Large uterine leiomyoma presenting as pseudo-Meigs’ syndrome with an elevated ca125: a case report and literature review

Abdelgawad, Mohamed; Barghuthi, Lutfi; Davis, Tyler; Omar, Mahmoud; Kamel, Omar M; Gibbons, Jake Alan; Ragoza, Yury; Ismael, Hishaam

doi:10.1093/jscr/rjac253

Cited by 2 publications

(2 citation statements)

References 29 publications

(34 reference statements)

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“…Our case was visualized with well-defined margins but a heterogeneous pattern and was therefore regarded as atypical and confusing between the aforementioned entities. However, both leiomyomas and leiomyosarcomas rarely manifest as massive abdominal ascites [ 14 , 15 ]. This is usually correlated with massive uterine enlargement exceeding 20 cm in the maximum dimension [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Flares of Confusion: A Case Report of Uterine Leiomyoma and Angiomatosis Complexity on Imaging

Al-Ibraheem,

Abdulrahman,

Abdlkadir

et al. 2023

Cureus

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Over the past decade, a series of rare and extraordinary uterine tumors have been discovered, with some featuring exceptionally uncommon tumor types. This highlights the growing recognition of these rare tumors due to evolutionary radiologic advancements. However, evaluating these patients requires adequate understanding to avoid misinterpretation and potential confusion with alternative differential diagnoses. This case is the first documented instance of two coexistent uterine benign tumors in a 45-year-old unmarried female patient. The patient's medical, gynecological, and surgical histories were unremarkable. Conventional abdominopelvic imaging via computed tomography (CT) and magnetic resonance imaging (MRI) revealed significant uterine expansion, indicating an atypical leiomyomatous or potentially leiomyosarcomatous mass. Subsequently, [ 18 F]fluorodeoxyglucose ([ 18 F]FDG) positron emission tomography (PET)/CT revealed hypermetabolic uterine enlargement, suggesting further evaluation. The patient underwent radical hysterectomy, and histopathological analysis revealed multiple uterine fibroids concurrently existing against the uterine angiomatosis. This case is the first documented instance of intricate pathological interplay within the uterus.

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Section: Discussionmentioning

confidence: 99%

“…However, both leiomyomas and leiomyosarcomas rarely manifest as massive abdominal ascites [ 14 , 15 ]. This is usually correlated with massive uterine enlargement exceeding 20 cm in the maximum dimension [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Flares of Confusion: A Case Report of Uterine Leiomyoma and Angiomatosis Complexity on Imaging

Al-Ibraheem,

Abdulrahman,

Abdlkadir

et al. 2023

Cureus

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Pseudo-Meigs’ syndrome caused by rapidly enlarging hydropic leiomyoma with elevated CA125 mimicking ovarian malignancy: A case report and literature review

Zou,

Lou,

Huang

et al. 2023

Preprint

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Hydropic leiomyoma (HLM) is one of the rare subtypes of uterine leiomyoma. HLM is characterized by diffuse water degeneration and often secondary cystic changes. While HLM enlarged rapidly, especially with hydrothorax and ascites, they were often misdiagnosed as malignant tumors. Pseudo-Meigs’ syndrome is characterized by the presence of hydrothorax and ascites associated with pelvic masses (benign or malignant). Pseudo-Meigs’ syndrome presenting with elevated serum cancer antigen-125 (CA125) is rare and very likely misdiagnosed as a malignancy of the uterus or ovary. Pseudo-meigs’ syndrome with CA125 elevation caused by hydropic leiomyoma is rarer. Here, we reported a 45-year-old Chinese female with ascites, right hydrothorax and a rapidly enlarging pelvic mass. Preoperative abdominal and pelvic CT showed a giant solid mass in the fundus uteri, measuring 20×15×12 cm. The tumor marker CA125 was found to be elevated to 247.7 U/ml and 304.60 U/ml in serum and hydrothorax, respectively. She was initially diagnosed of uterine malignancy and underwent total abdominal hysterectomy and adhesiolysis. The final pathological diagnosis of the specimen was uterine hydropic leiomyoma with cystic changes. After the tumor removal, the ascites and hydrothorax disappeared rapidly and without recurrence. The serum CA125 dropped to 116.90 U/mL on day 7 and 5.6 U/mL on day 40. Follow-up was obtained at 6 months, 1 year, and 2 years after surgery, respectively. The patient's physical signs were all normal, with no recurrence of ascites or hydrothorax.

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Large uterine leiomyoma presenting as pseudo-Meigs’ syndrome with an elevated ca125: a case report and literature review

Cited by 2 publications

References 29 publications

Flares of Confusion: A Case Report of Uterine Leiomyoma and Angiomatosis Complexity on Imaging

Flares of Confusion: A Case Report of Uterine Leiomyoma and Angiomatosis Complexity on Imaging

Pseudo-Meigs’ syndrome caused by rapidly enlarging hydropic leiomyoma with elevated CA125 mimicking ovarian malignancy: A case report and literature review

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