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Case Report
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| Tubo-ovarian abscesses with elevated CA-125: A case report | ||||||
| Kwok Wan Yeung1, Hsin Chih Chao2 | ||||||
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1MD, Department of Radiology, Fooyin University Hospital, Pingtung, Taiwan No. 5, Chung-Shan Road, Tung-Kang, Pingtung, 928, Taiwan.
2MD, Department of Obstetrics and Gynecology, Fooyin University Hospital, Pingtung, Taiwan, No. 5, Chung-Shan Road, Tung-Kang, Pingtung, 928, Taiwan. | ||||||
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| How to cite this article |
| Yeung KW, Chao HC. Tubo-ovarian abscesses with elevated CA-125: A case report. Int J Case Rep Images 2016;7(9):583–586. |
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Abstract
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Introduction:
The detection of pelvic masses with an elevated blood cancer antigen 125 (CA-125) level is highly suggestive of ovarian cancer. However, various benign and inflammatory gynecological conditions and non-gynecological processes, such as liver and pulmonary diseases, may be associated with an elevated serum CA-125 level, especially in premenopausal women.
Case Report: An 18-year-old female patient with lower abdominal pain for three days presented to our hospital. No fever was noted. Blood cancer antigen 125 (CA-125) level was elevated (660 U/mL; normal value, <35 U/mL), while the levels of other tumor markers (a-fetoprotein, carcinoembryonic antigen, β-human chorionic gonadotropin, and CA-199) were within normal limits. Transabdominal ultrasonography showed multicystic lesions with interior septation in the adnexal regions on both sides, suggesting the presence of cystic masses in both ovaries. Contrast-enhanced magnetic resonance imaging (MRI) revealed dilated and tubular structures with fluid-fluid level, wall thickening, and enhancement in the right pelvic cavity, and oval and septated masses with wall thickening and enhancement in both adnexal regions. A MRI diagnosis of right tubo-ovarian abscess and left ovarian abscess was made. Laparoscopy confirmed bilateral tubo-ovarian abscesses with pelvic adhesion. Right salpingectomy, left partial salpingectomy with end-to-end anastomosis, and adhesiolysis were performed. The patient was discharged with an uneventful course five days later. The blood CA-125 level dropped to 127 U/mL in 1 week, and to a normal value (6.5 U/mL) five months after surgery. Conclusion: Using CA-125 in isolation has limited value in differentiating benign from malignant pelvic masses. CA-125 levels are elevated in ovarian malignancy, as well as in pelvic inflammation, especially in a young woman with a sexual history. Clinical history and radiological information from US, CT, MRI and PET/CT provide important additional information for the disease entity. | |
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Keywords:
Tubo-ovarian abscesses, Elevated CA-125
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Author Contributions
Kwok Wan Yeung – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Hsin Chih Chao – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2016 Kwok Wan Yeung et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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