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Iavarone I, Padovano M, Pasanisi F, Della Corte L, La Mantia E, Ronsini C. Meigs Syndrome and Elevated CA-125: Case Report and Literature Review of an Unusual Presentation Mimicking Ovarian Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1684. [PMID: 37763803 PMCID: PMC10535830 DOI: 10.3390/medicina59091684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Meigs syndrome is represented by a benign adnexal tumor, ascites, and hydrothorax. Even though the ovarian mass is often characterized by a fibroma-like origin, cancer antigen-125 (CA-125) serum levels could be elevated as in the development of ovarian cancer. Here, we present the case of a patient with Meigs syndrome and increased CA-125. Materials and Methods: We performed systematic research for articles including similar cases in PubMed, EMBASE, and Scopus in February 2023, adopting the string of idioms: "Meigs syndrome AND Cancer antigen 125", and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Eligible records were 25. Hydrothorax was right-sided in 10 cases over 25; left-sided in two patients over 25. Concerning ascites, two patients showed more than 6 L of ascitic fluid, whereas three patients had 6 L or less. CA-125 elevation ranged from 149 IU/mL to 3803 IU/mL. Adnexal mass histotypes were: struma ovarii (12 cases), thecomas (two cases), fibrothecomas (five cases), fibromas (five cases), and one sclerosing stromal tumor (SST). Conclusions: In postmenopausal women with elevated CA-125 serum levels and an adnexal mass suspicious for malignancy at ultrasound (US), ascites and pleural effusion, surgery, and histopathological examination are necessary. MS is a diagnostic option, with an excellent prognosis after exeresis of the mass.
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Affiliation(s)
- Irene Iavarone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (I.I.); (M.P.); (F.P.); (C.R.)
| | - Michela Padovano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (I.I.); (M.P.); (F.P.); (C.R.)
| | - Francesca Pasanisi
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (I.I.); (M.P.); (F.P.); (C.R.)
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Elvira La Mantia
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (I.I.); (M.P.); (F.P.); (C.R.)
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Liu Y, Tang GY, Liu L, Sun HM, Zhu HY. Giant struma ovarii with pseudo-Meigs’syndrome and raised cancer antigen-125 levels: A case report. World J Clin Cases 2022; 10:11155-11161. [PMID: 36338236 PMCID: PMC9631160 DOI: 10.12998/wjcc.v10.i30.11155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Struma ovarii is a type of monodermal mature teratoma composed entirely or mainly of thyroid tissue, accounting for 1% to 3% of all ovarian teratomas and 0.3% to 1.0% of all ovarian tumors. Of which, struma ovarii with ascites and pleural effusion, called pseudo-Meigs’syndrome and raised cancer antigen-125 levels (CA 125) is even rarer.
CASE SUMMARY This paper reports the diagnosis and treatment of a patient of struma ovarii with pseudo-Meigs’syndrome, presenting with the clinical features of ovarian carcinoma: Complex pelvic mass, gross ascites, right pleural effusion and markedly elevated serum CA 125 levels. During the operation, a cystic-solid mass about 20 cm × 10 cm × 5 cm in the right adnexa and a solid mass with the size of 3 cm × 2 cm × 0.1 cm in the left ovary were observed. She underwent right adnexectomy and resection of the left ovarian mass and histopathology revealed a mature left-sided ovarian teratoma and struma ovarii of right adnexal mass. During 1-year follow-up, the patient recovered well, tumor markers and other indicators returned to normal.
CONCLUSION The diagnosis and treatment process of this case suggests that the clinical symptoms of struma ovarii with pseudo-Meigs’syndrome are lack specificity, which is easily misdiagnosed. Clinicians should improve the understanding of this disease, enhance the awareness of early screening, and improve the level of diagnosis and treatment.
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Affiliation(s)
- Yan Liu
- Department of Gynecology, Weifang People’s Hospital, Weifang 261032, Shandong Province, China
| | - Gao-Yan Tang
- Department of Oncology, Weifang People’s Hospital, Weifang 261032, Shandong Province, China
| | - Lu Liu
- Department of Gynecology, Weifang People’s Hospital, Weifang 261032, Shandong Province, China
| | - Hui-Min Sun
- Department of Pathology, Weifang People’s Hospital, Weifang 261032, Shandong Province, China
| | - Hai-Yan Zhu
- Department of Oncology, Weifang People’s Hospital, Weifang 261032, Shandong Province, China
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Wang S, He X, Yang H, Chen L. Struma Ovarii Associated with Ascites and Elevated CA125: Two Case Reports and Review of the Literature. Int J Womens Health 2022; 14:1291-1296. [PMID: 36101557 PMCID: PMC9464449 DOI: 10.2147/ijwh.s379128] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Struma ovarii is a rare variety of specialized monodermal mature ovarian teratoma, it is composed predominantly of thyroid tissue. Ascites is present in one third of patients. The combination of struma ovarii, marked ascites and elevated CA125 is a rare condition, which may mimic ovarian cancer. We described two cases presenting with pelvic mass, ascites and elevated serum CA125 levels, frozen section and final pathology turned out to be struma ovarii. Ascites disappeared and the level of CA125 returned to normal level after operation. One of the cases was associated with pleural effusion, leading to a condition called pseudo-Meigs' syndrome. Then we reviewed the related literatures to explore the possible mechanism of ascites and pleural effusion, the reason of CA125 elevation and imaging manifestations of struma ovarii. In conclusion, struma ovarii should be considered in the differential diagnosis preoperatively, when presented with pelvic mass, ascites and an elevated CA125 level.
