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Lawson B, Rajendran I, Smith J, Shakur A, Sadler V, Sadler TJ, Addley HC, Freeman S. Mimics of primary ovarian cancer and primary peritoneal carcinomatosis - A pictorial review. Clin Radiol 2024; 79:736-748. [PMID: 39068115 DOI: 10.1016/j.crad.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/30/2024]
Abstract
Numerous conditions can mimic ovarian malignancy. Identifying the origin of a pelvic mass or disseminated peritoneal abnormality on imaging is important to ensure that the patient receives optimal management by the appropriate clinical team. Ovarian cancer mimics include infections and other neoplastic processes, for example, actinomycosis, lymphoma, and sarcoma. We will illustrate intraperitoneal and extraperitoneal ovarian and non-ovarian mimics. Primary peritoneal carcinomatosis mimics include processes such as deep infiltrating endometriosis and rare causes such as gliomatosis peritonei and diffuse peritoneal leiomyomatosis. We aim to illustrate the multimodality key imaging appearances of common and rarer types of mimics.
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Affiliation(s)
- B Lawson
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - I Rajendran
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - J Smith
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - A Shakur
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - V Sadler
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - T J Sadler
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - H C Addley
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - S Freeman
- Cambridge University Hospitals, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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Ali AA, Jeannot BM, Olasinde AA, Abdirizak Y, Amin AO, Muhumuza J, Sikakulya FK. A rare case of Demons-Meigs' syndrome with a 7.5 kg giant ovarian fibroma associated with severe dyspnea: case report. Ann Med Surg (Lond) 2023; 85:6243-6246. [PMID: 38098603 PMCID: PMC10718357 DOI: 10.1097/ms9.0000000000001424] [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: 09/02/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and importance Demons-Meigs syndrome is a rare condition characterized by the presence of a benign fibroma of the ovary, ascites, and pleural effusion. It is very uncommon, and the diagnosis is made with difficulty based on symptoms that usually mimic disseminated malignancy or tuberculosis, but imaging may confirm the diagnosis. The definitive treatment is laparotomy, after which the symptoms resolve. Case presentation We present a 36-year-old female with Demons-Meigs' syndrome with severe dyspnea who underwent an abdominal surgical exploration, which revealed ascites of 1500 ml and an ovarian fibroma weighing 7.5 kg and measuring 12 cm in length. There were no postoperative complications. CA-125 was undetectable at 3 months post-procedure. Clinical discussion The most common symptoms are dyspnea, fever, fatigue, and weight loss. In low- and middle-income countries, patients usually present with late-stage disease. The treatment of choice for Demons-Meigs' syndrome is exploratory laparotomy. Conclusion This tumor is often misdiagnosed as a uterine myoma on sonography. The symptoms resolved, and the patient became asymptomatic after laparotomy and thoracocentesis. For this reason, when patients present with effusion and an abdominal mass, a thorough assessment should be done to confirm if it is Demons-Meigs' syndrome, which can be completely cured by the removal of the tumor.
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Affiliation(s)
- Abdifatah Abdi Ali
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
- Dermatin Public Hospital of Mogadishu, Department of Obstetrics and Gynecology, Neonatal Intensive Care Unit, Republic of Somalia
| | - Baanitse Munihire Jeannot
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
- Département de Chirurgie, Faculté de Médecine, Université Catholique la Sapientia de Goma
| | - Anthony Ayotunde Olasinde
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Yusuf Abdirizak
- Dermatin Public Hospital of Mogadishu, Department of Obstetrics and Gynecology, Neonatal Intensive Care Unit, Republic of Somalia
| | - Abdirahin Omar Amin
- Dermatin Public Hospital of Mogadishu, Department of Obstetrics and Gynecology, Neonatal Intensive Care Unit, Republic of Somalia
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Franck Katembo Sikakulya
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
- Département de Chirurgie, Faculté de Médecine, Université Catholique de Graben de Butembo, Democratic Republic of the Congo
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A 36 kg Giant Ovarian Fibroma with Meigs Syndrome: A Case Report and Literature Review of Extremely Giant Ovarian Tumor. Case Rep Obstet Gynecol 2021; 2021:1076855. [PMID: 34434586 PMCID: PMC8382553 DOI: 10.1155/2021/1076855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
Ovarian tumors can get extremely giant to occupy the whole abdominal cavity. We report a case of 36 kg solid ovarian tumor, which was the largest ovarian solid tumor that have been ever reported. A 54-year-old woman presented to our hospital with a chief complaint of markedly distended abdominal wall. Preoperative imaging examinations revealed that most of the tumor was uniform and its density was like that of subcutaneous fat. Pleural effusion was detected in the right thoracic region. We organized a multidisciplinary team and successfully resected the right adnexa. The patient had an uneventful postoperative course, and she was discharged on the 7th postoperative day and diagnosed with a fibroma of the ovary with Meigs syndrome. A comprehensive literature search revealed 48 cases of extremely giant ovarian tumor in these 20 years. Six out of 48 cases are solid. Twelve out of 48 cases are malignant or borderline malignant, and patients' age and tumor size/weight were not related to the frequency of malignancy/borderline malignancy. As many as 4 out of 48 patients died before their first hospital visit or early after surgery. Clinicians should consider a considerable high mortality and frequency of severe surgical complications when planning the treatment strategy for extremely giant ovarian tumors.
