Mature cystic teratomas are among the most common benign ovarian tumors, yet every now and then they present like a puzzle that challenges every seasoned clinician. There are rare presentations where benign dermoid cyst has mimicked malignancy clinically, radiobiologically, and biochemically, reminding us why ovarian masses demand a holistic and cautious approach.
One of the cases that I came across was of a young girl who presented with pelvic pain and a large intra-abdominal mass reaching the umbilicus. Imaging suggested a lobulated solid cystic lesion with ascites, omental infiltration, and pleural effusion raising strong suspicion of malignancy. What heightened the dilemma further was the marked elevation of CA19-9 and CA-125, the tumor markers often associated with cancer.
Yes, as we all know, medicine loves exceptions.
Further investigations-the ascitic fluid, pleural fluid, and imaging-guided biopsies showed no malignant cells, and intraoperative findings revealed ruptured hemorrhagic components with inflammatory changes. Ultimately, histopathology confirmed the mature cystic teratoma with melanophages and hemosiderin-laden macrophages. Changes likely triggered by rupture, inflammation, and peritoneal irritation, explaining the elevated markers.
This case reinforces a crucial lesson: High CA19-9 and CA-125 levels do not always indicate malignancy, particularly in dermoid cysts. Radiology, biomarkers, and clinical findings must be integrated carefully, and surgical exploration remains the gold standard when suspicion persists. A powerful reminder that a gynaecology, benign pathology can wear the perfect disguise of malignancy and only meticulous evaluation unmasks it.
Great learning, thank you for sharing a case from your clinical experience. This case is truly a chance to understand that exceptions are not limited to certain therapeutic area.
As shown by the teratoma case, elevated markers can raise suspicion but do not always equate to malignant cancer. It underlines the importance of correlating labs with imaging, clinical signs and histopathology.
This case is a striking reminder of how mature cystic teratomas can occasionally imitate ovarian malignancy with remarkable accuracy. Elevated CA-125 and CA19-9, ascites, omental thickening, and even pleural effusion can easily mislead clinicians toward an aggressive pathology. Yet, as this case shows, inflammatory reactions from rupture or leakage can produce peritoneal irritation that mimics carcinomatosis both biochemically and radiologically. It highlights the importance of integrating clinical judgment, imaging nuances, fluid analysis, and when uncertainty persists surgical exploration. Ovarian tumors often challenge assumptions, and this example reinforces why multidisciplinary evaluation is essential before concluding malignancy.