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Affiliation(s)
- Shaoyu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
| | - Xinqin He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
| | - Huijuan Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
| | - Lihong Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
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Zhang R, Tian X, Luo Y, Dong H, Tian W, Zhang Y, Li D, Sun H, Meng Z. Case Report: Recurrent Malignant Struma Ovarii With Hyperthyroidism and Metastases, A Rare Case Report and Review of the Literature. Pathol Oncol Res 2022; 28:1610221. [PMID: 35620742 PMCID: PMC9127674 DOI: 10.3389/pore.2022.1610221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/21/2022] [Indexed: 11/13/2022]
Abstract
Background: SO (Struma ovarii) is a rare form of ovarian teratoma which originates from ovarian dermoid cysts. Due to the rarity of this disease, relevant studies might not be sufficiently documented, especially cases with hyperthyroidism and multiple metastases. Case Presentation: A 40-year-old female patient was admitted to our hospital due to management of early pregnancy along with a recurrent abdominal and pelvic mass. Contrast-enhanced CT images showed an irregular mass (10.7 × 8.6 × 12.8 cm) located in the right side from the hypogastrium to the pelvic cavity and another mass (3.8 × 3.7 cm) in the liver. Laboratory examination showed that CA125 (Carbohydrate Antigen-125) was 118.10 U/mL, Tg (thyroglobulin) was >300 ng/ml, FT4 (free thyroxine) was 22.11 pmol/L, and TSH (thyroid-stimulating hormone) was <0.004 mIU/L. She subsequently underwent liver mass dissection, omentectomy, tumor dissection, peritoneal nodule resection, as well as rectal anterior wall nodule resection. The patient was diagnosed with malignant SO (papillary type) along with multiple metastases. Also, we conducted a literature review based on 290 SO cases from 257 articles. Conclusion: This study showed that malignant SO might be prone to relapse and metastasize (a metastatic rate of 52.94%) and therefore aggressive management might need to be recommended for malignant SO. Also, laparotomy might need to be recommended for large tumors that cannot be resected by laparoscopic surgery since these tumors might be prone to rupture and thus produce peritoneal implants. Furthermore, Graves’ disease might need to be considered in the differential diagnosis.
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Affiliation(s)
- Ruyi Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Tian
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Luo
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin, China
| | - Haiwei Dong
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin, China
| | - Weijun Tian
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yujie Zhang
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong Li
- Department of Medical Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Haoran Sun
- Department of Medical Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
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Dalal N, Athwal PSS, Tharu B, Saravanan L, Mansour H. A Rare Case of Pseudo-Meigs' Syndrome With Ovarian Metastasis Presenting as Meigs' Syndrome. Cureus 2020; 12:e11022. [PMID: 33214950 PMCID: PMC7671297 DOI: 10.7759/cureus.11022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pseudo-Meigs' syndrome is defined as malignant ovarian tumor leading to ascites or/and pleural effusion, whereas Meigs' syndrome is a triad of ascites, pleural effusion, and benign ovarian tumor. The removal of an underlying tumor leads to rapid improvement in patient symptoms in both conditions. It is a rare phenomenon, and only 1% of ovarian tumors account for Meigs' syndrome. We report a case of a 70-year-old female presented with complaints of shortness of breath, vaginal bleeding, bloating, and increased abdominal girth. X-ray and lab workup revealed pleural effusion and raised CA 125 (cancer antigen 125), which along with clinical presentation raised suspicion for Meigs' syndrome, but on exploratory laparotomy ovarian serous carcinoma was diagnosed. Diagnosis of pseudo-Meigs' syndrome was established instead of Meigs' syndrome, which was initially suspected. Pseudo-Meigs' syndrome can mimic many other pathologies, which makes it a diagnostic challenge.
