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Erratum to: Tumor markers in mature cystic teratomas of the ovary
Article  in  Archives of Gynecology and Obstetrics · May 2008
DOI: 10.1007/s00404-008-0688-2 · Source: PubMed
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Arch Gynecol Obstet (2009) 279:145–147
DOI 10.1007/s00404-008-0688-2
ORIGINAL ARTICLE
Tumor markers in mature cystic teratomas of the ovary
Ustunyurt Emin · Gungor Tayfun · Iskender Cantekin · 
Ustunyurt Basak Ozlem · Bilge Umit · 
Mollamahmutoglu Leyla 
Received: 30 January 2008 / Accepted: 6 May 2008 / Published online: 28 May 2008
© Springer-Verlag 2008
Abstract
Objective The objective of this study was to evaluate the
serum levels of tumor markers in patients with ovarian
mature cystic teratomas.
Method Retrospective study of 215 patients operated at
Zekai Tahir Burak Women Health Education and Research
Hospital between January 2001 and October 2006 was
performed.
Results The median age was 36 years (range 13–80). The
mean tumor diameter was 7.7 § 4.6 cm (range 2–25). The
mean serum CA 125 level was 26.2 § 29.9 U/mL (range
1.4–225, normal value <35), and the mean serum CA 19-9
level was 83.5 § 179.2 IU/mL (range 0.6–1,000; normal
value <37). The elevated rate of CA 19-9, CA 125 was
39.6% (74/187) and 23.3% (50/215), respectively. The
mean age of patients and the rate of bilaterality of tumors
were similar in both patients with elevated CA19-9 and
with normal CA 19-9 level (P > 0.05). The mean tumor size
of patients with elevated CA 19-9 was greater than those
with normal CA19-9 level (P = 0.01).
Conclusion Serum CA 19-9 has the highest positivity rate
among other tumor markers in ovarian mature cystic terato-
mas. Elevated serum CA 19-9 levels are correlated with
larger tumor size. But the diagnostic value of elevated CA
19-9 in patients with MCT would be poor if the test was
used alone.
Keywords CA 19-9 · CA 125 · Mature cystic teratoma · 
Ovary · Tumor markers
Introduction
Mature cystic teratoma (MCT) is a common benign neo-
plasm accounting for 10–20% of all ovarian tumors [1].
Most cases present as an asymptomatic adnexal mass inci-
dentally detected on routine pelvic examination or with fat
component and calciWcations detected by pelvic imaging
studies. Complications of mature cystic teratomas occur at
about 20% of the cases which are torsion, rupture and
infection and malignant transformation [2].
Serum tumor markers have been used in the manage-
ment of pelvic masses and ovarian cancer. The CA 125
antigen is expressed in coelomic epithelia such as müllerian
epithelium, peritoneum, pleura and pericardium [3]. Clini-
cal application of Ca 125 in ovarian cancer includes moni-
toring disease response to treatment, detecting disease
recurrence and estimating prognosis. Serum CA 125 also
has a role in distinguishing benign pelvic masses from
malignant ones [4]. CA 19-9, a side branch of the Lewis
blood group system, is a sialylated Lewis A antigen that is
highly expressed by many adenocarcinomas of the diges-
tive tract. The müllerian duct-derived mucosa of the uterus
and fallopian tubes also synthesizes Lewis blood group
antigens [5]. Ovarian MCT contains various kinds of tis-
sues since it originates in parthenogenesis of the oocyte.
Some tumor markers, therefore, are expected to be positive.
Although sonographic diagnosis of ovarian MCT can accu-
rately be made, use of serum tumor markers have been
shown to provide additional information and may aid in
making a diVerential diagnosis which is very important for
patients with ovarian tumors, because the surgery
U. Emin · G. Tayfun · I. Cantekin · U. B. Ozlem · 
B. Umit · M. Leyla
The Department of Obstetrics and Gynecology, 
Zekai Tahir Burak Women’s Health Education Hospital, 
Ankara, Turkey
U. Emin (&)
Turan Gunes BulvarÂ, Korman Sitesi 51/B-11, 
06460 Ankara, Turkey
e-mail: dreminustunyurt@yahoo.com.tr
123
146 Arch Gynecol Obstet (2009) 279:145–147
performed is quite diVerent for benign and malignant
tumors [6, 7].
However, clinical usefulness of tumor markers in
patients with MCT of the ovary has been evaluated only in
few studies. In this study, we aimed to evaluate the serum
levels of tumor markers in patients with ovarian mature
cystic teratomas.
Methods
Clinical features of 215 pathologically-conWrmed MCT’s at
Zekai Tahir Burak Women Health Education and Research
Hospital between January 2001 and October 2006 were
reviewed, especially concerning tumor markers. Data were
obtained from hospital charts and the pathology registry.
Formaldehyde was used for specimen Wxation. Average
tumor size (greatest diameter) was determined by the review
of both the operativerecords and the gross pathologic
descriptions. All three germ cell layers were examined hist-
opathologically. The cases with malignant transformation
were excluded from the study.
