Article Data

  • Views 522
  • Dowloads 170

Case Reports

Open Access

Endometrioid carcinoma associated with ovarian endometriosis: need for cautions during treatment

  • Woo Yeon Hwang1,*,

1Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, 02447 Seoul, Republic of Korea

DOI: 10.22514/ejgo.2023.014 Vol.44,Issue 1,February 2023 pp.115-118

Submitted: 20 September 2022 Accepted: 25 November 2022

Published: 15 February 2023

*Corresponding Author(s): Woo Yeon Hwang E-mail:


Although endometriosis could be associated with certain epithelial ovarian cancers and elevated serum cancer antigen (CA) 19-9 levels, it is difficult to diagnose endometriosis using this marker. We report an unusual case of endometriosis that evolved into endometrioid carcinoma in an asymptomatic 38-year-old woman with elevated CA 19-9 levels who presented to our clinic. Transvaginal ultrasound and computed tomography of the abdomen and pelvis revealed endometriosis of the right ovary. A laparoscopy was performed to evaluate for chocolate cysts. However, based on the postoperative pathological assessment, she was diagnosed with endometrioid carcinoma associated with endometriosis and was reoperated for surgical staging. This case indicates that sudden elevation of CA 19-9 level might be a sign of malignancy, small asymptomatic endometriosis should not be ignored, and incidental diagnosis of ovarian cancer should be carefully assessed by surgical staging.


Endometrioid carcinoma; Endometriosis; CA 19-9; Surgical staging

Cite and Share

Woo Yeon Hwang. Endometrioid carcinoma associated with ovarian endometriosis: need for cautions during treatment. European Journal of Gynaecological Oncology. 2023. 44(1);115-118.


[1] Paik ES, Kim TJ, Choi CH, Kim BG, Bae DS, Lee JW. Clinical outcomes of patients with clear cell and endometrioid ovarian cancer arising from endometriosis. Journal of Gynecologic Oncology. 2018; 29: e18.

[2] Shafrir AL, Farland LV, Shah DK, Harris HR, Kvaskoff M, Zondervan K, et al. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Practice & Research Clinical Obstetrics & Gynaecology. 2018; 51: 1–15.

[3] Saavalainen L, Lassus H, But A, Tiitinen A, Härkki P, Gissler M, et al. Risk of gynecologic cancer according to the type of endometriosis. Obstetrics & Gynecology. 2018; 131: 1095–1102.

[4] Lee SP, Sung I, Kim JH, Lee S, Park HS, Shim CS. Usefulness of carbohydrate antigen 19-9 test in healthy people and necessity of medical follow-up in individuals with elevated carbohydrate antigen 19-9 level. Korean Journal of Family Medicine. 2019; 40: 314–322.

[5] Nakagawa N, Koda H, Nitta N, Nakahara Y, Uno J, Hashimoto T, et al. Reactivity of CA 19-9 and CA 125 in histological subtypes of epithelial ovarian tumors and ovarian endometriosis. Acta Medicinae Okayama. 2015; 69: 227–235.

[6] Tomassetti C, Johnson NP, Petrozza J, Abrao MS, Einarsson JI, Horne AW, et al. An international terminology for endometriosis, 2021. Journal of Minimally Invasive Gynecology. 2021; 28: 1849–1859.

[7] Audebert A, Petousis S, Margioula-Siarkou C, Ravanos K, Prapas N, Prapas Y. Anatomic distribution of endometriosis: a reappraisal based on series of 1101 patients. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018; 230: 36–40.

[8] Sampson JA. Endometrial carcinoma of the ovary, arising in endometrial tissue in that organ. Archives of Surgery. 1925; 10: 1.

[9] Scott RB. Malignant changes in endometriosis. Obstetrics & Gynecology. 1953; 2: 283–289.

[10] Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Human Reproduction Open. 2022; 2022: hoac009.

[11] Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, et al. ESGO/ISUOG/IOTA/ESGE consensus statement on preoperative diagnosis of ovarian tumors. Ultrasound in Obstetrics and Gynecology. 2021; 58: 148–168.

[12] Van Calster B, Van Hoorde K, Froyman W, Kaijser J, Wynants L, Landolfo C, et al. Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors. Facts, Views & Vision in ObGyn. 2015; 7: 32–41.

[13] Johnson NP, Hummelshoj L. Consensus on current management of endometriosis. Human Reproduction. 2013; 28: 1552–1568.

[14] Robinson KA, Menias CO, Chen L, Schiappacasse G, Shaaban AM, Caserta MP, et al. Understanding malignant transformation of endometriosis: imaging features with pathologic correlation. Abdominal Radiology. 2020; 45: 1762–1775.

[15] Magalhães JDS, Jammal MP, Crispim PCA, Murta EFC, Nomelini RS. Role of biomarkers CA-125, CA-15.3 and CA-19.9 in the distinction between endometriomas and ovarian neoplasms. Biomarkers. 2021; 26: 268–274.

[16] Chew KT, Zakaria IA, Abu MA, Ahmad MF, Hing EY, Abdul Ghani NA. Elevated serum CA 19-9 with adnexal mass: is it always an ovarian malignancy? Hormone Molecular Biology and Clinical Investigation. 2018; 34.

[17] Pandey D, Sharma R, Sharma S, Salhan S. Unusually high serum levels of CA 19-9 in an ovarian tumour: malignant or benign? Journal of Clinical and Diagnostic Research. 2017; 11: QD08–QD10.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time