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Fujiwara S, Tsuyoshi H, Nishimura T, Takahashi N, Yoshida Y. Precise preoperative diagnosis of struma ovarii with pseudo-Meigs' syndrome mimicking ovarian cancer with the combination of 131I scintigraphy and 18F-FDG PET: case report and review of the literature. J Ovarian Res 2018; 11:11. [PMID: 29391043 PMCID: PMC5796437 DOI: 10.1186/s13048-018-0383-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/26/2018] [Indexed: 12/11/2022] Open
Abstract
Background Struma ovarii is a rare ovarian neoplasm that often appears malignant on conventional imaging. Pseudo-Meigs’ syndrome with ascites, pleural effusion, and elevated serum CA 125 levels is much rarer and leads to misdiagnosis of ovarian cancer and unnecessary extended surgery. Case presentation A 50-year-old woman with abdominal distention and dyspnoea was referred to our hospital. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) showed a polycystic ovarian tumor with a solid component, pleural effusion, and massive ascites with negative cytology. Her serum CA 125 level was 1237 U/ml, indicating the presence of ovarian cancer. Based on increased uptake of 131I but no uptake of 18F–FDG in the tumor, the preoperative diagnosis was struma ovarii with pseudo-Meigs’ syndrome, which was confirmed histologically. She had no evidence of ascites and pleural effusion six months after surgery. Conclusions To date, there have been no systematic reviews focused on preoperative diagnosis with imaging modalities. The combination of 131I scintigraphy and 18F–FDG PET/CT in addition to conventional imaging modalities can provide the precise preoperative diagnosis of struma ovarii with pseudo-Meigs’ syndrome mimicking ovarian cancer, leading to the appropriate treatment strategy.
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Affiliation(s)
- Sayaka Fujiwara
- Department of Obstetrics and Gynecology, Kizawa Memorial Hospital, 590 Shimokobi, Kobi-cho, Minokamo-shi, Gifu, 505-8503, Japan
| | - Hideaki Tsuyoshi
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Toshiya Nishimura
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Nozomu Takahashi
- Department of Obstetrics and Gynecology, Kizawa Memorial Hospital, 590 Shimokobi, Kobi-cho, Minokamo-shi, Gifu, 505-8503, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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7
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A nanocomposite containing Prussian Blue, platinum nanoparticles and polyaniline for multi-amplification of the signal of voltammetric immunosensors: highly sensitive detection of carcinoma antigen 125. Mikrochim Acta 2017. [DOI: 10.1007/s00604-017-2470-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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8
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Yadav S, Tomar R, Verma N, Khurana N, Triathi R. Struma Ovarii with Pseudo-Meigs' Syndrome and Raised Cancer Antigen-125 Levels Masquerading as an Ovarian Carcinoma Case report and literature review. Sultan Qaboos Univ Med J 2017; 17:e229-e233. [PMID: 28690899 DOI: 10.18295/squmj.2016.17.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/21/2017] [Accepted: 02/16/2017] [Indexed: 12/22/2022] Open
Abstract
The monodermal teratoma struma ovarii is a rare ovarian tumour; however, struma ovarii presenting with pseudo-Meigs' syndrome and raised cancer antigen (CA)-125 levels is even rarer. In elderly patients, this presentation can potentially lead to a misdiagnosis of a malignant ovarian carcinoma, resulting in unnecessary extensive surgery. We report a 55-year-old female who presented to the Lok Nayak Jai Prakash Narayan Hospital, New Delhi, India, in 2016 with progressive abdominal discomfort, fatigue and abdominal distention. Clinical and radiological features were indicative of a malignant ovarian tumour and ascites. Serum CA-125 levels were elevated at 258 U/mL. A left-sided salpingo-oophorectomy was performed, after which the serum CA-125 levels normalised. There was no evidence of recurrence at a six-month follow-up. A frozen section procedure confirmed the diagnosis of a struma ovarii. This rare condition should be considered as a differential diagnosis in patients presenting with ovarian masses, ascites and raised CA-125 levels.
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Affiliation(s)
- Surekha Yadav
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Reena Tomar
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nidhi Verma
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Rewa Triathi
- Department of Obstetrics & Gynecology, Lok Nayak Jai Prakash Narayan Hospital, New Delhi, Delhi, India
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10
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Jin C, Dong R, Bu H, Yuan M, Zhang Y, Kong B. Coexistence of benign struma ovarii, pseudo-Meigs' syndrome and elevated serum CA 125: Case report and review of the literature. Oncol Lett 2015; 9:1739-1742. [PMID: 25789033 PMCID: PMC4356400 DOI: 10.3892/ol.2015.2927] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/21/2015] [Indexed: 01/01/2023] Open
Abstract
Struma ovarii is an uncommon ovarian teratoma comprised predominantly of mature thyroid tissue. The combination of pseudo-Meigs’ syndrome, and elevation of CA 125 to the struma ovarii is a rare condition that can mimic ovarian malignancy. We reported a case of benign struma ovarii, presenting with the clinical features of advanced ovarian carcinoma: complex pelvic mass, gross ascites, bilateral pleural effusion and markedly elevated serum CA 125 levels. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Ascites and pleural effusion were not evident and the CA 125 levels returned to normal following surgical excision. A systematic review of reported cases of coexistent benign struma ovarii, pseudo-Meigs’ syndrome and elevated serum CA 125 was performed. Struma ovarii accompanied by pseudo-Meigs’ syndrome and elevated serum CA 125 should be considered in the differential diagnosis of ovarian epithelial cancer.