All the blood samples were obtained preoperatively.
The determination methods were radioimmunoassay for
AFP, CA 19-9, CA 15-3 and CA 125 and enzyme immu-
noassay for CEA. Analyses are performed on the Modular
Analytics E170 module (Roche Laboratory Systems,
Mannheim, Germany). The cutoV values for AFP, CEA,
CA 19-9, CA 15-3 and CA 125 are 11.3 ng/ml, 3.4 ng/ml,
37 U/mL, 25 U/mL and 35 U/mL, respectively. As a part
of gynecologic examination, all patients underwent trans-
vaginal or transabdominal sonography. Other imaging
and endoscopic procedures were performed in patients
with highly elevated serum tumor markers to rule out any
gastrointestinal disease.
Oophorectomy, cystectomy, or hysterectomy with uni-
lateral or bilateral salpingo-oophorectomy was performed
as treatment modality according to, age, fertility desire, and
presence of other pathology.
Statistical analysis was performed with the SPSS/PC
11.0 package (SPSS: Chicago, IL). Statistical evaluation of
the data was performed by Chi-square test, Student’s t test.
A P value <0.05 was considered statistically signiWcant.
Results
The mean age of all patients was 37.3 § 12.9 years (range
13–80). Thirty-six patients (16.7%) were postmenopausal.
Tumor size ranged from 2 to 25 cm in diameter with a
mean (§SD) of 7.7 § 4.6 cm. The bilaterality rate was
9.8% (21/215).
The serum levels of tumor markers are shown in Table 1.
The mean serum CA 19-9 level was 83.5 § 179.2 IU/mL,
mean serum CA 125 level 26.2 § 29.9 U/mL, mean serum
alpha-fetoprotein level (AFP) 1.8 § 1.6 ng/mL, mean
serum carcino-embryogenic antigen (CEA) level 2.3 §
2.2 ng/mL, and mean serum CA 15-3 level 18.2 § 8.2
U/mL. Among the Wve tumor markers, CA 19-9 revealed
the highest elevated rate (39.6%), whereas AFP revealed
the lowest (0.6%).
The comparison of patients with and without an elevated
CA 19-9 level is presented in Table 2. The mean tumor size
of patients with elevated CA 19-9 level was signiWcantly
greater than those with normal CA 19-9 level (8.8 § 4.5 vs.
7.1 § 4.5 cm, respectively, P = 0.01). Likewise, the mean
serum CA 125 level and the rate of elevated CA 125 were
signiWcantly higher in patients with elevated serum CA
19-9 level. There was no statistically signiWcant diVerence
in terms of mean age, rate of bilaterality between the two
groups.
Patients having normal CA 19-9 and CA 125 level con-
stituted 53.5% of the study population. Elevated CA 19-9
and normal CA 125 levels were detected in 41 patients
(21.9%). Whereas 13 patients (7%) had elevated CA 125
levels but normal CA 19-9 levels. Elevation of both CA 19-
9 and CA 125 levels were detected in 33 patients (17.6%).
CA 19-9 levels were greater than 100 IU/mL in 32 patients
(17.1%) and greater than 500 IU/mL in 9 patients (4.8%).
Discussion
Mature cystic teratoma is the most commonly encountered
germ cell neoplasm of the ovary. Although frequently
asymptomatic and detected incidentally, some of the cases
may come to clinical attention with complications which
are seen approximately in 20% of cases.
Table 1 Serum tumor markers 
of patients
Tumor marker n CutoV 
value
Serum level 
(mean § SD)
Range Elevated 
rate (n/total)
CA 19-9 (U/mL) 187 37 83.5 § 179.2 0.6–1000 39.6% (74/187)
CA 125 (U/mL) 215 35 26.2 § 29.9 1.4–225 23.3% (50/215)
AFP (ng/mL) 165 11.3 1.8 § 1.6 0.5–18.1 0.6% (1/165)
CEA (ng/mL) 178 3.4 2.3 § 2.2 0.1–15.2 16.3% (29/178)
CA 15-3 (U/mL) 193 25 18.2 § 8.2 3.8–58.2 18.7% (36/193)
123
Arch Gynecol Obstet (2009) 279:145–147 147
Results of this study have showed that CA 19-9 is more
frequently elevated than CA 125 and hence a more useful
marker in MCT. CA 19-9 was reported to be elevated in as
many as 59% of cases [8]. CA 19-9 was elevated in 39.6%
of patients with mature cystic teratoma in our study. The
diagnostic value of elevated CA 19-9 in patients with MCT
would therefore be poor if the test was used alone. But ele-
vated serum CA 19-9 may be suggestive of MCT in
patients with a pelvic mass the nature of which could not be
determined by sonography alone.
CA 19-9 has been immunohistochemically demonstrated
in the bronchial mucosa and glands of MCT and it has been
shown to be secreted into the cystic cavity of the lesion.
