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Gaspari L, Paris F, Taourel P, Soyer-Gobillard MO, Kalfa N, Sultan C. Adolescent ovarian thecoma presenting as progressive hyperandrogenism: case report and review of the literature. Gynecol Endocrinol 2020; 36:839-842. [PMID: 32174224 DOI: 10.1080/09513590.2020.1739265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Hyperandrogenism is frequent and under investigated in adolescent girls. A 15-year-6-month-old French girl presented with oligomenorrhea and slowly progressing virilization 2 years post-menarche. Medical history revealed prenatal pesticide exposure through maternal professional activity and recurrent premature thelarche. Severe hirsutism, mild facial acne and clitoromegaly were noted. Serum androgens (testosterone: 94 ng/dL, 4-androstenedione: 8.23 ng/mL) were high and non-classic 21-hydroxylase deficiency was excluded. Pelvic ultrasonography showed a left ovarian mass, confirmed by computed tomography scan. Tumor markers were negative. Laparoscopic surgery was performed. The pathological diagnosis was benign luteinized thecoma. Postoperatively, the menstrual cycle and serum androgens became normal and hirsutism slowly improved. Hyperandrogenism 2 years after menarche should be systematically investigated, even if slowly progressive, since it may be a symptom of a rare virilizing ovarian tumor, like thecoma.
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Affiliation(s)
- Laura Gaspari
- Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital A.-de-Villeneuve, CHU Montpellier et Université Montpellier, Montpellier, France
| | - Françoise Paris
- Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital A.-de-Villeneuve, CHU Montpellier et Université Montpellier, Montpellier, France
| | - Patrice Taourel
- Département d'Imagerie, Hôpital Lapeyronie, CHU Montpellier et Université Montpellier, Montpellier, France
| | | | - Nicolas Kalfa
- Département de Chirurgie Pédiatrique, Hôpital Lapeyronie, CHU Montpellier et Université Montpellier, Montpellier, France
| | - Charles Sultan
- Unité d'Endocrinologie-Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital A.-de-Villeneuve, CHU Montpellier et Université Montpellier, Montpellier, France
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Kajiyama A, Edo H, Takeya C, Kubushiro K, Oharaseki T, Gomi T. Spontaneously Ruptured Paraovarian Tumor of Borderline Malignancy with Extremely Elevated Serum Carbohydrate Antigen 125 (CA125) Levels: A Comparison of the Imaging and Pathological Features. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:919-925. [PMID: 28835604 PMCID: PMC5580534 DOI: 10.12659/ajcr.904462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Female, 22 Final Diagnosis: Paraovarian tumor of borderline malignancy Symptoms: Hypochondriac pain Medication: — Clinical Procedure: — Specialty: Radiology
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Affiliation(s)
- Akiko Kajiyama
- Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiromi Edo
- Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Chiaki Takeya
- Department of Gynecology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kaneyuki Kubushiro
- Department of Gynecology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshiaki Oharaseki
- Department of Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tatsuya Gomi
- Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan
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Fremed MA, Levin TL, Sun KY, Weiser DA. Ovary preservation in the treatment of childhood Meigs syndrome. Pediatr Blood Cancer 2015; 62:2011-4. [PMID: 26011288 DOI: 10.1002/pbc.25586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/15/2015] [Indexed: 11/10/2022]
Abstract
Meigs syndrome, the combination of benign ovarian tumor, ascites, and pleural effusion, is present in a small percentage of ovarian fibromas and is infrequently reported in children. When associated with elevated CA-125 suspicion is raised for malignancy, often prompting aggressive surgical intervention. We present a case of childhood Meigs syndrome and review the relevant literature with emphasis on ovary preservation. Out of nine identified pediatric cases, one involved ovary sparing treatment and none recurred or progressed to malignancy. Our report highlights the importance of presurgical identification of Meigs syndrome in order to curtail salpingo-oophorectomy when feasible.
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Affiliation(s)
| | - Terry L Levin
- Department of Radiology, Division of Pediatric Radiology, Montefiore Medical Center, Bronx, New York
| | - Katherine Y Sun
- Department of Pathology, Montefiore Medical Center, Bronx, New York
| | - Daniel A Weiser
- Departments of Pediatrics and Genetics, Albert Einstein College of Medicine, Bronx, New York.,Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Bronx, New York
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Chan WY, Chang CY, Yuan CC, Chen PH. Correlation of ovarian fibroma with elevated serum CA-125. Taiwan J Obstet Gynecol 2014; 53:95-6. [DOI: 10.1016/j.tjog.2012.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 10/25/2022] Open
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Liou JH, Su TC, Hsu JC. Meigs' syndrome with elevated serum cancer antigen 125 levels in a case of ovarian sclerosing stromal tumor. Taiwan J Obstet Gynecol 2012; 50:196-200. [PMID: 21791307 DOI: 10.1016/j.tjog.2011.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2010] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Meigs' syndrome presenting as an ovarian tumor with elevated serum cancer antigen 125 (CA 125) levels is unusual. Only 37 cases have been reported, including three cases of ovarian sclerosing stromal tumor (SCT). Many reports have suggested that the presence of ascites is the major factor inducing mesothelial expression of CA 125. CASE REPORT An 18-year-old woman presented with massive ascites, elevated serum CA 125 levels, and radiographic evidence of ovarian tumor. The histological and immunohistochemical examinations revealed a benign SCT. CONCLUSION SCT is a benign ovarian tumor and complete excision is curative. We also review all 37 cases and discuss possible mechanisms of Meigs' syndrome and elevated serum CA 125 level.