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Affiliation(s)
- Chengjuan Jin
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ruiying Dong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Hualei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Mingyuan Yuan
- Department of Obstetrics and Gynecology, Jiaozhou Central Hospital of Qingdao, Qingdao, Shandong 266300, P.R. China
| | - Youzhong Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Ranade R, Rachh S, Basu S. Late Manifestation of Struma Peritonei and Widespread Functioning Lesions in the Setting of Struma Ovarii Simulating Highly Differentiated Follicular Carcinoma. J Nucl Med Technol 2014; 43:231-3. [DOI: 10.2967/jnmt.114.149294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/27/2014] [Indexed: 11/16/2022] Open
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Peyron N, Coulon A. Struma ovarii, pseudo-Meigs' syndrome and raised CA125, a rare association. Answer to May e-quid. Diagn Interv Imaging 2012; 93:643-7. [PMID: 22818078 DOI: 10.1016/j.diii.2012.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- N Peyron
- Service d'imagerie médicale, hospices civils de Lyon, hôpital de la Croix-Rousse, Lyon, France.
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13
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Ehara R, Koga T, You S, Natori H, Kamimura T, Nishimura M, Matsuo K. Pseudo-Meigs'syndrome as a cause of exertional dyspnea: a case report. Kurume Med J 2010; 56:85-7. [PMID: 20505286 DOI: 10.2739/kurumemedj.56.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 61-year-old otherwise healthy woman presented with gradually worsening exertional dyspnea. Routine examinations revealed bilateral pleural effusion with no other notable cardiopulmonary diseases. Systemic examinations showed ascites and a pelvic tumor, which turned out to be right ovarian endometrioid adenocarcinoma. Surgical removal and chemotherapy against the ovarian cancer resulted in disappearance of the ascites and pleural effusion, establishing a diagnosis of pseudo-Meigs'syndrome. It is common for reported cases of pseudo-Meigs' syndrome to initially present with dyspnea, therefore it is important to consider this disorder when attempting a differential diagnosis in female patients presenting with dyspnea without other noticeable conditions.
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Wolff EF, Hughes M, Merino MJ, Reynolds JC, Davis JL, Cochran CS, Celi FS. Expression of benign and malignant thyroid tissue in ovarian teratomas and the importance of multimodal management as illustrated by a BRAF-positive follicular variant of papillary thyroid cancer. Thyroid 2010; 20:981-7. [PMID: 20718682 PMCID: PMC2964358 DOI: 10.1089/thy.2009.0458] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The most common type of ovarian germ cell tumor is the teratoma. Thyroid tissue, both benign and malignant, may be a component of an ovarian teratoma. Here we review this topic and illustrate major features by presenting multimodal management of a patient with BRAF-positive disseminated follicular thyroid cancer arising in an ovarian teratoma. SUMMARY Malignant thyroid tissue is often difficult to distinguish from benign thyroid tissue arising in ovarian teratomas. Preoperatively, an elevated thyroglobulin (Tg) level, laboratory or clinical evidence of hyperthyroidism, or ultrasonography appearance of "struma pearl" should prompt referral to oncologist for surgical management of a possibly malignant ovarian teratoma. Postoperatively, tumor tissue should be referred to pathologists experienced with differentiating benign from malignant struma ovarii. Once diagnosed, treatment of this rare condition should be handled by a team of specialists with combined treatment modalities. We cared for woman with disseminated thyroid cancer arising in an ovarian teratoma whose history illustrates the complexity of managing ovarian teratomas with malignant thyroid tissue. At age 33 she had an intraoperative rupture of an ovarian cyst, thought to be struma ovarii. During her next pregnancy, pelvic masses were noted; biopsies revealed well-differentiated papillary thyroid carcinoma, follicular variant. She was euthyroid, but had elevated serum Tg levels. Surgical staging demonstrated widely metastatic intraabdominal dissemination. A thyroidectomy revealed no malignancy. A post-(131)I treatment scan revealed diffuse uptake throughout the abdomen. She then developed abdominal pain and, on computed tomography, was found to have multiple intraabdominal foci of disease. Serum Tg was 264 ng/mL while on L-thyroxine for hypothyroidism and to obtain thyrotropin suppression. A 18 fluorodeoxyglucose positron emission tomography scan showed no pathological uptake. The tumor was found to be BRAF mutation positive (K601E). She underwent extensive secondary debulking and a second course of (131)I with lithium pretreatment. Posttreatment scan revealed diffuse abdominal uptake. Six months posttherapy, the patient is asymptomatic with a serum Tg of 18.1 ng/mL. CONCLUSIONS Aggressive multimodal management appears to be the most promising approach for malignant thyroid tissue arising in ovarian teratomas.
