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CA-125: What does that lab really mean?

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Ovarian torsion can occur in young girls with pelvic masses. Elevated CA-125 tumor markers may mislead diagnosis, delaying crucial surgery for ovarian torsion.

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Area of Science:

  • Pediatric Gynecology
  • Surgical Diagnosis
  • Oncology

Background:

  • Ovarian torsion is a gynecologic emergency, often diagnosed late.
  • Pelvic masses in pre-pubertal females warrant thorough evaluation.
  • Tumor markers aid in characterizing ovarian masses but have limitations.

Observation:

  • A 10-year-old pre-pubertal female presented with abdominal pain and an ovarian mass.
  • Elevated cancer antigen 125 (CA-125) levels raised suspicion for neoplasm.
  • This led to a delay in surgical intervention.

Findings:

  • The patient was ultimately diagnosed with ovarian torsion, not a neoplasm.
  • The utility of CA-125 in pediatric cases is uncertain.
  • Over-reliance on tumor markers can cause diagnostic errors.

Implications:

  • Limited use of tumor markers is advised in pediatric ovarian mass work-up.
  • Prompt surgical exploration may be necessary despite ambiguous tumor marker results.
  • Accurate diagnosis of ovarian torsion is critical to prevent ovarian damage.