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Abdelgawad M, Barghuthi L, Davis T, Omar M, Kamel OM, Gibbons J, Ragoza Y, Ismael H. Large uterine leiomyoma presenting as pseudo-Meigs’ syndrome with an elevated ca125: a case report and literature review. J Surg Case Rep 2022; 2022:rjac253. [PMID: 35685293 PMCID: PMC9173737 DOI: 10.1093/jscr/rjac253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Ascites, pelvic mass and elevated CA-125 in females carry a grim prognosis, likely an ovarian carcinoma. However, more benign etiologies such as Meigs’ and pseudo-Meigs’ syndrome must be considered. Pseudo-Meigs’ syndrome presenting with an elevated CA-125 is rare and presents a diagnostic challenge. Medline and PubMed were queried for pseudo-Meigs’ syndrome cases. We present a 35-year-old female patient who presented with abdominal swelling and weight gain. Imaging demonstrated a 29-cm large intraabdominal mass with significant ascites with elevation of CA-125. Surgical resection was performed, and pathology identified uterine leiomyoma. Twenty-one cases of pseudo-Meigs’ syndrome were identified in the literature. Most patients presented with abdominal distention, and some also reported dyspnea. All patients, including our case, were treated surgically. No recurrence reported among these cases. Surgery is the mainstay for radical treatment in pseudo-Meigs’ syndrome. Resolution of the ascites and hydrothorax occurs following resection of the tumor.
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Affiliation(s)
- Mohamed Abdelgawad
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Lutfi Barghuthi
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Tyler Davis
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Mahmoud Omar
- Department of Surgery , School of Medicine, Tulane University, New Orleans, LA, USA
| | - Omar M Kamel
- Department of Surgery , School of Medicine, Tulane University, New Orleans, LA, USA
| | - Jake Gibbons
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Yury Ragoza
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Hishaam Ismael
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
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Guo L, Wang MZ, Wang LJ, Zang AH, Jia DM, Hou L, Zhang P. Giant broad ligament leiomyoma with postoperative infection diagnosed with contrast-enhanced ultrasound: Case report and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:138-147. [PMID: 34647631 DOI: 10.1002/jcu.23081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/26/2021] [Accepted: 09/30/2021] [Indexed: 06/13/2023]
Abstract
A 33-year-old woman of giant broad ligament leiomyoma with myxoid degeneration was misdiagnosed as ovarian tumor. The patient underwent a transabdominal myomectomy and developed a pelvic infection after operation diagnosed with contrast-enhanced ultrasound. She was cured and ultimately discharged after symptomatic treatment. Only 21 cases of giant broad ligament leiomyomas with a diameter larger than 12 cm were included. The present systematic review aimed to increase awareness of the clinical characteristics and treatment methods of giant broad ligament leiomyoma, and reduce the rates of misdiagnosis and postoperative complications.
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Affiliation(s)
- Li Guo
- Department of Obstetrics and Gynecology, Qingdao Municipal Hospital Group, Qingdao University, Qingdao, Shandong, China
| | - Mi Zhou Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Group, Qingdao University, Qingdao, Shandong, China
| | - Li Jing Wang
- Department of Obstetrics and Gynecology, Qingdao Municipal Hospital Group, Qingdao University, Qingdao, Shandong, China
| | - Ai Hua Zang
- Department of Ultrasound, Qingdao Municipal Hospital Group, Qingdao University, Qingdao, Shandong, China
| | - Dong Mei Jia
- Department of Pathology, Qingdao Municipal Hospital Group, Qingdao University, Qingdao, Shandong, China
| | - Lin Hou
- Department of Biochemistry and Molecular Biology, Basic Medical College, Qingdao University, Qingdao, Shandong, China
| | - Ping Zhang
- Department of Obstetrics and Gynecology, Qingdao Municipal Hospital Group, Qingdao University, Qingdao, Shandong, China
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Wang YW, Fan Q, Qian ZX, Wang JJ, Li YH, Wang YD. Abdominopelvic leiomyoma with large ascites: A case report and review of the literature. World J Clin Cases 2021; 9:1424-1432. [PMID: 33644211 PMCID: PMC7896699 DOI: 10.12998/wjcc.v9.i6.1424] [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: 10/13/2020] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Leiomyoma of the uterus is relatively common, but uterine leiomyoma of the greater omentum is rare.
