Marked elevation of CA 19-9 in ovarian teratoma. Should we be worried? A case report

Abstract

Mature cystic teratoma (MCT) is a very common ovarian neoplasm, consisting of at least two layers of well-differentiated germ cells. Most cases are diagnosed incidentally during ultrasound in asymptomatic women, although some cases may present clinical symptoms compatible with acute complications that must be ruled out. Sometimes, clinical findings and imaging tests may raise doubts, including those regarding possible malignancy, and elevated CA 19-9 levels can help clarify the diagnosis and even suggest more adequate management, as marked elevations of this marker have been reported to indicate the presence of acute complications. We present a patient with one year of insidious abdominal pain and dyspareunia, followed by an acute painful episode. Ultrasound revealed a complex adnexal tumor compatible with MCT, but CA 19-9 was markedly elevated and introduced some concerns. Finally, the case was diagnosed and treated as a twisted ovarian teratoma.