Meigs' syndrome with highly elevated ca. 125 levels in a patient with Takayasu arteritis: a case report

Takayasu's Arteritis presenting as a dissecting aortic aneurysm history: a case report

Introduction

Takayasu's Arteritis, formerly known as "pulseless disease", is a chronic idiopathic vasculitis which affects the large vessels in the body. First described in the 1800's, this rare condition is more commonly found in Asian women in their 40's. The aorta and its main branches are the primary vessels affected, with the most typical features reflected as ischemia or aneurysm formation. With Takayasu's Arteritis being a rare condition and its acute phase presentation often similar to other conditions, diagnosis is often difficult.

Case Presentation

A 48 year old Irish Caucasian female, who presented as a typical history of an aortic dissection (chest pain radiating to her back in an interscapular region and a systolic blood pressure differential of 50 mmHg between her right and left upper limbs), was investigated with a number of imaging modalities and diagnosed with Takayasu's Arteritis, involving arteries affecting a number of organs. She was treated as per protocol for Takayasu's Arteritis. A diagnosis of cervical cancer quickly followed.

Conclusion

This case report highlights that a differential diagnosis should never be dispelled based upon a "typical" history. The importance of modern day imaging techniques such as CT, MRI and angiography, can often be paramount to confirming a diagnosis and the extent of the pathology.

A possible link between Takayasu's Arteritis and gynaecological malignancies may exist.

Rheumatic disorders as paraneoplastic syndromes

The long-established observation that some rheumatologic disorders (RDs) are associated with--or precede--the clinical manifestations of a variety of solid and hematological tumors represents an important clue for the early diagnosis and effective treatment of the cancers. Inflammatory myopathies, seronegative rheumatoid arthritis and some atypical vasculitides are the most frequently reported paraneoplastic RDs, although paraneoplastic scleroderma- and lupus-like syndromes, erythema nodosum, and Raynaud's syndrome have also been observed. Generally, the clinical course of a paraneoplastic RD parallels that of the cancer, and surgical removal of the tumor or its medical treatment usually results in a marked regression of the clinical manifestations of the RD. Most paraneoplastic RDs are difficultly distinguishable from idiopathic RDs. Even so, some atypical features of the clinical presentation raise the suspicion of an underlying tumor. This review summarizes current hypotheses for the pathogenesis that leads a tumor to present as an RD and discusses the clinical features that help distinguish paraneoplastic from idiopathic RDs.

Ovarian sclerosing stromal tumor presenting as Meigs' syndrome with elevated CA-125

Meigs' syndrome caused by sclerosing stromal tumor is extremely rare and only two cases have been reported to date. An elevated serum level of CA-125 is also unusual and it has been thought that it is the consequence of physical irritation and inflammation. In this report, we present the case of a 50-year-old postmenopausal woman with a sclerosing stromal tumor presenting with Meigs' syndrome and an elevated CA-125 level (1476.8 IU/mL). This case highlights the difficulty in discerning the diagnosis of Meigs' syndrome from that of an ovarian malignancy and it should be considered in the differential diagnosis in postmenopausal patients with pelvic mass, ascites, pleural effusions and elevated serum CA-125.