Complex Cyst

[enb103]

I have had a cyst for over a year which was discovered when I was pregnant.  I had an ultrasound done when I was 6 weeks postpartum and it was there but no change.  I had another one done 5 months later which was the end of May and it is slightly bigger 2x2x3 whereas before it was 1x1x2.  I just had another ultrasound done which was three weeks after the last and no change was noted.  However, I'm now 5 weeks pregnant and they did a CA-125 test.  The number has come back extremely high 450's.  I'm waiting to hear when they are going to do surgrey but have been told that the Ca-125 can be highly elevated from hormones.  They are calling the cyst to be endometrial and looks fine on the ultrasound, I was told not to worry.  But now with the CA-125 test being so high I"m really really worried.  What are your opinions, will I have to terminate the pregnancy (i don't want to do that)

Thanks
ENB 103

[Annekathryn Goodman, M.D.]

Hi There,

it sounds like you some a small growth on the ovary. The fact that is has not gone away over a year suggests it is not a cyst of ovulation. The fact that it has not rapidly
changed means that it is unlikely to be a malignancy. CA 125 levels are not helpful in pregnancy. I have pasted here is one abstract on this issue.

Since this cyst is so slow growing, it may be reasonable to wait until the second trimester of pregnancy to remove it or just watch through pregnancy and remove after delivery. Of course, your doctor who is looking at the scans and who knows you will be the best judge of that
best wishes

J Reprod Med. 1998 Apr;43(4):387-92.
Maternal CA-125 levels in pregnancy and the puerperium.
Spitzer M, Kaushal N, Benjamin F.
Department of Obstetrics and Gynecology, Queens Hospital Center, Jamaica, NY 11432, USA.

OBJECTIVE: To determine the levels of CA-125 throughout pregnancy and the puerperium to establish a baseline, thereby indicating what values may be indicative of the pathologic conditions usually associated with elevated CA-125 levels.

STUDY DESIGN: A prospective, longitudinal study was carried out on a consecutive series of pregnant women to determine their CA-125 levels throughout pregnancy and during the puerperium. Blood was drawn at four- to six-week intervals for clinically indicated tests. The residual sera were kept frozen, and subsequently CA-125 measurements were determined by radioimmunoassay.

RESULTS: Of 34 women enrolled in the study, 20 completed the evaluations throughout pregnancy and in the puerperium. The remaining 14 had evaluations for varying portions of their pregnancies but not throughout pregnancy or during the puerperium. The results in these two groups were compared and found not to be statistically significantly different. For the group as a whole, the levels of CA-125 were high, with wide fluctuations in the first trimester; the levels in the early first trimester (five to eight weeks) were particularly high, with a mean of 55.8 and median of 36.2 (range, 6.9-251.2) U/mL. The levels then dropped and remained < 35 U/mL through the rest of pregnancy (including immediately prior to delivery). Another peak, with wide fluctuations, occurred soon after delivery, with a mean of 39.8 and median of 41.9 (range, 10.7-296.7) U/mL. In the late postpartum period (2-10 weeks after delivery) there was a return to baseline levels in all subjects.

CONCLUSION: This study showed that there is a distinct pattern in CA-125 levels during pregnancy and the puerperium. Due to the wide fluctuations in CA-125 levels in very early pregnancy and the immediate postpartum period, CA-125 values during these periods are not useful for clinical correlation with the pathologic conditions known to be associated with elevated levels of CA-125. However, further study is needed to determine whether extreme values in the first trimester or elevated levels after the first trimester are diagnostic or predictive of any conditions related to pregnancy.