Elevated serum CA 19-9 with adnexal mass: is it always an ovarian malignancy?

Chew, Kah Teik; Zakaria, Izyan Atiqah; Abu, Muhammad Azrai; Ahmad, Masood; Hing, Erica Yee; Ghani, Nur Azurah Abdul

doi:10.1515/hmbci-2018-0011

Cited by 4 publications

(5 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This suggests the potential mechanisms through which CA 19-9 was detected elevated in the blood, either through secretions of the antigen from bronchial glands direct to the bloodstream or in case of leakage through the absorption from the surrounding tissues. Accordingly, in patients with a ruptured endometrioma, it has been proposed that fluid leakage from the endometriotic cyst and the subsequent exchange among peritoneal fluid and serum could result in elevated serum CA 19-9 levels [41]. This could also explain the significantly elevated CA 19-9 in cases of torsion; one could hypothesize that necrosis, as a consequence of torsion, could cause dissemination of the cystic component of the MCT and can raise the serum CA 19-9 levels.…”

Section: Discussionmentioning

confidence: 99%

Is There a Role of Elevated CA 19-9 Levels in the Evaluation of Clinical Characteristics of Mature Cystic Ovarian Teratomas? A Systematic Review and Meta-analysis

Prodromidou¹,

Pandraklakis²,

Loutradis³

et al. 2019

Cureus

View full text Add to dashboard Cite

The role of preoperative CA 19-9 levels in patients with ovarian mature cystic teratoma (MCT) and the association of elevated levels of the biomarker with patients' and tumor characteristics were evaluated. Four electronic databases were searched for articles published up to September 2019. Trials that evaluated the significance of elevated CA 19-9 in patients with ovarian MCTs and publications with > 20 patients were considered eligible for inclusion. Seven studies that included 995 patients with an ovarian MCT who were evaluated with elevated (n = 364) or normal (n = 631) CA 19-9 levels were included. Mean tumor size was significantly increased in patients with elevated CA 19-9 levels (p = 0.038). The rate of ovarian torsion was significantly increased in the elevated CA 19-9 group (p = 0.04). The present study highlights the importance of CA 19-9 as a marker in the diagnosis of MCT, and a meta-analysis supports that it could raise a high degree of clinical suspicion of early recognition of torsion and early surgical management due to complications related to increased size. Nonetheless, the diagnostic value of CA 19-9 is still limited and CA 19-9 can still serve only as a supplementary diagnostic tool in patients with MCTs.

show abstract

Section: Discussionmentioning

confidence: 99%

Is There a Role of Elevated CA 19-9 Levels in the Evaluation of Clinical Characteristics of Mature Cystic Ovarian Teratomas? A Systematic Review and Meta-analysis

Prodromidou¹,

Pandraklakis²,

Loutradis³

et al. 2019

Cureus

View full text Add to dashboard Cite

show abstract

“…Herein, we report six cases of patients with AIP, causing the elevation of CA 19-9 ranging from 1950 U/mL to 12,000 U/mL, and a case of a patient with liver steatosis and an increased CA 19-9 value to 1930 U/mL. When considering differential diagnosis due to the low specificity of tumor markers and lack of obvious radiological image, various diseases should be taken into consideration [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 68 , 69 ]; however, a mildly increased dimension of the pancreas in MRI with areas of fluid signals could correspond to past AIP that induced increased CA 19-9. According to the literature, about 25% of patients with AIP show values of CA 19-9 > 37 U/mL, and only around 12.2% of them show elevated levels > 100 U/mL [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL

