Elevated CA125 level associated with Meigs' syndrome: case report and review of the literature

Abstract

Meigs' syndrome is the association of ovarian fibroma, pleural effusion, and ascites. Meigs' syndrome with marked elevation of CA125 is an unusual clinical condition reported in 27 cases in the literature. The patient was a 46-year-old woman with right pleural effusion, ascites, ovarian tumor, and CA125 level of 1808 U/mL. Tomography revealed ascites and bilobate pelvic tumor of approximately 25 cm. The diagnosis of advanced epithelial ovarian cancer was considered, and the patient was treated with chemotherapy. Three chemotherapy schemes were applied due to the total lack of response in tumor volume; however, CA125 decreased to 90 U/mL. Thus, surgery was performed with resection of 25 cm of the left ovarian tumor, with intact capsule and without implants; the result of histopathologic analysis was fibroma. Postoperative CA125 was 11 U/mL. Patients with elevated CA125 and ascites cytology positive for malignancy must be cautiously treated due to the possibility of false positives, even if the probability is low. Therefore, minimally invasive surgery for biopsy collection must be considered. Although the association between ovarian tumor, pleural effusion, ascites, and marked elevation of CA125 is highly indicative of epithelial ovarian cancer, Meigs' syndrome must be considered in the differential diagnosis.

Ovarían Fibroma in the Era of Laparoscopic Surgery: A General Surgeon’s Experience

“…Hydrothorax is secondary to ascites due to transdiaphragmatic passage. Unusual high levels of CA-125 have been found in patients with Meig's syndrome (10,11,12) which, associated with a solid pelvic mass and ascites, can be misdiagnosed as a malignant ovarian tumor. The removal of the ovarian mass is the only resolutive treatment for these patients (13).…”

Correlation of ovarian fibroma with elevated serum CA-125

“…Year [3] 2009 56 1064 2500 Morán-Mendoza et al [4] 2004 46 1808 500 Patsner et al [5] 2000 62 185 300 57 850 1000 52 520 1500 60 64 100 72 1200 1500 58 80 100 Chan et al [6] 2000 13 970 2100 Timmerman et al [7] 1995 71 484 1000 73 42 500 Lin et al [8] 1992 74 2120 7000 72 7000 6000…”

О Синдроме Мейгса Вследствие Экстракорпорального Оплодотворения

“…Плевральный выпот возникает у 3 % пациенток с овариальными опухолями, достигаю щими > 6 см в диаметре. В 70 % случаев плевральный выпот правосторонний, в 10 % -левосторонний и в 20 % -2 сторонний [2,[4][5][6].…”

“…Хотя плевральный выпот у больных с синдромом Мейгса часто считают транссудатом, иногда содер жание в нем белка превышает 35 г/л, что свидетель ствует об экссудате; в отдельных случаях плевраль ный выпот может быть геморрагическим [2,[4][5][6]. Образование плеврального транссудата или экссуда та объясняется транспортом выпота из брюшной по лости в плевральную через лимфатическую систему диафрагмы [1].…”

“…После хирургического удаления пер вичной опухоли наблюдается быстрое рассасывание асцита и плеврального выпота (как правило, через 2 нед.) [4][5][6].…”