Abnormal Elevated CA 19-9 in the Dermoid Cyst: A Sign of the Ovarian Torsion?

Abstract

Dermoid cyst is the most common germ cell tumor of the ovary containing various tissue elements. Ovarian torsion is a common complication of which ultrasonographic diagnosis is confusing. We report here a 14-year-old adolescent with painless torsion of the ovary including dermoid cyst and with abnormal elevated CA 19-9 serum levels. Elevated CA 19-9 level may be related to ovarian torsion and may predict the extent of tissue necrosis.

Use of cancer antigen 125, cancer antigen 19‐9, and the neutrophil‐to‐lymphocyte ratio to diagnose mature cystic teratoma with torsion

“…Mature cystic teratoma (MCT)—also known as dermoid cyst or benign cystic teratoma of the ovary—is the most frequently diagnosed germ‐cell ovarian tumor, particularly among reproductive‐aged women . Indeed, this condition accounts for 60% of all primary benign ovarian tumors worldwide . Ovarian MCTs typically comprise well‐differentiated tissues derived from the three germ‐cell layers (endoderm, mesoderm, and ectoderm), and are usually made up of mature tissues (e.g.…”

“…Torsion is the most frequent complication of MCT, occurring among 15%–16% of all patients . Owing to a moderate volume and contents of varying density, the center of gravity of an MCT is usually biased to one side .…”

CA 19-9 Elevation in a Benign Ovarian Cystic Teratoma, A Case Report and Review of Literature

“…We present this case in order to build on the growing body of evidence suggesting that CA 19-9 levels are useful in the diagnosis and management of MCT [7,10]. Cases of ovarian neoplasms such as ovarian clear-cell and endometrioid carcinomas [11] with increased CA 19-9 levels, and benign neoplasms with increased CA 19-9 have been documented in the literature previously [3][4][5]. Pyeon et al [5] reported a case of a benign ovarian cyst with CA 19-9 levels of 2,753 U/mL that then returned to normal postoperatively [5].…”

“…In general, the accepted normal reference range of CA 19-9 is <37 U/mL. Aside from a handful of case reports [1][2][3][4][5] and larger analyses [5][6][7] the association between elevated CA 19-9 level and Mature Cystic Teratoma (MCT) is scarcely reported. Yet, CA 19-9's role in diagnosis remains unclear.…”

Acute Gynaecological Emergency Caused by Ruptured Dermoid

“…There have been no reported cases of such high levels of CA 19-9 observed in any of these studies associated with benign ovarian dermoid. Burcu Artunc Ulkumen et al 13 presented a case report of torsion of a dermoid with CA 19-9 level of1983 U/ml. He attributed the raised level of the tumor marker to torsion of the dermoid and tissue necrosis.…”