Struma Ovarii with Pseudo-Meigs’ Syndrome and Raised Cancer Antigen-125 Levels Masquerading as an Ovarian Carcinoma: Case report and literature review

Abstract

S truma ovarii are mature ovarian teratomas derived from one type of germ cell; these monodermal variants account for >5% of mature teratomas and 0.3-1% of ovarian tumours.1 These types of tumours predominantly consist of thyroid tissue (>50% of the overall ovarian mass) and the usual age of presentation is during the fifth and sixth decades of life.1 The reported rate of malignant transformation is 5-37%, in which the struma ovarii transforms into a thyroid-type carcinoma.2 The usual presentation of struma ovarii is as an abdominopelvic mass, although it may present with hyperthyroidism in approximately 5% of cases.3 Radiologically, a benign ovarian mass presenting with ascites and raised cancer antigen (CA)-125 levels can be misdiagnosed as a malignant ovarian tumour. 2,4,5 In such cases, a correct intraoperative diagnosis can prevent extensive surgery. Case ReportA 55-year-old female presented to the Lok Nayak Jai Prakash Narayan Hospital, New Delhi, India, in 2016 with progressively increasing abdominal discomfort, The monodermal teratoma struma ovarii is a rare ovarian tumour; however, struma ovarii presenting with pseudo-Meigs' syndrome and raised cancer antigen (CA)-125 levels is even rarer. In elderly patients, this presentation can potentially lead to a misdiagnosis of a malignant ovarian carcinoma, resulting in unnecessary extensive surgery. We report a 55-year-old female who presented to the Lok Nayak Jai Prakash Narayan Hospital, New Delhi, India, in 2016 with progressive abdominal discomfort, fatigue and abdominal distention. Clinical and radiological features were indicative of a malignant ovarian tumour and ascites. Serum CA-125 levels were elevated at 258 U/mL. A left-sided salpingo-oophorectomy was performed, after which the serum CA-125 levels normalised. There was no evidence of recurrence at a six-month follow-up. A frozen section procedure confirmed the diagnosis of a struma ovarii. This rare condition should be considered as a differential diagnosis in patients presenting with ovarian masses, ascites and raised CA-125 levels.

Precise preoperative diagnosis of struma ovarii with pseudo-Meigs’ syndrome mimicking ovarian cancer with the combination of 131I scintigraphy and 18F–FDG PET: case report and review of the literature

“…In the review of the literature, the focus was on preoperative diagnosis using imaging modalities and struma ovarii with pseudo-Meigs’ syndrome (Table 1 ) [ 1 , 9 – 20 ] or massive ascites (Table 2 ) [ 21 – 32 ] and an elevated level of CA125 mimicking advanced ovarian cancer. Most cases were preoperatively misdiagnosed as advanced ovarian cancer based on the findings of conventional imaging.…”

Struma ovarii with massive ascites mimicking ovarian carcinoma treated with conservative laparoscopic surgery: a case report

“…Chromogranin A (H) and synaptophysin (I) were negative, which signified no thyroid carcinoid component. Struma ovarii with massive ascites mimicking ovarian carcinoma treated with conservative laparoscopic surgery of cases 4,5) . Malignant struma ovarii accounts for approximately 5 -10% of struma ovarii that can be histologically identified as differentiated thyroid carcinoma 6,7) .…”

Struma Ovarii Associated with Ascites and Elevated CA125: Two Case Reports and Review of the Literature

“…The details of those cases were showed in Table 1. 1,4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The ascites and pleural effusion are usually serous. Unlike malignant process, hypoproteinemia is exceedingly rare.…”