The mechanism of an elevated CA 19-9 in MCT is princi-
pally the leakage from cystic cavity into the blood stream
[9]. Elevation of CA 19-9 therefore might be anticipated
with larger or bilateral MCT since leakage into the blood-
stream is more probable in both conditions. In the literature,
data regarding association between serum CA 19-9 levels
and certain clinical features other than malignant transfor-
mation are very limited and few studies have addressed this
issue Our results indicate that tumor size was the only clini-
cal Wnding that correlated with elevated CA 19-9 levels,
however, bilaterality is not associated with elevated serum
CA 19-9 levels. This is in contrast to the study of Dede
et al. in which elevated CA 19-9 was associated with a high
rate of bilaterality with a likelihood ratio of 2.8 [7]. This
was the only study that has stated such an association. Men-
opausal status was also not correlated with serum CA 19-9
levels.
An important Wnding of our study is that 32 (17.1%)
patients had highly elevated levels of CA 19-9 (>100 IU/
mL) and 9 (4.8%) having greater than 500 IU/mL. During
the preoperative period imaging and endoscopic procedures
revealed no extra ovarian disease in those patients. Abnor-
mally high elevations of CA 19-9 in MCT have also been
previously reported in the literature [10]. Consistently Ito
[9] have reported that 31 out of 250 patients with MCT had
CA 19-9 levels greater than 101 IU/mL. Preliminary evalu-
ation of gastrointestinal tract for malignancies is therefore
unnecessary if clinical Wndings and sonography suggest
MCT, since highly elevated CA 19-9 levels were encoun-
tered in our patients who do not have concomitant gastroin-
testinal pathology.
Two conclusions can be derived from this study. First,
among other tumor markers, CA 19-9 has the highest posi-
tivity rate in MCT which correlates well with tumor size
but not with bilaterality or menopausal status. However, it
has a limited diagnostic value when used alone. Second, a
highly elevated level of CA 19-9 is not an uncommon Wnd-
ing in patients with MCT, therefore does not necessitate
immediate evaluation of gastrointestinal tract.
References
1. Ayhan A, Bukulmez O, Genc C, Karamursel BS, Ayhan A (2000)
Mature cystic teratomas of the ovary: case series from one institu-
tion over 34 years. Eur J Obstet Gynecol Reprod Biol 88(2):153–
157. doi:10.1016/S0301-2115(99)00141-4
2. Lipson SA, Hricak H (1996) MR imaging of the female pelvis.
Radiol Clin North Am 34(6):1157–1182
3. Bischof P (1993) What do we know about the origin of CA 125?
Eur J Obstet Gynecol Reprod Biol 49(1–2):93–98
4. Bast RC Jr, Badgwell D, Lu Z, Marquez R, Rosen D, Liu J et al
(2005) New tumor markers: CA125 and beyond. Int J Gynecol
Cancer 15(Suppl 3):274–281 Review
5. Scharl A, Crombach G, Vierbuchen M, Göhring U, Göttert T, Holt
JA (1991) Antigen CA 19-9: presence in mucosa of nondiseased
müllerian duct derivatives and marker for diVerentiation in their
carcinomas. Obstet Gynecol 77(4):580–585
6. Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA (1998)
Cystic teratomas of the ovary: diagnostic value of sonography.
AJR Am J Roentgenol 171(4):1061–1065
7. Dede M, Gungor S, Yenen MC, Alanbay I, Duru NK, Hasimi A
(2006) CA19-9 may have clinical signiWcance in mature cystic
teratomas of the ovary. Int J Gynecol Cancer 16(1):189–193
8. Kikkawa F, Nawa A, Tamakoshi K, Ishikawa H, Kuzuya K,
Suganuma N et al (1998) Diagnosis of squamous cell carcinoma
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9. Ito K (1994) CA19-9 in mature cystic teratoma. Tohoku J Exp
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263
Table 2 Comparison of 
patients with or without an 
elevated CA 19-9 level
Patients with elevated 
CA19.9 (N = 74)
Patients with normal 
CA19.9 (N = 113)
P value
Age (mean § SD) 36.9 § 13.4 37.5 § 12.6 0.768
Menopause n (%) 14 (18.9) 21 (18.6) 0.954
Tumor size 8.8 § 4.5 7.1 § 4.5 0.01
Bilaterality 9 (12.2) 9 (8.0) 0.341
Elevated CA 125 n (%) 33(44.6) 13 (11.5) <0.001
Serum CA 125 level (mean § SD) 33.8 § 26.9 21.0 § 28.4 0.003
Serum CA 19.9 level (mean § SD) 193.6 § 247.7 11.5 § 8.9 <0.001
View publication stats
123
http://dx.doi.org/10.1016/S0301-2115(99)00141-4
https://www.researchgate.net/publication/5345388
	Tumor markers in mature cystic teratomas of the ovary
	Introduction
	Methods
	Results
	Discussion
	References
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