Recurrent Endometriotic Cyst with High Ca-125 Level Mimicking Malignancy

Gynecologists who treat endometriosis, a chronic, disabling disease, face difficulties diagnosing and treating the condition. Endometriotic cyst, with internal septations and opacities sonologically, mimics malignancy. Increased levels of CA 125 Are used as a tumor marker in epithelial ovarian malignancies. It is also an important prognostic indicator and follow-up tool in managing ovarian malignancies. A moderate increase in CA125 levels is observed in physiological conditions like ovulation and benign conditions like endometriosis and PID. We present here a case of extremely elevated serum CA 125 level in a patient who presented with recurrent ovarian endometriosis. Mrs. X, 46 years old, presented with a complex ovarian cyst with CA 125 level- 1021 iu/ml. With a history of laparotomy for endometriotic cysts in the past. Intraoperatively bilateral complex ovarian cysts were identified, which were densely adherent to the lateral pelvic wall and rectum posteriorly. The ovarian cysts were excised with a hysterectomy. The Patient developed dribbling of urine on the third postoperative day. CT urogram revealed a right ureterovaginal fistula. Laparotomy done. Uretero ureteral anastomosis done by a urologist. The Postoperative patient remained dry. Histopathological evaluation revealed benign endometriosis. Extensive and aggressive surgeries are usually done for ovarian malignancies to provide optimal reduction. However, in our patient, risk assessment for malignancy based on radiological factors and tumor markers was highly suggestive of malignancy. Yet, the histopathology turned out to be benign endometriosis. Therefore, to avoid invasive investigations and surgeries associated with high morbidity, emphasis must be made on the possibility of raised CA 125 levels in benign conditions such as endometriosis.