Coexistence of benign struma ovarii, pseudo-Meigs’ syndrome and elevated serum CA 125: Case report and review of the literature

Abstract

Abstract. Struma ovarii is an uncommon ovarian teratoma comprised predominantly of mature thyroid tissue. The combination of pseudo-Meigs' syndrome, and elevation of CA 125 to the struma ovarii is a rare condition that can mimic ovarian malignancy. We reported a case of benign struma ovarii, presenting with the clinical features of advanced ovarian carcinoma: complex pelvic mass, gross ascites, bilateral pleural effusion and markedly elevated serum CA 125 levels. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Ascites and pleural effusion were not evident and the CA 125 levels returned to normal following surgical excision. A systematic review of reported cases of coexistent benign struma ovarii, pseudo-Meigs' syndrome and elevated serum CA 125 was performed. Struma ovarii accompanied by pseudo-Meigs' syndrome and elevated serum CA 125 should be considered in the differential diagnosis of ovarian epithelial cancer. IntroductionStruma ovarii is a rare ovarian neoplasm consisting almost exclusively of mature thyroid tissue (>50%) derived from germ cells in a mature teratoma (1). Few of these cases undergo malignant transformation (2). Meigs' syndrome refers to a solid benign ovarian neoplasm, such as fibroma or thecoma accompanied by ascites and hydrothorax which are required to completely resolve following removal of the tumor (3). Pesudo-Meigs' syndrome is often characterized by pleural effusion and ascites caused by a pelvic tumor other than an ovarian fibroma. Rare cases of ovarian tumors have been associated with pseudo-Meigs' syndrome, such as struma ovarii tumors, mucinous or serous cystadenomas, germ cell tumors and ovarian metastasis from colon and gastric cancers (2). When coexisting with pesudo-Meigs' syndrome and elevation of CA 125, struma ovarii is highly suspected as an ovarian malignancy. Struma ovarii mimicking advanced ovarian carcinoma can cause difficulties in preoperative diagnosis (1). Diagnosis of struma ovarii can only be made by conducting histopathology (4). The present study focused on a patient presenting with struma ovarii, who was initially thought to have an ovarian malignancy prior to surgery based on clinical, radiological findings and raised CA 125 levels. However, the frozen section and final histopathology reports revealed benign struma ovarii. A systematic review of the related literatures on struma ovarii presenting as pseudo-Meigs' syndrome with elevated serum CA 125 was also conducted. Written informed consent was obtained from the patient. Case reportOn April 3, 2014, a 52-year-old, Chinese female, premenopausal, gravida 3, para 1, was admitted to the United Hospital of Dezhou (Dezhou City, China), complaining of oppression in chest and shortness of breath for 5 days. The patient's previous menstrual period was March 31, 2014. The patient did not complain of any pain or changes in micturition or bowel movements. The patient's medical history included surgery for an ovarian tumor 26 years previously and surgery for a broad ligament tum...

Management of malignant struma ovarii: is aggressive therapy justified? Case report and literature review

“…Even though CA-125 is increased in 80% of epithelial ovarian carcinomas, its specificity in the diagnosis is limited, as this marker may be elevated also in other malignancies (endometrium, breasts, lungs), as well as in endometriosis, or even in physiologic states like menstruation or pregnancy [ 9 , 26 ]. Reports have shown that CA-125 is not a specific tumor marker for MSO, an important percentage of cases having normal levels of CA-125 [ 9 – 11 , 26 ]. In a recent research performed on 144 published cases of MSO, only 51.6% had high levels of CA-125 [ 11 ].…”

Pseudo-Meigs Syndrome Caused by a Giant Uterine Leiomyoma with Cystic Degeneration: A Case Report

“…On the other hand, pseudo-Meigs syndrome is a similar condition associated with pelvic tumors, except for the fact that these ovarian tumors are benign, such as primary ovarian malignancies, ovarian metastasis of gastrointestinal malignancies, uterine leiomyomas and so on. [3][4][5][6][7][8] Pseudo-Meigs syndrome due to uterine leiomyoma is very rare. Here we report a patient case of pseudo-Meigs syndrome caused by a giant uterine leiomyoma with cystic degeneration, which was initially suspected to be a case of ovarian cancer.…”

“…3 A number of studies have reported cases of Pseudo-Meigs syndrome associated with struma ovarii, mature teratoma, uterine myoma, ovarian cancer and ovarian metastasis of malignancies. The Pseudo-Meigs syndrome is often diagnosed upon close examination and classically during follow-up appointments subsequently to the treatment of other malignanttumors [4][5][6][7][8]. The pathophysiology or the origin of the ascites and pleural effusion found in patients presenting either the Meigs or the pseudo-Meigs syndrome remains uncertain.…”

Association of Pseudo-Meigs’ Syndrome with Struma Ovarii and High CA125 Mimicking Ovarian Malignancy

“…3 Meigs' syndrome is the association of fibromas, ascites, and pleural effusion that resolve after surgical resection of the ovarian tumor. 3,4,11,12 Spiegelberg was the first to present the description of the syndrome in 1866; two decades later, Trait reported that the presence of an ovarian tumor with ascites and pleural effusion is not always associated with malignancy.…”

“…1,5,7,12,18,19 PMS associated with struma ovarii and accompanied by a rise in Ca125 is very rare: only eight cases have been reported in the medical literature to date (Table 1). [2][3][4]7,8,11,12,18,19 The possible causes of the increase of Ca125 in Meigs' syndrome include irritation of the mesothelial cells by the ovarian tumor, ascites, or pleural effusion, which leads to the antigen being released onto the surface of the serous membranes or the peritoneum. 7,16,18,19 To date, no correlation has been found among volume of ascites fluid volume, tumor size, or the value of Ca125 in Meigs' syndrome.…”