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Tsukao H, Ueda T, Fujii Y, Sakai T, Yamaguchi W, Nakaya J, Kojima T. Incomplete pseudo-Meigs' syndrome caused by endometrial ovarian cyst: A case report. Respir Med Case Rep 2021; 33:101387. [PMID: 33854937 PMCID: PMC8024708 DOI: 10.1016/j.rmcr.2021.101387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 11/05/2022] Open
Abstract
A 63-year-old female was admitted to our hospital with history of persistent dyspnea. Right pleural effusion and ovarian tumor were discovered, but here were no significant findings on thoracoscopy under local anesthesia. The pleural effusion was suspected to be secondary to Meigs' syndrome, and a diagnosis of endometriotic ovarian cyst was made. Since the pleural effusion resolved after surgery, the patient was diagnosed with incomplete pseudo-Meigs' syndrome. We consider this to be a valuable case, as there are no previously reported cases of pseudo-Meigs' syndrome derived from an endometriotic ovarian cyst, to the best of our knowledge.
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Affiliation(s)
- Hitokazu Tsukao
- Department of Respiratory Internal Medicine, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui-shi, Fukui-ken, 910-8526, Japan
| | - Tsubasa Ueda
- Department of Respiratory Internal Medicine, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui-shi, Fukui-ken, 910-8526, Japan
| | - Yuya Fujii
- Department of Respiratory Internal Medicine, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui-shi, Fukui-ken, 910-8526, Japan
| | - Takahiro Sakai
- Department of Respiratory Internal Medicine, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui-shi, Fukui-ken, 910-8526, Japan
| | - Wataru Yamaguchi
- Department of Respiratory Internal Medicine, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui-shi, Fukui-ken, 910-8526, Japan
| | - Junya Nakaya
- Department of Respiratory Internal Medicine, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui-shi, Fukui-ken, 910-8526, Japan
| | - Toru Kojima
- Department of Respiratory Internal Medicine, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui-shi, Fukui-ken, 910-8526, Japan
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Kikowicz M, Gozdowska J, Durlik M. Massive Ascites of Unknown Origin: A Case Report. Transplant Proc 2020; 52:2527-2529. [PMID: 32276839 DOI: 10.1016/j.transproceed.2020.01.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022]
Abstract
Ascites is the excessive accumulation of fluid in the peritoneal cavity and predominantly caused by liver cirrhosis, cancers, or heart failure. In this study, a 31-year-old woman with chronic renal failure of unknown etiology treated with hemodialysis and peritoneal dialysis was often hospitalized because of ascites, which appeared 4 years after the second kidney transplantation. The patient was regularly (every 2-3 weeks) treated with paracentesis. Peritoneal fluid tested negative for bacterial (including atypical) and fungal infections and tuberculosis. Doppler ultrasound and liver FibroScan did not show any irregularities. Computed tomography (CT) revealed an enlarged left ovary. A high level of CA 125 was found. The second diagnostic laparoscopy revealed no changes in the ovaries, and there were no tumor cells. Diagnostics were extended, but no deviations were revealed. Suspecting drug etiology, mycophenolic acid was discontinued, bringing no improvement. Diagnostic tests caused suspicion of Meigs' syndrome; therefore, oophorectomy of left ovary was conducted, revealing numerous small cysts filled with serous fluid, without tumor cells in the ovary or peritoneal fluid. Despite the procedure performed, ascites was recurrent. Five month later, ascites spontaneously stopped growing. Paracentesis to decompress ascites was no longer required. There were 9 paracenteses performed from oophorectomy (the latest on May 23, 2019). The need for repetitive paracentesis, significantly reducing the patient's quality of life, required diagnosis for casuistic diseases. The described case is atypical because of the confusing etiology of ascites and its spontaneous cessation. Despite numerous examinations and recession of ascites, the cause of the problem is not entirely clear.
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Affiliation(s)
- Magdalena Kikowicz
- Department of Transplantation Medicine, Nephrology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Gozdowska
- Department of Transplantation Medicine, Nephrology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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