MASSA OVARIUM REKUREN DENGAN KADAR CA-125 SANGAT TINGGI YANG MENYERUPAI KEGANASAN: LAPORAN KASUS
RECURRENT OVARIAN MASS WITH EXTREMELY ELEVATED CA-125 MIMICKING MALIGNANCY: CASE REPORT
Abstract
Ovarian endometrioma is a form of endometriosis that often presents a diagnostic challenge due to its ability to mimic ovarian malignancy both clinically and biochemically. Markedly elevated CA-125 levels may further raise suspicion of malignancy, potentially leading to overdiagnosis and overtreatment. We report the case of a 39-year-old woman with a recurrent ovarian mass presenting with progressive dysmenorrhea, abdominal enlargement, and menstrual irregularities. Examination revealed a large abdominal mass with a significantly elevated CA-125 level of 1,500 U/mL. Ultrasonography demonstrated a cystic lesion with a characteristic “ground glass appearance” without solid components, suggestive of endometrioma. However, intraoperative findings of extensive adhesions raised strong suspicion of malignancy. Frozen section analysis suggested a benign lesion consistent with endometrioma, which was subsequently confirmed by final histopathological examination. The patient subsequently underwent total hysterectomy and unilateral salpingo-oophorectomy, followed by postoperative GnRH agonist therapy. This case highlights that ovarian endometrioma can closely mimic ovarian malignancy, particularly in the presence of markedly elevated CA-125 levels. Histopathological examination remains the gold standard for definitive diagnosis. A comprehensive and individualized approach is essential to avoid unnecessary aggressive management and to optimize patient outcomes.
Abstrak
Endometrioma ovarium merupakan salah satu bentuk endometriosis yang sering menimbulkan tantangan diagnostik karena dapat menyerupai keganasan ovarium, baik secara klinis maupun biokimiawi. Peningkatan kadar CA-125 yang sangat tinggi sering kali memperkuat kecurigaan terhadap keganasan sehingga berpotensi menyebabkan overdiagnosis dan overtreatment. Dilaporkan kasus seorang wanita berusia 39 tahun dengan massa ovarium rekuren yang disertai keluhan dismenore progresif, pembesaran abdomen, dan gangguan menstruasi. Pemeriksaan menunjukkan massa abdomen berukuran besar dengan kadar CA-125 mencapai 1.500 U/mL. Ultrasonografi memperlihatkan lesi kistik dengan gambaran khas ground glass appearance tanpa komponen solid yang mengarah pada diagnosis endometrioma. Namun, temuan intraoperatif berupa adhesi luas menimbulkan kecurigaan kuat terhadap keganasan ovarium. Pemeriksaan frozen section menunjukkan lesi jinak yang konsisten dengan endometrioma dan selanjutnya dikonfirmasi melalui pemeriksaan histopatologi definitif tanpa ditemukan tanda keganasan. Pasien menjalani histerektomi total dan salpingo-ooforektomi unilateral, diikuti terapi agonis GnRH pascaoperasi. Kasus ini menunjukkan bahwa endometrioma ovarium dapat menyerupai keganasan ovarium, terutama pada kondisi dengan kadar CA-125 yang sangat tinggi. Pemeriksaan histopatologi tetap merupakan standar emas dalam menegakkan diagnosis definitif. Pendekatan diagnostik yang komprehensif dan individual diperlukan untuk menghindari tindakan yang tidak perlu serta mengoptimalkan luaran pasien.
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