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Affiliation(s)
- Erin F. Wolff
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Marybeth Hughes
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Maria J. Merino
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Jeremy L. Davis
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Craig S. Cochran
- Clinical Endocrinology Branch, National Institute of Diabetes, Digestive, and Kidney Diseases; National Institutes of Health, Bethesda, Maryland
| | - Francesco S. Celi
- Clinical Endocrinology Branch, National Institute of Diabetes, Digestive, and Kidney Diseases; National Institutes of Health, Bethesda, Maryland
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15
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Jiang W, Lu X, Zhu ZL, Liu XS, Xu CJ. Struma ovarii associated with pseudo-Meigs' syndrome and elevated serum CA 125: a case report and review of the literature. J Ovarian Res 2010; 3:18. [PMID: 20670426 PMCID: PMC2923141 DOI: 10.1186/1757-2215-3-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 07/29/2010] [Indexed: 12/20/2022] Open
Abstract
The association of pseudo-Meigs' syndrome, elevation of CA 125 to the struma ovarii is a rare condition. So far only nine cases have been reported in English literature through MEDLINE search. Here we report a 46-year-old case of the struma ovarii, presented with ascites, hydrothorax, right ovarian mass and elevated serum CA 125 level. These findings were misdiagnosed for an ovarian malignancy at the first impression. Immediate resolution of the ascites, hydrothorax and normalization of the serum CA 125 level were followed by ovarian mass removal. Struma ovarii could be a rare cause of ascites, hydrothorax, ovarian mass and elevated CA 125. This rare condition should be considered in the differential diagnosis in patents with ascites and pleural effusions but with negative cytology.
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Affiliation(s)
- Wei Jiang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, P,R, China.
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Malignant Struma Ovarii: An Analysis of 88 Cases, Including 27 With Extraovarian Spread. Int J Gynecol Pathol 2009; 28:405-22. [DOI: 10.1097/pgp.0b013e3181a27777] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Coexistence of struma ovarii with marked ascites and elevated CA-125 levels: case report and literature review. Arch Gynecol Obstet 2008; 279:753-7. [DOI: 10.1007/s00404-008-0794-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 08/28/2008] [Indexed: 11/25/2022]
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Paladini D, Vassallo M, Sglavo G, Nappi C. Struma ovarii associated with hyperthyroidism, elevated CA 125 and pseudo-Meigs syndrome may mimic advanced ovarian cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:237-238. [PMID: 18618418 DOI: 10.1002/uog.5399] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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19
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Mitrou S, Manek S, Kehoe S. Cystic struma ovarii presenting as pseudo-Meigs' syndrome with elevated CA125 levels. A case report and review of the literature. Int J Gynecol Cancer 2008; 18:372-5. [DOI: 10.1111/j.1525-1438.2007.00998.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Struma ovarii is a rare ovarian teratoma consisted predominantly of mature thyroid tissue. Although the vast majority of strumas are benign, they can present mimicking malignancy. We report a case of a postmenopausal woman who presented with a large pelvic mass, ascites, and high CA125 levels. Further investigation confirmed the existence of bilateral pleural effusions. The patient underwent laparotomy, and histology revealed a benign struma ovarii. Twelve months after the removal of the tumor, the patient remained disease free, with no clinical or radiologic evidence of effusion, and normal CA125 levels. This is only the fifth case in the English literature of a benign struma ovarii presenting as pseudo-Meigs' syndrome with elevated CA125. Struma ovarii should be included in the differential diagnosis of a pelvic mass that presents with ascites, hydrothorax, and elevated tumor markers.