Ciesielka,

Jakimów,

Tekiela

et al. 2024

JCM

View full text Add to dashboard Cite

Background: CA 19-9 is a commonly assessed tumor marker, considered characteristic of pancreatic ductal adenocarcinoma (PDAC) and biliary tract cancers; however, the positive predictive value of CA 19.9 is too low, and the usage of CA 19.9 as a screening tool in the healthy population remains controversial. Methods: The presented case illustrates a reversed diagnosis of highly elevated serum CA 19-9 levels in a 54-year-old female complaining of pain in the epigastric region, shortly after COVID-19 vaccination. Laboratory tests showed a significantly elevated level of the CA 19-9 marker (>12,000 U/mL, reference value: <37 U/mL) with normal pancreatic enzyme activity. The patient underwent imaging examination, which showed no abnormalities, except for increased pancreatic dimension and areas of fluid signal in the pancreas in magnetic resonance imaging (MRI), which may correspond to autoimmune pancreatitis (AIP). The patient remains asymptomatic with a recommendation for a follow-up MRI in 12 months. Results: A literature review conducted revealed multi-causal CA 19-9 increases above 1000 U/mL, including non-cancerous diseases of the lung, pancreas, liver, ovary, kidney, and others. The median concentration of CA 19-9 regardless of the cause of disease was 2810 U/mL (IQR ± 6895). The median CA 19-9 values in men and women were 3500 (IQR ± 10,050) and 2455 (IQR ± 3927), respectively, and differ significantly between the compared groups (p < 0.05). There was no difference between CA 19-9 values and the categorized cause of the increase. Conclusions: Conducting differential diagnosis, it should not be forgotten that most international guidelines recommend the use of CA 19-9 only in conjunction with pathology of pancreas in radiological imaging; however, even such a combination can point the diagnostic pathway in the wrong direction. A highly elevated CA 19-9 level, typically associated with PDAC, may be the result of benign disease including AIP related to COVID-19 vaccination.

show abstract

“…Endometriotic cysts are prevalent benign gynecological disorders linked to high CA-125 and CA-19.9 levels. However, excessively elevated markers and an adnexal mass suggest ovarian cancer, making it difficult to distinguish between the two diagnoses [ 7 ]. CA-125 can be helpful as a tumor marker to distinguish between benign and malignant ovarian masses.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, compared to mucinous tumors, serous tumors showed a stronger correlation with elevated CA-125 levels. The tumor marker CA-125 is now generally acknowledged as a predictive and prognostic factor in CA-125-positive ovarian cancers [7,8]. The most common site of endometriotic lesions is the ovary [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Endometriotic Cystic Ovaries and Huge Splenic Epithelial Cyst With Elevated CA-125, CA19-9: A Report of a Rare Case

Abdulla,

Saeed,

Abdul Aziz

et al. 2023

Cureus

View full text Add to dashboard Cite

Histologically benign splenic cysts (SCs) resemble splenic sacs. SCs are rare. Here, we present and discuss a new case of bilateral endometriotic cystic ovaries with massive SCs. A 26-year-old single female visited the hospital with left lower quadrant discomfort and suprapubic pain for three months, accompanied by anorexia, weight loss for these three months, and persistent dysmenorrhea for two years. Splenic examination revealed a soft abdomen with left hypochondria, suprapubic tenderness, and a lump in the upper left quadrant. All laboratory results were normal, except for two cancer antigens (CA-125 and CA 19-9). Therefore, magnetic resonance imaging was used to make the definitive diagnosis, which revealed bilateral ovarian endometrioma with a left upper abdominal cystic mass of splenic origin. When CA-125 and CA-19-9 readings are high, physicians should investigate endometriotic and SCs. Imaging aids diagnosis. Histopathological results are essential. Tools and follow-up should rule out malignancy, and surgery is the best treatment option.

show abstract

Elevated serum CA 19-9 with adnexal mass: is it always an ovarian malignancy?

Cited by 4 publications

References 10 publications

Is There a Role of Elevated CA 19-9 Levels in the Evaluation of Clinical Characteristics of Mature Cystic Ovarian Teratomas? A Systematic Review and Meta-analysis

Is There a Role of Elevated CA 19-9 Levels in the Evaluation of Clinical Characteristics of Mature Cystic Ovarian Teratomas? A Systematic Review and Meta-analysis

Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL

Bilateral Endometriotic Cystic Ovaries and Huge Splenic Epithelial Cyst With Elevated CA-125, CA19-9: A Report of a Rare Case

Contact Info

Product

Resources

About