Markedly elevated CA19-9 associated with benign ovarian cyst and ascites

Area of Science:

• Oncology
• Gastroenterology
• Gynecology

Background:

• Ascites, particularly blood-stained exudate, often raises suspicion for malignancy.
• Elevated tumor markers like CA19-9 are typically associated with gastrointestinal or ovarian cancers.
• Diagnostic challenges arise when clinical and imaging findings do not correlate with tumor marker levels.

Purpose of the Study:

• To report a rare case of markedly elevated CA19-9 in the context of benign ovarian pathology and ascites.
• To illustrate the potential for tumor markers to yield false-positive results in diagnostic workups.
• To emphasize the importance of integrating all diagnostic data, not relying solely on tumor markers.

Main Methods:

• Case presentation of a 60-year-old woman with ascites following a fall.
• Laboratory investigations including tumor markers (CA125, AFP, CEA, CA19-9).
• Cross-sectional imaging (CT, MRI) and diagnostic laparoscopy.
• Monitoring of CA19-9 levels post-intervention.

Main Results:

• Patient presented with ascites and a significantly elevated CA19-9 level (2880 U/ml).
• Initial suspicion for pancreatic or cholangiocarcinoma due to CA19-9 levels, despite normal AFP and CEA.
• Imaging studies were unremarkable for malignancy; laparoscopy revealed a benign ruptured ovarian cyst.
• Post-drainage of ascites and resolution of the ovarian cyst, CA19-9 normalized.

Conclusions:

• This case represents the highest reported elevation of CA19-9 associated with benign ovarian pathology and ascites.
• It underscores that elevated CA19-9 levels can occur in non-malignant conditions, necessitating comprehensive diagnostic evaluation.
• The findings emphasize the critical need to correlate tumor marker results with clinical presentation, imaging, and other diagnostic modalities to avoid misdiagnosis.