Extreme elevation of CA 19–9 levels in mature cystic teratoma without any complications: A case report

Cho, Angela; Kim, Bo Ram; Lim, So Hyun; Park, Chul Min

doi:10.1016/j.amsu.2022.103803

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…9,10 Many case reports show extreme elevation of CA 19-9 serum levels, observed in young women with benign dermoid cyst. 2,4,5 In another study involving 163 women concluded that elevated serum 19-9 levels correlated with larger tumor diameters and higher torsion rates. A systematic metaanalysis encompassing 7 studies including 995 patients supported that CA 19-9 could raise a high degree of clinical suspicion of torsion in dermoid cysts, thereby aiding in early surgical management.…”

Section: Discussionmentioning

confidence: 99%

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The role of carbohydrate antigen 19-9 in the clinical evaluation of mature cystic teratomas: an observational study at a tertiary care centre

Manohar,

2023

Int J Reprod Contracept Obstet Gynecol

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Background: Carbohydrate antigen (CA) 19-9 is a tumour marker mainly used in the evaluation of gastrointestinal tract malignancies including pancreas, colon and biliary tract. Cases of ovarian tumours such as mucinous neoplasms have been reported to have high levels of CA 19-9. However, its role in the management of cystic teratomas (MCT) which are the most common benign ovarian tumours encountered in gynaecology, is not studied in depth in literature. Methods: In our study, we observed the levels of CA 19-9 in 40 patients presenting with MCT. Its association to the cyst size, contents, laterality and torsion or rupture were documented. Results: The various clinical parameters evaluated in our study such as larger cyst size, presence of torsion and tooth as a content had a positive association with elevated CA 19-9 levels (p<0.05). However, CA 19-9 had no significant relationship with the laterality of the cyst. Thus, CA 19-9 may serve as an important adjunct tool to ultrasonography in the management of dermoid cysts (MCT), particularly in those with larger sizes and at risk of torsion. Conclusions: High levels of CA 19-9 can be observed in benign ovarian tumors like mature cystic teratoma (MCT) and it need not always be associated with malignancy or malignant transformation of benign tumors. Levels more than 100 IU may warrant further imaging studies to rule out gastro-intestinal pathologies. Unnecessary medical investigations or patient anxiety can be avoided in cases of moderate elevation in CA 19-9 levels.

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Section: Discussionmentioning

confidence: 99%

“…Squamous cell carcinoma is the most common type (80-90%) of malignant transformation. 2 Carbohydrate antigen (CA) 125 has been used in the diagnosis of ovarian cancer, and serum levels of this antigen are elevated in approximately 80% of women with epithelial ovarian cancer.…”

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confidence: 99%

The role of carbohydrate antigen 19-9 in the clinical evaluation of mature cystic teratomas: an observational study at a tertiary care centre

Manohar,

2023

Int J Reprod Contracept Obstet Gynecol

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“…Pathologically ovarian dermoid cyst was diagnosed [ 23 ]. Cho A. et al [ 24 ] reported a case of a 26-year-old woman with an ovarian cyst discovered during a routine gynecological examination with CA 19-9 levels of 1634 U/mL. Two months after surgery, CA 19-9 levels decreased to 64 U/mL [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…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

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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.

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The efficacy of tyrosine kinase inhibitors combined with chemotherapy for recurrent ovarian cancer: a systematic review and network meta-analysis

CHEN,

LI,

2024

Minerva Biotechnol Biomol Res

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Extreme elevation of CA 19–9 levels in mature cystic teratoma without any complications: A case report

Cited by 3 publications

References 18 publications

The role of carbohydrate antigen 19-9 in the clinical evaluation of mature cystic teratomas: an observational study at a tertiary care centre

The role of carbohydrate antigen 19-9 in the clinical evaluation of mature cystic teratomas: an observational study at a tertiary care centre

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

The efficacy of tyrosine kinase inhibitors combined with chemotherapy for recurrent ovarian cancer: a systematic review and network meta-analysis

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