CASE 924: OVARIAN TUMOR and Increased CA-125 LEVELS, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICALCENTER, HCMC VIETNAM,

 A  42 year-old single woman,  reported regular monthly menstruation with no abdominal pain during periods. But in this month's period, the patient experienced dull pain in the lower abdomen. The pain subsided after menstruation ended. 

Past medical history: The patient has had annual general blood tests at Medic since 2024, with no abnormalities recorded. 

On August 10, 2026, she had an annual blood test, and an additional CA- 125 test which showed elevated levels, leading to an abdominal and pelvic MRI and ultrasound.

.

Pelvic MRI:

Left ovarian cystic lesion, 65x50mm in diameter, with clear, smooth borders, no septa, no solid tissue, homogeneous high signal on T1W1, heterogeneous high signal on T2W2, and heterogeneous diffusion restriction.

• Dilation at the left fallopian tube.

• The uterus has several fibroids within the muscle, measuring 14mm, 20mm, and 50mm in diameter, not compressing the endometrium or surrounding areas.

Mucinous cyst in the left ovary, size 65x50mm (O-RADS 2). Dilated at the left fallopian tube. Multiple uterine fibroids within the muscle.

Pelvic ultrasound:

Multiple uterine fibroids (L4, L5/Figo)

Bilateral ovaries: homogeneous hypoechoic ground-glass opacities, measuring 52x69mm (left) and 17x20mm (right), with no protrusions or septa in the cyst wall, a clear capsule, and no increased vascularity : Bilateral ovary endometriosis cysts.

Pelvic ultrasound suspected bilateral endometrioma, left greater than right tumor and tubal drainage due to fluid accumulationwhixh was not ruling out as endometrial hyperplasia in the fallopian tube.

Discussions and Conclusions 

Ultrasound findings of ovarian tumors (benign/malignant). O-RADS 2 classification. Blood tests: CA- 125 and ROMA Test (CA-125 and HE 4) 

Note: CA- 125/blood levels are elevated; patient's age should be taken into account.

• ≥ 50 years old, menopause + ovarian tumor + increased CA- 125 test: suspected ovarian cancer 

• < 50 years old, still menstruating + ovarian tumor +  increased CA -125: look for other benign causes

Ultrasound achieves a specificity of up to 95.4% and an accuracy of 88% in distinguishing between benign and malignant tumors. The accuracy of CA125 is only 76%, as it is susceptible to the influence of other inflammatory factors in the body.

In May 2026, the World Health Organization and international associations officially renamed Polycystic Ovary Syndrome (PCOS) to Ovarian Endocrine-Metabolic Syndrome (PMOS). 

By correctly identifying the condition as PMOS, treatment goals shift beyond a narrow focus on the ovaries (such as ovulation induction or assisted reproduction). The root of the issue lies within the metabolic system, carrying potential risks such as obesity, type 2 diabetes, and long-term cardiovascular disease. Adjust diet and physical activity to manage insulin resistance. Manage weight to reduce strain on the systemic endocrine system. Proactively control blood sugar and blood pressure to protect heart health in the long term.

Combining the CA125 marker (high sensitivity) with ultrasound (high specificity) remains the optimal strategy for minimizing unnecessary surgeries for benign tumors. The shift to the PMOS nomenclature symbolizes a new era in women's health management. By viewing the condition as a systemic disorder, medicine not only improves success rates in fertility treatment but also enhances long-term quality of life, protecting patients against future cardiovascular and metabolic complications.