Large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe anemia treated by laparoscopic surgery

Abstract

BackgroundThe Meigs' syndrome is a rare but well-known syndrome defined as the triad of benign solid ovarian tumor, ascites, and pleural effusion. Meigs' syndrome always requires surgical treatment. However, the optimal approach for its management has not been sufficiently investigated.Case presentationWe report a patient with a large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe hemolytic anemia that was treated by laparoscopic surgery. This case highlights the difficulties that may be encountered in the management of patients with Meigs’ syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach and the adverse impact that Meigs’ syndrome can have on the patient’s condition, especially if it is associated with acute pain and severe anemia. Considering the patient’s serious clinical condition and assuming that she had Meigs' syndrome with a twisted large ovarian mass and possible hemolytic anemia, we first concentrated on effective medical management of our patient and chose the most appropriate surgical treatment after laparoscopic examination. The main aim of our initial approach was preoperative management of the anemia. Blood transfusions and glucocorticoid therapy resulted in stabilization of the hemoglobin level and normalization of the bilirubin levels, which confirmed the appropriateness of this approach. Laparoscopic surgery 4 days after admission enabled definitive diagnosis of the tumor, confirmed torsion and removed the bulky ovarian fibroma, resulting in timely resolution of symptoms, short hospitalization, relatively low morbidity and a rapid return to her social and professional life.ConclusionsThis case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach, and the adverse impact that Meigs' syndrome can have on the patient's condition, especially if it is associated with acute pain and severe anemia. The present case suggests that laparoscopic surgery for potentially large malignant tumors is feasible and safe, but requires an appropriate medical and gynecological oncology expertise.

The Effect of Age and Body Mass Index on the Surgical Anatomy of Supraumbilical Port Insertion: Implications for Laparoscopic and Robotic Surgery

“…Hence, individual anatomic characteristics still need to be taken into account and surgeons should still universally apply controlled entry techniques and recognize signs of peritoneal entry such as a drop in insufflation pressure. Nevertheless, our findings provide objective evidence to support the safe use of supraumbilical port entry to acquire peritoneal access and enable improved visibility and maneuverability over traditional umbilical entry in patients with large uteri [11, 12], large ovarian masses [13], and during pregnancy [14, 15]. …”

Mass lesions of ovary - Tumor markers can be misleading

“…In addition to the effusions, torsion with subsequent necrosis can result in elevated CA-125 levels. 11 A case of twisted sclerosing stromal tumor also has been recently reported with Ca-125 levels of 339.20 IU/ml. 12 In the present series we had 4 SCTs with above normal Ca-125 values.…”

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

“…6,7 In their report of a case of pseudo-Meigs' syndrome due to a uterine leiomyoma, Amant et al suggested various mechanisms which might cause ascites in such cases, including lymphatic obstruction by the tumour, irritation of the peritoneum by the tumour, the release of toxins and inflammatory products, hypoalbuminemia and decreased venous and lymphatic drainage. 7 In addition, the use of a dye test was advocated to determine the exact cause of pleural effusion.…”