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Meigs syndrome presenting with severely elevated CA-125 level.

Alicia Palmieri¹, Karim ElSahwi², Verda Hicks²

¹Obstetrics & Gynecology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA alicia.palmieri@hmhn.org.

BMJ Case Reports

|March 3, 2021

Summary

Meigs syndrome, a rare condition, can mimic ovarian cancer. This case highlights the importance of pathological evaluation for accurate diagnosis, even with elevated cancer antigen 125 (CA-125) levels and imaging suggestive of malignancy.

Keywords:

gynaecological cancer obstetrics and gynaecology

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Area of Science:

Gynecologic Oncology
Pathology

Background:

Pelvic mass, ascites, and pleural effusions are concerning symptoms that can indicate advanced ovarian carcinoma.
Elevated cancer antigen 125 (CA-125) levels further increase suspicion for gynecologic malignancies.

Observation:

A 64-year-old woman presented with a large pelvic mass, ascites, and bilateral pleural effusions, with a markedly elevated CA-125 level.
Imaging revealed multiple pelvic masses, raising strong suspicion for ovarian cancer.

Findings:

Surgical pathology confirmed a large ovarian fibroma (26 cm), diagnosing Meigs syndrome.
Post-operative resolution of ascites and pleural effusion supported the Meigs syndrome diagnosis.

Implications:

This case underscores that Meigs syndrome can present similarly to ovarian cancer, necessitating pathological confirmation.
Accurate diagnosis is crucial for appropriate management and avoiding unnecessary aggressive treatment for presumed ovarian malignancy.