Waldenström's macroglobulinemia masquerading as ovarian cancer with peritoneal carcinomatosis, ascites, and elevated CA-125

Two Cases of Macroglobulinemia with Elevated Serum CA125: Case Reports and Literature Review

Waldenström macroglobulinemia (WM) is a relatively rare hematological malignancy characterized by serum monoclonal IgM gammopathy and bone marrow infiltration of lymphoma cells (small B lymphocytes, plasmacytoid lymphocytes, or plasma cells). Elevated CA125 is most seen in ovarian cancer or some benign diseases such as pelvic inflammatory disease and endometriosis. No cases of WM combined with elevated CA125 have been reported so far. Here, we report two rare cases of WM with abnormally high CA125 at the onset of illness. Patient 1 had a nine-year history of pulmonary shadow with a moderately increased CA125 level. Subsequently, she was diagnosed with WM-related lung involvement by biopsy. Patient 2 presented with WM manifestation and a significantly elevated CA125 level of unknown significance. Based on bone marrow smear results and serum IgM levels, the diagnosis of WM was established in both patients. After rigorous physical examination, imaging screening, and pathological biopsy, any underlying disease associated with elevated CA125 in both patients was excluded. CA125 and IgM levels decreased with effective treatment for WM, suggesting that abnormally elevated CA125 was related to the progression of macroglobulinemia. Suspicious WM patients with elevated serum CA125 of unknown significance need to be alert to a special manifestation of macroglobulinemia. More clinical concern is needed. At the same time, the clinician could monitor the patient's serum CA125 level changes to assist in the judgment of the efficacy of the original disease. This report extends the understanding of WM and the application of CA125.

Sigmoid cancer mimicking ovarian echotexture on transvaginal ultrasound: Case report with literature review

Ultrasound is a first line imaging modality for the evaluation of female pelvic pain. Pelvic pain constitutes one of the most common reasons for presentation to the emergency department with increasing use of point of care ultrasound. Infrequently, point of care or formal ultrasound evaluation may lead to misdiagnosis of extraovarian disease. This can have serious consequences, especially if an extraovarian malignancy is mistaken for a normal ovary or an ovary with a benign process. We present a case of a 41-year-old female who presented to the emergency department for a chief complaint of pelvic pain and vaginal bleeding. Transvaginal ultrasound demonstrated a left adnexal mass, later characterized as a sigmoid colon cancer on MRI and pathology, simulating ovarian echotexture with peripheral hypoechoic components resembling follicles. This article will review the literature of various cases of extraovarian pathology misidentified as ovarian processes and highlight the importance of considering these extraovarian mimickers to prevent potential morbidity and mortality of a missed diagnosis.