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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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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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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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Meigs' syndrome with elevated CA-125 and HE-4: a case of luteinized fibrothecoma. MENOPAUSE REVIEW 2015; 14:152-4. [PMID: 26327905 PMCID: PMC4498034 DOI: 10.5114/pm.2015.52157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/20/2015] [Accepted: 02/09/2015] [Indexed: 12/22/2022]
Abstract
Presence of fibrothecoma is not usually accompanied by elevated levels of tumor markers. In recent years, however, there have been isolated reports of fibrothecoma and Meigs’ syndrome, accompanied by an increase in tumor markers. We present a case of fibrothecoma with Meigs’ syndrome and elevated levels of both CA-125 (cancer antigen 125) and HE-4 (human epididymis protein 4). In this paper, we present a case of Meigs’ syndrome associated with an increased CA-125 and HE-4 level due to ovarian fibrothecoma.
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Hanane B, Sanaa M, Nahid Z, Abdelaziz B, Najiba Y, Abdelkrim B. [Pseudo-Meigs syndrome: report of a case]. Pan Afr Med J 2014; 17:184. [PMID: 25396010 PMCID: PMC4229009 DOI: 10.11604/pamj.2014.17.184.3875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 01/21/2014] [Indexed: 11/27/2022] Open
Abstract
Introduction Le pseudo-Meigs syndrome comprend une tumeur pelvienne bénigne (en dehors des fibrothécomes ovariens) ou maligne associée à des épanchements, pleural et ou péritonéal, qui disparaissent après l'exérèse tumorale. Nous rapportons l'observation d'une patiente âgée de 47 ans, qui présentait une pleurésie droite associée à une ascite et une tumeur ovarienne maligne. L’évolution après l'exérèse chirurgicale de la masse tumorale même en l'absence d'une chimiothérapie montrait une disparition des épanchements. Le pseudo-Meigs syndrome est rare. Il nécessite des biopsies pleurales et péritonéales négatives, et la disparition des épanchements après l'exérèse chirurgicale de la tumeur, avant toute chimiothérapie. Une telle distinction est importante aussi bien sur le plan thérapeutique que pronostique.
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Affiliation(s)
- Benjelloun Hanane
- Service des Maladies Respiratoires, Centre hospitalier Ibn Rochd, Casablanca, Maroc
| | - Morad Sanaa
- Service des Maladies Respiratoires, Centre hospitalier Ibn Rochd, Casablanca, Maroc
| | - Zaghba Nahid
- Service des Maladies Respiratoires, Centre hospitalier Ibn Rochd, Casablanca, Maroc
| | - Bakhatar Abdelaziz
- Service des Maladies Respiratoires, Centre hospitalier Ibn Rochd, Casablanca, Maroc
| | - Yassine Najiba
- Service des Maladies Respiratoires, Centre hospitalier Ibn Rochd, Casablanca, Maroc
| | - Bahlaoui Abdelkrim
- Service des Maladies Respiratoires, Centre hospitalier Ibn Rochd, Casablanca, Maroc
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