CASE SUMMARY Here, we report the case of a 22-year-old woman who presented with a 3 mo history of progressive abdominal distension and a hypervascular abdominopelvic mass. Due to a high serum concentration of CA125, the preoperative diagnosis was unclear. During surgery, 5 L of ascites was removed. An 18.8 cm solid mass, which was pedunculated from the uterine fundus and exhibited complex adhesion to the greater omentum, was removed. The CA125 level was reduced postoperatively, and a pathologic study confirmed that the mass was a leiomyoma that originated in the uterus.
CONCLUSION Uterine leiomyoma can share vessels with the greater omentum. This case highlights the difficulty of diagnosing pseudo-Meigs syndrome and the importance of imaging and laboratory examinations.
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Affiliation(s)
- Yi-Wei Wang
- Department of Gynecological Oncology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Qiong Fan
- Department of Gynecological Oncology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Zhao-Xia Qian
- Department of Radiology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Jin-Jin Wang
- Department of Pathology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Yu-Hong Li
- Department of Gynecological Oncology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Yu-Dong Wang
- Department of Gynecological Oncology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
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Yonehara Y, Yanazume S, Kamio M, Togami S, Tasaki T, Douchi T. Concentrated ascites re-infusion therapy for pseudo-Meigs' syndrome complicated by massive ascites in large pedunculated uterine leiomyoma. J Obstet Gynaecol Res 2014; 40:1944-9. [PMID: 25056475 DOI: 10.1111/jog.12448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/09/2014] [Indexed: 01/24/2023]
Abstract
Pseudo-Meigs' syndrome accompanied by massive ascites in uterine leiomyoma is rare. We encountered a rare case of a 37-year-old, nulliparous woman with a lower abdominal tumor and severe abdominal distention due to massive ascites. Serum cancer antigen 125 and vascular endothelial growth factor levels were elevated to 1007.9 U/mL and 103 pg/mL, respectively. She was tentatively diagnosed with ovarian cancer. Emergency concentrated ascites re-infusion therapy was performed to improve dyspnea, abdominal pain, and her preoperative respiratory condition. Concentrated ascites re-infusion therapy eliminated dyspnea and abdominal discomfort without decreasing serum albumin levels. The patient underwent laparotomy, which revealed a fist-sized pedunculated uterine leiomyoma arising from the right uterine fundus. Myomectomy was performed. Pseudo-Meigs' syndrome mimics advanced ovarian cancer due to massive ascites and markedly elevated serum cancer antigen 125 and vascular endothelial growth factor levels. Concentrated ascites re-infusion therapy was effective in improving the subjective symptoms of pseudo-Meigs' syndrome and the patient's preoperative condition.
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Affiliation(s)
- Yukie Yonehara
- Department of Obstetrics and Gynecology, Imamura Hospital, Kagoshima, Japan
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Hector RC, Cruz AM. Ascites in a 13-year-old miniature horse mare with an ovarian granulosa theca-cell tumour: A manifestation of Meigs' syndrome? EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R. C. Hector
- Paton and Martin Veterinary Services; Equine Hospital; Aldergrove British Columbia Canada
| | - A. M. Cruz
- Paton and Martin Veterinary Services; Equine Hospital; Aldergrove British Columbia Canada
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Chourmouzi D, Papadopoulou E, Drevelegas A. Magnetic resonance imaging findings in pseudo-Meigs' syndrome associated with a large uterine leiomyoma: a case report. J Med Case Rep 2010; 4:120. [PMID: 20426844 PMCID: PMC2873451 DOI: 10.1186/1752-1947-4-120] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 04/28/2010] [Indexed: 11/22/2022] Open
Abstract
Introduction Pseudo-Meigs' syndrome is a rare pathological entity characterized by the presence of a pelvic mass other than an ovarian fibroma. The mass is associated with ascites with or without hydrothorax. Case presentation We describe the case of a 41-year-old Caucasian woman with a large uterine leiomyoma associated with massive ascites. A magnetic resonance imaging scan showed a large subserosal leiomyoma with multiple areas of cystic degeneration. Conclusion To the best of our knowledge, this is the first reported case of pseudo-Meigs' syndrome caused by a uterine leiomyoma and diagnosed using magnetic resonance imaging. The pathophysiology of this syndrome and the role of magnetic resonance imaging are emphasized in this case report.
