Increasing Trends in Deep Infiltrating Endometriosis (DIE) with Bilateral Endometrioma from Adolescence till Menopause.

Endometriosis is a clinical and a pathological entity characterised by the presence of tissue resembling functional endometrial gland and stroma outside the uterine cavity. Endometriosis most commonly affects women in the age group of 24-35 yrs.1 Postmenopausal endometriosis accounts for less than 3% of the cases.2 The common clinical presentation in a case of endometriosis include chronic pelvic pain, dysmenorrhoea, infertility, dyschezia, dyspareunia and adnexal mass. Diagnosis is usually suspected on basis of signs and symptoms and confirmed on imaging. Transvaginal ultrasound and MRI (especially in DIE) remains not only a diagnostic modality but also the best guide to decide the management.3 Many a times, gravity of symptoms may not correlate with severity of disease and patient may remain asymptomatic even with severest form of disease. Many a years may be lost before the definitive diagnosis and management of endometriosis is established.

Elevated serum CA 19-9 levels in dermoid cyst: a predictor of ovarian torsion and tissue necrosis?

Dermoid cyst (mature cystic teratoma) with well differentiated derivatives of all the three-germ cell layer is a benign tumour with ovaries being the commonest site. Dermoid cyst accounts for more than half of ovarian tumours in girls below 20 years of age. 80% of dermoid cyst are seen in reproductive age group between 20-40 years. Size of dermoid cyst usually varies between 5-10 cm and it may be bilateral in 10% of cases. Malignant transformation is very rare occurrence only in 1-3% cases, however torsion may occur in 15% of dermoid cyst. Carbohydrate antigen or cancer antigen 19-9 is usually raised in gastrointestinal tumours, pancreatic malignancy, pseudocyst of pancreas. However, it may be raised in some other malignancies and benign condition like torsion of dermoid cyst. Authors report an unusual case of torsion large dermoid cyst with tissue necrosis along with significantly elevates levels of serum CA 19-9. A 30-year-old P1L1 female presented with chief complaint of heaviness and pain lower abdomen and loss of five kilogram weight for last three months. A provisional diagnosis of dermoid was made. Serum CA 19-9 level were 1126 IU significantly raised. An exploratory laparotomy done under regional anaesthesia. A large demoid cyst 12*10 cm with torsion and areas of gangrene in ovarian tissue was seen replacing left ovary. Large and small intestine, stomach, pancreas were explored to rule out any pathology. Histopathology confirmed diagnosis of mature cystic teratoma. There was significant fall in serum Ca 19-9 levels to 247 U/ml two weeks after surgery and levels returned to normal limit six weeks after surgery.