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Hatami M, Breining D, Owers RL, Del Priore G, Goldberg GL. Malignant Struma Ovarii – A Case Report and Review of the Literature. Gynecol Obstet Invest 2007; 65:104-7. [PMID: 17890867 DOI: 10.1159/000108654] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 04/20/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of mature thyroid tissue. Of these cases, 5-8% are clinically hyperthyroid and 5-10% of these tumors are malignant. CASE REPORT A 53-year-old female presented with a 19 x 5 x 5 cm pelvic mass that was treated with bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node sampling, omentectomy and appendectomy and staging for an ovarian tumor. There was no evidence of distant metastases or lymph node invasion. Re-evaluation of the patient after surgery revealed that she was clinically euthyroid and there was no thyroid malignancy. Histopathology revealed papillary thyroid carcinoma arising in struma ovarii (malignant struma ovarii). CONCLUSION Malignant struma ovarii is a very rare malignant ovarian teratoma. In young patients unilateral oophorectomy and complete surgical staging should be considered when the tumor is confined to the one ovary (stage Ia). Long-term follow-up for the detection of metastases or tumor recurrence by serial serum thyroglobulin and (131)I scan or positron emission tomography/computed tomography may be required in selected patients with this rare tumor.
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Affiliation(s)
- Mehrangiz Hatami
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Women's Health, Bronx, NY 10461, USA.
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21
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Ezon I, Zilbert N, Pinkney L, Wei JJ, Malik R, Nadler EP. A large struma ovarii tumor removed via laparoscopy in a 16-year-old adolescent. J Pediatr Surg 2007; 42:E19-22. [PMID: 17706482 DOI: 10.1016/j.jpedsurg.2007.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Struma ovarii is rare ovarian tumor that is characterized by the presence of at least 50% thyroid tissue on histologic examination. This usually benign neoplasm is predominantly found in women between the ages of 40 and 60 years and infrequently in the pediatric age group. In the foregoing report, we present an unusual case of a large struma ovarii in a 16-year-old adolescent girl with abdominal pain and increasing abdominal girth. Removal of the mass was achieved via a laparoscopic approach. We conclude that the diagnosis of struma ovarii should be considered in adolescent girls presenting with large cystic ovarian masses and that a laparoscopic approach to management is the treatment of choice.
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Affiliation(s)
- Isaac Ezon
- Division of Pediatric Surgery and Department of Surgery, New York University School of Medicine, New York, NY 10016, USA
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Obeidat BR, Amarin ZO. Struma ovarii with pseudo-Meigs' syndrome and elevated CA125 levels. J OBSTET GYNAECOL 2007; 27:97-8. [PMID: 17365481 DOI: 10.1080/01443610601076267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- B R Obeidat
- Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Irbid, Jordan
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23
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Koh LW, Sun YL, Koh PH, Chiu HY, Chen SY, Huang MH. Ovarian capillary hemangioma presenting as pseudo-Meigs’ syndrome: A case report. J Minim Invasive Gynecol 2007; 14:367-9. [PMID: 17478373 DOI: 10.1016/j.jmig.2006.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 10/26/2006] [Accepted: 10/27/2006] [Indexed: 11/16/2022]
Abstract
We report a case of pseudo-Meigs' syndrome, consisting of bilateral ovarian hemangiomas, hydrothorax, ascites, and an elevated CA 125 level, which was resolved after laparoscopic bilateral salpingo-oophorectomy.
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Affiliation(s)
- Lim Woh Koh
- Department of Obstetrics and Gynecology, Show Chwan Memorial Hospital, Changhua, Taiwan
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24
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Rim SY, Kim SM, Choi HS. Struma ovarii showing clinical characteristics of ovarian malignancy. Int J Gynecol Cancer 2006; 15:1156-9. [PMID: 16343201 DOI: 10.1111/j.1525-1438.2005.00328.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Struma ovarii is a rare form of ovarian neoplasm, composed entirely or predominantly of thyroid tissue and generally a benign germ cell tumor of the ovary. Ascites have been reported in approximately 15-20% of all cases. However, the combination of struma ovarii and elevated CA125 has rarely been reported. We experienced a rare case of a postmenopausal woman with benign struma ovarii associated with massive ascites, a complex pelvic mass. There was marked elevation of her CA125 level. The clinical impression was ovarian malignancy. Surgical excision of the ovarian mass induced immediate resolution of the ascites and a normalization of the serum CA125 level. No recurrence of the ascites or of the tumor has been observed during the 10-month follow-up. Struma ovarii can mimic ovarian malignancy clinically, particularly if complex and associated with ascites and an elevated CA125 level.
