Case Presentation: The patient is a 35-year-old female who presented to the emergency department with a chief complaint of abdominal swelling and 10-pound weight gain over the last month. She also reported diffuse abdominal pain, nausea, and vomiting during this time. She had a past medical history of fibromyalgia. She had no relevant social or family history. Vital signs were within normal limits. On physical examination, her abdomen was distended and tender to palpation. An abdominal mass was palpated in the left lower quadrant. Additionally, a fluid wave with shifting dullness was appreciated on exam.
Complete blood count was significant for an elevated leukocyte count of 12.8 10^3/µL. Blood work also revealed a markedly elevated CA 125 level of 272.9 ng/ml. Computed tomography scan of the abdomen and pelvis demonstrated significant ascites and a large intraabdominal mass measuring 28.8 cm. The patient was taken to the operating room with a suspected diagnosis of ovarian cancer. However, the mass was identified intraoperatively and found to originate from the uterine fundus. Pathology of the tumor came back as an aggressive-behaving uterine leiomyoma. Additionally, ascitic cytology collected during the procedure was negative for malignant cells. Postoperatively, her abdominal swelling and weight gain resolved, and she was subsequently discharged.
Discussion: Meigs’ syndrome is the triad of a benign ovarian fibroma or thecoma combined with both ascites and hydrothorax. A clinically similar yet distinct pathological entity is pseudo-Meigs’ syndrome. As in patients with Meigs’ syndrome, those with pseudo-Meigs’ syndrome present with ascites and hydrothorax. However, unlike Meigs’ syndrome, pseudo-Meigs’ syndrome is associated with either a non-fibroma, non-thecoma ovarian tumor or a uterine leiomyoma. Alone, pseudo-Meigs’ syndrome is a rare diagnosis. A concomitant elevation in cancer antigen 125 (CA 125) in a patient with the diagnosis of pseudo-Meigs’ syndrome is an even rarer finding.
Findings of ascites, a pelvic mass, and an elevated CA 125 in a patient are suggestive of ovarian cancer. However, as demonstrated by this case and others, benign etiologies are also possible causes of these findings. Furthermore, an elevated CA 125 is not 100% specific for ovarian carcinoma, particularly in premenopausal patients. CA 125 can also be elevated in cases of pelvic inflammatory disease, pregnancy, uterine leiomyomas, and endometriosis. Thus, although ovarian cancer is a likely diagnosis in many patients presenting with ascites, a pelvic mass, and an elevated CA 125, Meigs’ syndrome and pseudo-Meigs’ syndrome are additional considerations on the differential. Though clinically identical, Meigs’ syndrome and pseudo-Meigs’ syndrome can be differentiated from one another based on tumor origin or pathological examination of the tumor.
Conclusions: In a patient presenting with ascites, a pelvic mass, and an elevated CA 125, Meigs’ syndrome and pseudo-Meigs’ syndrome are additional considerations on the differential diagnosis. Although an elevated CA 125 is suggestive of ovarian cancer, it is not 100% specific for this diagnosis.