BACKGROUND
Tumor marker elevation during surveillance after borderline ovarian tumor surgery commonly raises concern for recurrence. However, CA125 and CA19-9 are nonspecific and may also increase in extrapelvic inflammatory disease.
CASE REPORT
A 66-year-old woman underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, and partial rectal resection for bilateral serous borderline ovarian tumor, International Federation of Gynecology and Obstetrics stage IB. Tumor marker levels remained normal for several years after surgery. Eight years later, CA125 increased to 65 U/mL and CA19-9 to 140.5 U/mL, with CA19-9 subsequently peaking at 610 U/mL. Repeated pelvic magnetic resonance imaging, PET-CT, cytologic assessment of the vaginal cuff, upper gastrointestinal endoscopy, and hepatobiliary and pancreatic evaluation showed no evidence of recurrent borderline ovarian tumor or other malignancy. During the same period, interstitial lung disease progressed radiologically, respiratory symptoms worsened, and serologic testing demonstrated myeloperoxidase-antineutrophil cytoplasmic antibody positivity. Progressive myeloperoxidase-antineutrophil cytoplasmic antibody-associated interstitial lung disease was considered a plausible extrapelvic explanation for the persistent marker elevation. Pirfenidone and low-dose prednisolone were initiated, and although tumor marker levels initially continued to rise, they subsequently decreased from their peak values during follow-up while repeated gynecologic evaluation remained negative.
CONCLUSIONS
This case highlights a potential limitation in the interpretation of tumor marker elevation during borderline ovarian tumor surveillance. Persistent CA125 and CA19-9 elevation does not necessarily indicate gynecologic recurrence when repeated pelvic evaluation is negative. In selected patients, pulmonary or systemic inflammatory disease may be considered according to symptoms, imaging findings, and overall clinical context.

Keywords: Lung Diseases; Ovary; Gynecology; Vasculitis