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Affiliation(s)
- Jia-Hung Liou
- Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan
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Sugiyama A, Urushihara N, Fukumoto K, Fukuzawa H, Nagae H, Watanabe K, Mitsunaga M, Hasegawa S, Koyama M. Ovarian fibroma with marked ascites and elevated serum levels of CA-125 in a young girl. J Pediatr Surg 2011; 46:1001-4. [PMID: 21616270 DOI: 10.1016/j.jpedsurg.2011.02.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/18/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
We report a case of ovarian fibroma with marked ascites and elevated serum CA-125 levels in a young girl. Ovarian fibromas are rare in children. They usually present as a solid mass and may be associated with ascites and elevated serum CA-125 levels. Because of their solid nature and these associations, they can be mistaken for a malignant tumor, resulting in unnecessary oophorectomy. Ovarian fibromas are benign neoplasms, and the prognosis is extremely good. Surgical management should be an ovarian-sparing tumor excision. Although uncommon in pediatric patients, ovarian fibromas should be included in the differential diagnosis of ovarian mass in children.
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Affiliation(s)
- Akihide Sugiyama
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Aoi-ku, Shizuoka 420-8660, Japan.
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Benjapibal M, Sangkarat S, Laiwejpithaya S, Viriyapak B, Chaopotong P, Jaishuen A. Meigs' Syndrome with Elevated Serum CA125: Case Report and Review of the Literature. Case Rep Oncol 2009; 2:61-66. [PMID: 20740147 PMCID: PMC2918831 DOI: 10.1159/000210441] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
An elevated serum CA125 level in association with a pelvic mass, pleural effusion, and massive ascites usually signifies a dismal prognosis in a postmenopausal woman. However, surgery and histopathological examination are required for the correct diagnosis and treatment, since an elevated CA125 level can be falsely positive for ovarian malignancy. We present a case of Meigs’ syndrome due to right ovarian fibroma with elevated CA125 level in a postmenopausal woman.
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Affiliation(s)
- Mongkol Benjapibal
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Most ovarian disorders are benign, with the majority being functional ovarian cysts and benign neoplasms. Imaging can often aid in diagnosis and risk assessment. Benign ovarian disorders are frequently incidental findings, but they may cause symptoms from hormonal overproduction, mass effects, or torsion. In addition to symptoms, any ovarian abnormality can raise the specter of malignancy. Knowledge of the cause, presentation, and natural history of these benign ovarian disorders helps providers counsel and treat patients appropriately.
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Morán-Mendoza A, Alvarado-Luna G, Calderillo-Ruiz G, Serrano-Olvera A, López-Graniel CM, Gallardo-Rincón D. Elevated CA125 level associated with Meigs' syndrome: case report and review of the literature. Int J Gynecol Cancer 2006; 16 Suppl 1:315-8. [PMID: 16515612 DOI: 10.1111/j.1525-1438.2006.00228.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Meigs' syndrome is the association of ovarian fibroma, pleural effusion, and ascites. Meigs' syndrome with marked elevation of CA125 is an unusual clinical condition reported in 27 cases in the literature. The patient was a 46-year-old woman with right pleural effusion, ascites, ovarian tumor, and CA125 level of 1808 U/mL. Tomography revealed ascites and bilobate pelvic tumor of approximately 25 cm. The diagnosis of advanced epithelial ovarian cancer was considered, and the patient was treated with chemotherapy. Three chemotherapy schemes were applied due to the total lack of response in tumor volume; however, CA125 decreased to 90 U/mL. Thus, surgery was performed with resection of 25 cm of the left ovarian tumor, with intact capsule and without implants; the result of histopathologic analysis was fibroma. Postoperative CA125 was 11 U/mL. Patients with elevated CA125 and ascites cytology positive for malignancy must be cautiously treated due to the possibility of false positives, even if the probability is low. Therefore, minimally invasive surgery for biopsy collection must be considered. Although the association between ovarian tumor, pleural effusion, ascites, and marked elevation of CA125 is highly indicative of epithelial ovarian cancer, Meigs' syndrome must be considered in the differential diagnosis.
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Affiliation(s)
- A Morán-Mendoza
- Sub-direction of Internal Medicine, National Institute of Cancerology, Mexico City, Mexico.
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