Document Type : Case Reports


Dept. Of Pathology, SBL Diagnostics, Mysore, India


We report a case of florid polypoid endometriosis presenting with advanced bulky disease in pelvis with serum CA – 125 levels of 7844U/ml. The extent of tumor, CT scan findings, elevated serum CA – 125 levels were suggestive of ovarian malignancy. Histopathology demonstrated endometrial glands and stroma. Glands were neither crowded nor complex and were separated by a fibromatous stroma that contained endometrial stromal cells. These features were consistent with diagnosis of polypoid endometriosis, a recently described entity with a clinical presentation completely different from conventional endometriosis. Our case emphasizes the association of high levels of CA – 125 with benign gynaecologic conditions.


  1. Shiau CS, Chang MY, Chiang CH, Hsieh CC, Hsieh TT. Ovarian endometrioma ssociated with very high serum CA-125 levels. Chang Gung Med J 2003;26(9):695-9.
  2. Jacobs I, Bast RCJ. The CA 125 tumor-associated antigen: a review of the literature. Hum Reprod 1989;4:1-12.
  3. Ho HN, Wu MY, Chen SU. Total antioxidant status and nitric oxide do not increase in peritoneal fluids from women with endometriosis. Hum Reprod 1997;1:2810-5.
  4. Di-Xia C, Schwartz PE, Xinguo L, Zhan Y. Evaluation of CA 125 levels in differentiating malignant from benign tumors in patients with pelvic masses. Obstet Gynecol 1988;72:23-7.
  5. Ghaemmaghami F, Karimi Zarchi M, Hamedi B. High levels of CA125 ( over 1,000IU/ml ) in patients with gynecologic disesase and no malignant conditions : three cases and literature review. Arch Gynecol Obstet 2007;276(5):559-61.                                                                                                        
  6. Gocmen A, Karaca M, Tarakcioglu M. A ruptured ovarian endometrioma mimicking ovarian malignancy: case report. Eur J Gynaecol Oncol 2003;24(5):445-6.
  7. Kwek JW, H'ng MW, Chew SH, Tay EH. Florid polypoid endometriosis of the cervix with left ureteric obstruction: a mimic of cervical malignancy. Ultrasound Obstet Gynecol 2010;36(2):252-4.
  8. Parker RL, Dadmanesh F, Young RH, Clement PB. Polypoid endometriosis: a clinicopathologic analysis of 24 cases and a review of the literature. Am J Surg Pathol 2004;28:28597.
  9. Laird LA, Hoffman JS, Omrani A Multifocal polypoid endometriosis presenting as huge pelvic masses causing deep vein thrombosis. Arch Pathol Lab Med 2004;128(5):561-4.
  10. Kaushal S, Dadhwal V, Mathur SR, Ray R, Durgapal P, Deka D. Multifocal polypoid endometriosis in a young woman simulating vaginal and pelvic neoplasm. J Clin Pathol 2010;63(5):452-4
  11. Mills SE. Sternberg’s Diagnostic Surgical Pathology. 4th ed. New York: Lippincott Williams and Wilkins; 2004.
  12. Tolman CJ, Vaid T, Schreuder HW. Extremely elevated CA-125 in benign ovarian disease due to stretch of the peritoneum. BMJ Case Rep 2012;doi:10.1136/bcr-2012-006664.