Elevated CA 125 level in a mucinous cystadenoma and a teratoma: a case report
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(2020) 14:141
CASE REPORT
Open Access
Elevated CA 125 level in a mucinous cystadenoma and a teratoma: a case report Chanil Deshan Ekanayake1*, Nayoman Munasinghe1, Iranthi Kumarasinghe2 and Sachini Rasnayake1
Abstract Background: The presence of a suspicious ovarian cyst with elevated cancer antigen 125 level in a woman of reproductive age poses a serious therapeutic dilemma. Mature cystic teratomas and mucinous cystadenomas may also cause an increase in cancer antigen 125. Case presentation: A 43-year-old Sinhalese woman with a history of anovulatory subfertility for 5 years presented with heavy menstrual bleeding and secondary dysmenorrhea of 6 months’ duration. Imaging (pelvic ultrasound and computed tomography of the abdomen and pelvis) revealed a hemorrhagic cyst (6 × 4 cm) on the right side and a multilocular cyst with solid areas (10 × 7 cm) on the left side. Her cancer antigen 125 level was 2715 U/ml. Following a multidisciplinary team meeting, a fertility-sparing staging laparotomy was performed, which included right cystectomy, left oophorectomy, infracolic omentectomy, and peritoneal washings. Histology revealed a mucinous cystadenoma of the right ovary and a mature cystic teratoma on the left ovary. No malignant cells were observed in peritoneal washings. The patient’s cancer antigen 125 level dropped to 74.8 U/ml 1 month after surgery. Conclusion: Rarely, teratomas and mucinous cystadenomas may also give rise to an extremely high cancer antigen 125 level. The risk of malignancy index and risk of malignancy algorithm may both be misleading in these instances. Therefore, multidisciplinary input, fertility-sparing surgery, and follow-up are paramount to achieve optimal treatment and patient satisfaction. Keywords: CA 125, Mature cystic teratoma, Mucinous cystadenoma
Background The presence of a suspicious ovarian cyst with elevated cancer antigen 125 (CA 125) level in a woman of reproductive age poses a serious therapeutic dilemma in terms of achieving optimal treatment versus fulfilling the patient’s fertility expectations. CA 125 is a high-molecularweight glycoprotein that is derived from the coelomic epithelium and as such is found in the endometrium, peritoneum, and pericardium [1, 2]. CA 125 is commonly used as a biomarker for epithelial ovarian cancer diagnosis because it correlates with malignancy risk [3]. * Correspondence: [email protected] 1 Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka Full list of author information is available at the end of the article
Teratomas constitute 15–20% of all ovarian tumors and are the commonest ovarian tumor in the reproductive age group [1]. CA 125 may be elevated in 13.5–25% of teratoma cases, but it is only mildly elevated [4, 5]. Mucinous cystadenoma is also a benign mucin-containing epithelial ovarian tumor that is usually found in middleaged women in whom CA 125 levels can rarely be elevated [6].
Case presentation A 43-year-old Sinhalese woman with a history of ano
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