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Case Reports
. 2021 Jun;20(2):103-107.
doi: 10.5114/pm.2021.106100. Epub 2021 May 25.

Pelvic mass, ascites, hydrothorax: a malignant or benign condition? Meigs syndrome with high levels of CA 125

Guglielmo Stabile  1 , Giulia Zinicola  2 , Federico Romano  1 , Antonio Simone Laganà  3 , Chiara Dal Pozzolo  2 , Giuseppe Ricci  1   2
Affiliations
Case Reports

Pelvic mass, ascites, hydrothorax: a malignant or benign condition? Meigs syndrome with high levels of CA 125

Guglielmo Stabile et al. Prz Menopauzalny. 2021 Jun.

Abstract

Introduction: Abdominal-pelvic mass, ascites and pleural effusion are suggestive of malignant metastatic ovarian cancer. This triad is also present in a rare benign condition called Meigs syndrome. Rarely this condition is associated with an increased CA 125 level.

Case report: A 62-year-old woman with a history of abdominal pain underwent an ultrasound (US) examination and a chest X-ray. The imaging revealed the presence of a large pelvic mass and ascites with a monolateral pleural effusion and a high level of the tumor marker CA 125. The patient underwent a total abdominal hysterectomy, salpingoophorectomy, removal of the pelvic mass, pelvic lymphadenectomy and peritoneal biopsies. The histology showed an ovarian fibrothecoma.

Discussion: The US analysis according to international ovarian tumor analysis simple rules revealed "inconclusive results"; the logistic regression model LR2 and Adnex suggested a high risk of malignancy. The presence of ascites and the size of the lesion associated with a high level of CA 125 affected the correct assessment of the risk of malignancy, exposing the patient to overtreatment.

Conclusions: Meigs syndrome is characterized by the resolution of symptoms after surgical removal of the pelvic mass. However, it mimics the clinical picture of a malignant metastatic ovarian cancer. Clinicians have to exclude ovarian cancer and recognize the syndrome to reduce inappropriate procedures.

Keywords: CA 125; Meigs syndrome; ascites; fibrothecoma; hydrothorax; ovarian cancer; pelvic mass.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
A – Ultrasound (US) transabdominal image showing the right adnexal mass and acoustic shadows, B – US transvaginal image showing massive ascites in the pouch of Douglas and a normal uterus
Fig. 2
Fig. 2
A, B – chest X-ray scans in which a left monolateral hydrothorax is noticeable
See this image and copyright information in PMC

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