Non-Hodgkin's lymphoma presenting as a pelvic mass with elevated CA-125.
BACKGROUND
We report a case of pelvic lymphoma with an elevated serum CA-125 level, initially misdiagnosed as ovarian carcinoma. A review of the literature is presented and a possible mechanism for CA-125 elevation in diseases other than ovarian cancer is discussed.


METHODS
A 50-year-old woman presented with symptoms of progressive dyspnea, early satiety, fatigue, and weight loss. Workup revealed a pelvic mass and an elevated CA-125 level. Paclitaxel and carboplatin were administered to facilitate therapy and provide symptomatic relief for a presumed bulky ovarian carcinoma. A biopsy was obtained after the initiation of chemotherapy, yielding the diagnosis of diffuse large B cell non-Hodgkin's lymphoma, stage II-B. A regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone followed by radiotherapy resulted in long-term disease remission. A search of the literature revealed several clinical series describing the elevation of CA-125 in a variety of diseases, both benign and malignant.


CONCLUSIONS
In the setting of a newly diagnosed pelvic mass, care should be taken when interpreting an elevated CA-125 level. While ovarian cancer is high on the list of differential diagnoses, lymphoma cannot be excluded until a tissue diagnosis is obtained.
Allen
Gregory W
GW
Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
Forouzannia
Afshin
A
Bailey
Howard H
HH
Howard
Steven P
SP
D018394:CA-125 Antigen / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000175:diagnosis*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis
D018394:CA-125 Antigen