Tubo-ovarian abscesses with elevated CA-125: A case report

Abstract

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 (α-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. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 9, September 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(9):583–586. www.ijcasereportsandimages.com Yeung et al. 583 CASE REPORT OPEN ACCESS Tubo-ovarian abscesses with elevated CA-125: A case report Kwok Wan Yeung, Hsin Chih Chao