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Affiliation(s)
- Danai Chourmouzi
- Interbalkan Medical Center, Asklipiou, Pylaia 57001, Thessaloniki, Greece.
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Kaneta Y, Nishino R, Asaoka K, Toyoshima K, Ito K, Kitai H. Ovarian hemangioma presenting as pseudo-Meigs' syndrome with elevated CA125. J Obstet Gynaecol Res 2003; 29:132-5. [PMID: 12841694 DOI: 10.1046/j.1341-8076.2003.00088.x] [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: 12/15/2022]
Abstract
We report the first case of ovarian hemangioma presenting as pseudo-Meigs' syndrome with elevated CA125. Abdominopelvic computed tomography (CT) assumed ovarian carcinoma. Chest CT revealed pleural effusion. Intraoperative frozen-section examination of the right ovary showed benign hemangioma. After operation, chest radiograph and ultrasonography showed no pleural effusion or ascites.
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Affiliation(s)
- Yoshibumi Kaneta
- Department of Obstetrics and Gynecology, Saitama Social Insurance Hospital, Saitama, Japan.
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Migishima F, Jobo T, Hata H, Sato R, Ikeda Y, Arai M, Kuramoto H. Uterine leiomyoma causing massive ascites and left pleural effusion with elevated CA 125: a case report. J Obstet Gynaecol Res 2000; 26:283-7. [PMID: 11049239 DOI: 10.1111/j.1447-0756.2000.tb01323.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A 51-year-old patient presented with an abdominal mass and ascites as well as a left pleural effusion. Her serum CA125 was 820 U/ml. Surgical exploration revealed a benign leiomyoma of the uterus without malignant cytology in the ascites. Postoperatively, the pleural effusion was resolved dramatically and the CA125 decreased to the normal range after 4 months post-operatively. This is an extremely rare case of pseudo-Meigs' syndrome caused by uterine leiomyoma.
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Affiliation(s)
- F Migishima
- Department of Obstetrics and Gynecology, School of Medicine, Kitasato University, Kanagawa, Japan
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Brown RS, Marley JL, Cassoni AM. Pseudo-Meigs' syndrome due to broad ligament leiomyoma: a mimic of metastatic ovarian carcinoma. Clin Oncol (R Coll Radiol) 1998; 10:198-201. [PMID: 9704185 DOI: 10.1016/s0936-6555(98)80071-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pseudo-Meigs' syndrome is a rare complication of benign leiomyomas of the female genital tract. We report a patient with pseudo-Meigs' syndrome due to a large broad ligament leiomyoma, which also caused bilateral reversible hydronephrosis. This unusual combination of pseudo-Meigs' syndrome, broad ligament leiomyoma and hydronephrosis requiring ureteric stenting does not appear to have been reported previously. Features of the syndrome that led to a diagnostic problem, the mimicking of metastatic ovarian carcinoma, are presented. The little that is known of the pathogenesis of the pleural and ascitic fluids is discussed. An elevated level of serum CA 125 antigen is reported, we believe for the first time in association with pseudo-Meigs' syndrome.
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Affiliation(s)
- R S Brown
- Meyerstein Institute of Oncology, Middlesex Hospital, London, UK
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