Price T, Muasher S. An update on surgical versus expectant management of ovarian endometriomas in infertile women. BioMed research Int. 2015;2015. Fedele L, Bianchi S, Bocciolone L, Di GN, Parazzini F. Pain symptoms associated with endometriosis. Obstet Gynecol. 1992;79(5 (Pt 1)):767-9. Clement PB. Diseases of the peritoneum. In Blaustein’s pathology of the female genital tract 1994 (pp. 647-703). Springer, New York, NY. Hesla JS, Rock JA. Endometriosis. In: Rock JA, Jones HW (eds) Te Linde’s operative gynecology, 9th edn. Lipincott-Raven, Philadelphia. 2033:599-603. Ishikawa H, Taga M, Haruki A, Shirasu K, Minaguchi H, Hara M. Huge ovarian endometrial cyst: a case report. Eur J Obstet Gynecol Reprod Biol. 1997;74(2):215-7. Reuter KL, Davidoff A, Cooney JV, Hunter RE. An unusually large endometrioma simulating an ovarian malignancy. Am J Roentgenol. 1988;151(4):834-5. Salani R, Backes FJ, Fung MF, Holschneider CH, Parker LP, Bristow RE, Goff BA. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of gynecologic oncologists recommendations. Am J Obstet Gynecol. 2011;204(6):466-78. Einhorn N, Sjövall K, Knapp RC, Hall P, Scully RE, Bast RC Jr, et al. Prospective evaluation of serum CA 125 levels for early detection of ovarian cancer. Obstet Gynecol. 1992;80(1):14-8. Skates SJ, Menon U, MacDonald N, Rosenthal AN, Oram DH, Knapp RC, et al. 7 Calculation of the risk of ovarian cancer from serial CA-125 values for preclinical detection in postmenopausal women. J Clin Oncol. 2003;21(10 Suppl):206s-210s.

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endometriosisendometrioma

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