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Affiliation(s)
- S Y Rim
- Department of Obstetrics and Gynecology, College of Medicine, Chonnam National University, Gwangju, Korea
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26
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Guida M, Mandato VD, Di Spiezio Sardo A, Di Carlo C, Giordano E, Nappi C. Coexistence of Graves' disease and benign struma ovarii in a patient with marked ascites and elevated CA-125 levels. J Endocrinol Invest 2005; 28:827-30. [PMID: 16370564 DOI: 10.1007/bf03347575] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Struma ovarii is the most common monodermal ovarian teratoma and consists mainly of thyroid tissue. Only 5% of patients with this tumor have features of hyperthyroidism. The pathophysiology of hyperthyroidism in struma ovarii is not clear. CASE We describe a case of benign struma ovarii, presenting with the clinical features of an ovarian cancer: large complex pelvic mass, large amount of ascites and markedly elevated CA-125 serum levels. The patient was initially treated for Graves' disease, on the basis of ultrasonographic, laboratoristic and scintigraphic evidence. The resistance to the medical treatment led to thyroidectomy. After surgery the hyperthyroidism persisted and, suddenly, the patient presented ascites. A large pelvic mass was then diagnosed which, at the pathologic examination, was diagnosed as a struma ovarii. CONCLUSION The struma ovarii always has to be considered when a pelvic mass is associated with features of hyperthyroidism.
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Affiliation(s)
- M Guida
- Department of Obstetrics and Gynaecology, University of Naples Federico II, Italy
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27
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Costa MA, Póvoa AM, Pires MC, Paiva VL, Pinto C, Martínez-de-Oliveira J. Struma ovarii: a rare form of presentation and clinical review. Acta Obstet Gynecol Scand 2005; 84:819-20. [PMID: 16026413 DOI: 10.1111/j.0001-6349.2005.0498a.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M A Costa
- Department of Obstetrics and Gynecology, University Hospital São João, Oporto, Portugal.
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Salman MC, Basaran A, Guler T, Gultekin M, Dursun P, Karcaaltincaba M, Kes S, Ayhan A. Meigs' syndrome with highly elevated ca. 125 levels in a patient with Takayasu arteritis: a case report. Arch Gynecol Obstet 2005; 272:90-2. [PMID: 15815942 DOI: 10.1007/s00404-005-0735-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Accepted: 12/17/2004] [Indexed: 11/26/2022]
Abstract
A 56-year-old post-menopausal woman presented with abdominal swelling and shortness of breath. An evaluation of abdomen and pelvis showed ascites and a solid mass. Serum CA-125 level was elevated (509 IU/ml). A computerized tomography-angiography was performed since the pulses of upper extremities could not be palpated. The patient was diagnosed to be suffering from Takayasu arteritis. The exploratory laparotomy revealed a fibroma of the ovary.
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Affiliation(s)
- Mehmet Coskun Salman
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Yakacik mah. Cilek sok. No: 15/4, Ankara, Keçioren, Turkey.
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Loizzi V, Cormio G, Resta L, Fattizzi N, Vicino M, Selvaggi L. Pseudo-Meigs syndrome and elevated CA125 associated with struma ovarii. Gynecol Oncol 2005; 97:282-4. [PMID: 15790478 DOI: 10.1016/j.ygyno.2004.12.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Indexed: 12/13/2022]
Abstract
BACKGROUND Struma ovarii is a rare form of ovarian neoplasm composed entirely and predominantly of thyroid tissue. The association of pseudo-Meigs syndrome, elevation of CA125 and hyperthyroidism to struma ovarii is a rare condition. CASE We report an unusual presentation of a postmenopausal woman with benign struma ovarii associated with pseudo-Meigs syndrome, hypertiroidism, and elevated CA125 serum level, and a large complex right pelvic mass thereby mimicking an ovarian cancer. CONCLUSIONS Struma ovarii is a rare cause of ascites, hydrothorax, elevated CA125, and hyperthyroidism. This rare condition should be considered in the differential diagnosis in patients with ascites and pleural effusions but with negative cytology.
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Affiliation(s)
- Vera Loizzi
- Department of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy.
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Tjalma WAA. Ascites, pleural effusion, and CA 125 elevation in an SLE patient, either a Tjalma syndrome or, due to the migrated Filshie clips, a pseudo-Meigs syndrome. Gynecol Oncol 2005; 97:288-91. [PMID: 15790480 DOI: 10.1016/j.ygyno.2004.12.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Indexed: 12/25/2022]
Abstract
BACKGROUND The combination ascites, pleural effusion, and elevated CA 125 are usually associated with a malignancy. CASE A 38-year-old SLE patient consulted her physician for shortness of breath. On clinical examination, she had a tender abdomen and reduced breathing sounds. X-ray and computed tomography of the chest showed pleural effusion. An adjustment of her SLE maintenance therapy was performed. Vaginal ultrasound and computed tomography of the abdomen revealed massive ascites and an intracavitair myoma of 2 cm, but no obvious mass in the pelvis. CA 125 was 887 U/ml. A laparoscopy was performed showing ascites and 2 Filshie clips embedded in the peritoneum of the vesicouterine pouch, but no sign of malignancy. Both clips were removed. The cytology of the aspirated ascites showed sings of acute inflammation. Within 10 weeks, the pleural effusion was resolved and the CA 125 normalized. CONCLUSION The combination of ascites, pleural effusion, CA 125 elevation, and no tumor in an SLE patient is either a Tjalma syndrome or due to the migrated Filshie clips a pseudo-Meigs syndrome.
