Endometriosis is defined as the presence of the endometrial tissue, glands, and stroma, outside the endometrium and myometrium and is characterized by chronic pain and subfertility. Recently, clinical interviews and imaging have increasingly supplemented, and in certain contexts replaced, laparoscopy as the main diagnostic method. However, when we suspect cancer, laparoscopic inspection of abdominal and pelvic cavity, with biopsies and histological confirmation remains the gold standard. The most important biomarker used in endometriosis diagnosis remains CA 125, which is a well established marker in ovarian cancer. The sensitivity of CA 125 limits its clinical usefulness in endometriosis diagnosis. In this paper we present the case of the patient with significantly elevated levels of CA 125 and high suspicion of ovarian neoplasm in imaging studies.
BeckerCMBokorAHeikinheimoO, et alESHRE guideline: endometriosis. Hum Reprod Open2022; 2022(2): hoac009.
2.
EskenaziBWarnerML. Epidemiology of endometriosis. Obstetr Gynecol Clin N Am1997; 24(2): 235–258.
3.
TreloarSABellTANagleCM, et alEarly menstrual characteristics associated with subsequent diagnosis of endometriosis. Am J Obstetr Gynecol2010; 202(6): 534.e1–534.e6.
4.
JanssenEBRijkersACMHoppenbrouwersK, et alPrevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: a systematic review. Hum Reprod Update2013; 19(5): 570–582.
5.
CoxHHendersonLAndersenN, et alFocus group study of endometriosis: struggle, loss and the medical merry-go-round. Int J Nurs Pract2003; 9(1): 2–9.
6.
DennyEMannCH. Endometriosis and the primary care consultation. Eur J Obstetr Gynecol Reprod Biol2008; 139(1): 111–115.
7.
CulleyLLawCHudsonN, et alThe social and psychological impact of endometriosis on women’s lives: a critical narrative review. Hum Reprod Update2013; 19(6): 625–639.
8.
SetäläMHärkkiPMatomäkiJ, et alSexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection. Acta Obstetr Gynecol Scand2012; 91(6): 692–698.
9.
SimoensSHummelshojLDunselmanG, et alEndometriosis cost assessment (the EndoCost Study): a cost-of-illness study protocol. Gynecol Obstetr Investig2010; 71(3): 170–176.
10.
MayKEConduit-HulbertSAVillarJ, et alPeripheral biomarkers of endometriosis: a systematic review. Hum Reprod Update2010; 16(6): 651–674.
11.
SeckinBAtesMCKirbasA, et alUsefulness of hematological parameters for differential diagnosis of endometriomas in adolescents/young adults and older women. Int J Adolesc Med Health2021; 33(2): 20180078.
12.
DuraisamySRamasamySKharbandaS, et alDistinct evolution of the human carcinoma-associated transmembrane mucins, MUC1, MUC4 AND MUC16. Gene2006; 373: 28–34.
13.
JacobsI. Screening for ovarian cancer by CA-125 measurement. Lancet1988; 331(8590): 889.
14.
BarbieriRLNiloffJMBastRC, et alElevated serum concentrations of CA-125 in patients with advanced endometriosis. Fertil Steril1986; 45(5): 630–634.
15.
ChenIVethVBChoudhryAJ, et alPre- and postsurgical medical therapy for endometriosis surgery. Cochrane Database Syst Rev2020; 11(11): CD003678.
16.
BharwaniNReznekRHRockallAG. Ovarian cancer management: the role of imaging and diagnostic challenges. Eur J Radiol2011; 78(1): 41–51.
17.
ForstnerRMeissnitzerMWSchlattauA, et alMRI in ovarian cancer. Imaging Med2012; 4(1): 59–75.
18.
IyerVRLeeSI. MRI, CT, and PET/CT for ovarian cancer detection and adnexal lesion characterization. Am J Roentgenol2010; 194(2): 311–321.
19.
TakeuchiMMatsuzakiKHaradaM. Computed diffusion-weighted imaging for differentiating decidualized endometrioma from ovarian cancer. Eur J Radiol2016; 85(5): 1016–1019.
20.
KafaliHArtucHDemirN. Use of CA125 fluctuation during the menstrual cycle as a tool in the clinical diagnosis of endometriosis; a preliminary report. Eur J Obstetr Gynecol Reprod Biol2004; 116(1): 85–88.
21.
van der SpuyZMWoodMFieggenG, et alSerum CA 125 concentrations in women with endometriosis or uterine fibroids treated with gonadotrophin-releasing hormone agonist analogues. S Afr Med J1993; 83(7): 510–513.
22.
GhaemmaghamiFKarimi ZarchiMHamediB. High levels of CA125 (over 1,000 IU/ml) in patients with gynecologic disease and no malignant conditions: three cases and literature review. Arch Gynecol Obstet2007; 276(5): 559–561.
23.
JohanssonJSantalaMKauppilaA. Explosive rise of serum CA 125 following the rupture of ovarian endometrioma. Hum Reprod1998; 13(12): 3503–3504.
24.
KashyapRJ. Extremely elevated serum CA125 due to endometriosis. Aust NZ J Obst Gynaeco1999; 39(2): 269–270.
