Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.
Department of Paraclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.
J Med Case Rep. 2020 Sep 3;14(1):141. doi: 10.1186/s13256-020-02458-x.
The presence of a suspicious ovarian cyst with elevated cancer antigen 125 level in a woman of reproductive age poses a serious therapeutic dilemma. Mature cystic teratomas and mucinous cystadenomas may also cause an increase in cancer antigen 125.
A 43-year-old Sinhalese woman with a history of anovulatory subfertility for 5 years presented with heavy menstrual bleeding and secondary dysmenorrhea of 6 months' duration. Imaging (pelvic ultrasound and computed tomography of the abdomen and pelvis) revealed a hemorrhagic cyst (6 × 4 cm) on the right side and a multilocular cyst with solid areas (10 × 7 cm) on the left side. Her cancer antigen 125 level was 2715 U/ml. Following a multidisciplinary team meeting, a fertility-sparing staging laparotomy was performed, which included right cystectomy, left oophorectomy, infracolic omentectomy, and peritoneal washings. Histology revealed a mucinous cystadenoma of the right ovary and a mature cystic teratoma on the left ovary. No malignant cells were observed in peritoneal washings. The patient's cancer antigen 125 level dropped to 74.8 U/ml 1 month after surgery.
Rarely, teratomas and mucinous cystadenomas may also give rise to an extremely high cancer antigen 125 level. The risk of malignancy index and risk of malignancy algorithm may both be misleading in these instances. Therefore, multidisciplinary input, fertility-sparing surgery, and follow-up are paramount to achieve optimal treatment and patient satisfaction.
对于育龄期女性，如果存在伴有癌抗原 125 水平升高的可疑卵巢囊肿，这会带来严重的治疗困境。成熟囊性畸胎瘤和黏液性囊腺瘤也可能导致癌抗原 125 升高。
一位 43 岁的僧伽罗女性，因排卵障碍性不孕病史 5 年，出现 6 个月的经量过多和继发性痛经。影像学检查（盆腔超声和腹部及盆腔 CT）显示右侧有一个出血性囊肿（6×4cm），左侧有一个多房囊性肿块伴实性区域（10×7cm）。她的癌抗原 125 水平为 2715U/ml。经过多学科团队会议讨论，决定进行保留生育能力的分期腹腔镜手术，包括右侧囊肿切除术、左侧卵巢切除术、结肠下网膜切除术和腹腔冲洗术。组织学检查显示右侧卵巢为黏液性囊腺瘤，左侧卵巢为成熟囊性畸胎瘤。腹腔冲洗液中未观察到恶性细胞。术后 1 个月，患者的癌抗原 125 水平降至 74.8U/ml。
在罕见情况下，畸胎瘤和黏液性囊腺瘤也可能导致癌抗原 125 水平极高。在这些情况下，风险指数和风险算法都可能具有误导性。因此，多学科参与、保留生育能力的手术和随访对于实现最佳治疗效果和患者满意度至关重要。
