Abnormal elevated CA 19-9 in the dermoid cyst: a sign of the ovarian torsion?

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. A 14-year-old virgin adolescent was admitted to our clinic because of pelvic pain lasting for 1 week. Abdominopelvic ultrasonography revealed a lobulated cystic lesion with a diameter of 11 cm in the right adnexa. Abdominopelvic MR revealed a 16 cm cystic lesion consisting of heterogeneous solid structures. The left ovary and other intra-abdominal structures were normal. Tumor markers were as follows: CEA: 1.90 U/mL, AFP: 0.94 U/mL, CA 15-3: 13.4 U/mL, CA 19.9: 1983 U/mL, and CA 125: 217 U/mL. Another possible gastrointestinal system pathology was ruled out by imaging modalities. Pfannenstiel incision was made, and right ovarian torsion with necrosis was detected. Right salpingooophorectomy was performed, and frozen section revealed dermoid cyst. Pathological evaluation was compatible with dermoid cyst and the ovarian torsion. High levels of CA 19-9 and CA-125 and the rapid increase in the diameter of the cyst are not always associated with malignancy. However, a detailed preoperative evaluation is needed. Due to the need of early detection of ovarian torsion, CA 19-9 may be a good marker particularly for ovarian torsion and the extensity of ovarian necrosis. However, larger studies are needed to confirm this hypothesis.

Keywords

CA 19-9, dermoid cyst, ovarian torsion.