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Affiliation(s)
- Wiebren A A Tjalma
- Department of Gynecology and Gynecological Oncology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
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Zannoni GF, Gallotta V, Legge F, Tarquini E, Scambia G, Ferrandina G. Pseudo-Meigs' syndrome associated with malignant struma ovarii: a case report. Gynecol Oncol 2004; 94:226-8. [PMID: 15262148 DOI: 10.1016/j.ygyno.2004.03.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Malignant struma ovarii is a rare tumor, consisting of a struma ovarii with malignant transformation. The association of a malignant struma ovarii with pseudo-Meigs' syndrome and elevated Ca-125 levels has been never reported. CASE A 66-year-old woman presented with monolateral ovarian mass, ascites, hydrothorax, and elevated Ca-125 levels. Optimal medical staging was performed. Definitive histological examination revealed a malignant struma ovarii. The immediate and complete resolution of symptoms and rapid decline of both Ca-125 and thyroglobulin levels to normal value were achieved post-operatively. After counseling, strict follow-up was planned, and no adjuvant therapy was administered. CONCLUSION We report the first case of pseudo-Meigs' syndrome associated with malignant struma ovarii and elevated Ca-125 levels. The choice of not performing adjuvant therapy is feasible after optimal surgery and adequate staging procedure given to the usually clinical benign course and the low incidence of metastases in malignant struma ovarii. Careful patient counseling is required.
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García A, Castellví J, López M, Gil A, de la Torre J, Ramón y Cajal S. Malignant struma ovarii mimic clear cell carcinoma. Arch Gynecol Obstet 2004; 271:251-5. [PMID: 14986024 DOI: 10.1007/s00404-004-0605-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Accepted: 12/20/2003] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Struma ovarii are quite unusual lesions that represent less than 3% of all teratomas and its malignant transformation is very uncommon. The clinical manifestations are characteristic of pelvic tumor and the hormonal metabolism is not usually modified. Radiography, employing ultrasound procedures, is the most commonly used pre-surgical detection method but only histological examination makes the diagnosis. The malignance recognition by pathological study not always is easy; in this sense, it requires an exhaustive sampling of the lesion, being specially carefully in some aspects related with malignant transformation such as extending beyond the capsula and involving peripheral tissues. A thyroidal differentiation must be confirmed by immunohistochemical study and other local processes with similar histology should be ruled out. Given the exceptional character of malignant forms, there does not appear to be unanimous agreement on a standard therapy with a somewhat uncertain prognosis. CASE REPORT We show a case of a 22-year-old patient with an ovarian tumor that was discovered by ultrasound examination and surgically removed. The histologic study revealed struma ovarii with malignant transformation towards follicular carcinoma and unlike previously published cases, had a prevalence of clear cells. The patient was submitted to a second surgical staging intervention, with conservative surgery and follow-up controls being considered given that was a young woman with a desire to have children. Laparoscopy was employed as the best method capable to facilitate shorter convalescence. OUTCOME Clinical and analytical controls, measuring thyroglobulin levels, has been satisfactory up to the present.
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Affiliation(s)
- Angel García
- Department of Pathology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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Renaud MC, Plante M, Roy M. Ovarian thecoma associated with a large quantity of ascites and elevated serum CA 125 and CA 15-3. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2002; 24:963-5. [PMID: 12464996 DOI: 10.1016/s1701-2163(16)30596-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Elevation of tumour marker CA (cancer antigen) 125 associated with Meigs' or atypical Meigs' syndrome is widely recognized. Other tumour markers are available to assist in distinguishing between benign and malignant ovarian masses in the preoperative diagnosis. CASE PRESENTATION A 57-year-old woman presented with a suspicious pelvic mass and abundant ascites. Preoperative tumour markers CA 125 and CA 15-3 were elevated at 1750 U/mL and 60 U/mL, respectively. The woman underwent surgery, and 9 L of straw-coloured ascites were drained along with a solid-cystic ovarian mass. The final pathology disclosed an ovarian thecoma. Six months later, both tumour markers were normal. CONCLUSION This first report of 2 elevated tumour markers associated with atypical Meigs' syndrome cautions us not to rely on tumour markers to differentiate benign from malignant masses.
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Affiliation(s)
- Marie Claude Renaud
- Gynaecologic Oncology Service, L'Hotel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, QC
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