Ovarian Teratoma Torsion With Ca 19-9 Elevation: Case Report

Abstract

Ovarian torsion is a rare gynecologic emergency and causes serious medical problems. The diagnosis of ovarian torsion is not always easy. Ovarian torsion is the most common complication with a confusing ultrasonographic diagnosis. Although the demonstration of blood flow by Doppler ultrasonography does not rule out the diagnosis of ovarian torsion, a serum marker with high reliability and sensitivity in the preoperative diagnosis of ovarian torsion has not yet been defined. A 19-year-old G0P0 patient was admitted to our clinic with pelvic pain lasting 1 week. Abdominopelvic ultrasound revealed a 9 cm diameter lobulated cystic lesion in the right adnexa. Abdominopelvic magnetic resonance imaging (MRI) showed a 90 × 88 mm cystic lesion consisting of heterogeneous solid structures. The left ovary and other intra-abdominal structures were normal. Tumor markers were as follows: CEA: 24.90 U/mL, AFP: 40 U/mL, CA 15-3: 23.4 U/mL, CA 19-9: 383 U/mL. The patient's MRI report was suspicious for malignancy, and the diagnosis of torsion could not be clarified. As the patient’s condition progressed, laparotomy was decided upon, and a frozen examination was requested. Cystectomy was performed after the findings were compatible with a dermoid cyst. CA 19-9 is a tumor marker that is increased, especially after ovarian teratoma torsion, and may be useful in diagnosing clinical teratoma torsion. However, larger studies are needed to confirm this hypothesis.