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

Abstract

Ascites, pelvic mass and elevated CA-125 in females carry a grim prognosis, likely an ovarian carcinoma. However, more benign etiologies such as Meigs’ and pseudo-Meigs’ syndrome must be considered. Pseudo-Meigs’ syndrome presenting with an elevated CA-125 is rare and presents a diagnostic challenge. Medline and PubMed were queried for pseudo-Meigs’ syndrome cases. We present a 35-year-old female patient who presented with abdominal swelling and weight gain. Imaging demonstrated a 29-cm large intraabdominal mass with significant ascites with elevation of CA-125. Surgical resection was performed, and pathology identified uterine leiomyoma. Twenty-one cases of pseudo-Meigs’ syndrome were identified in the literature. Most patients presented with abdominal distention, and some also reported dyspnea. All patients, including our case, were treated surgically. No recurrence reported among these cases. Surgery is the mainstay for radical treatment in pseudo-Meigs’ syndrome. Resolution of the ascites and hydrothorax occurs following resection of the tumor.

Síndrome de pseudo-meigs secundario a leiomioma uterino. Reporte de un caso

“…Existen varias causas que sugieren la presencia de ascitis, la torsión del tumor alrededor de su pedículo da como resultado la producción de líquido; sin embargo, no explica la ascitis en los tumores no pediculados; la presión mecánica del tumor sobre los vasos y linfáticos, pero esta teoría es limitada en tumores que no son de gran tamaño; el trasudado de líquido y las citoquinas pro-inflamatorias pareciera ser actualmente la teoría más aceptada, además la irritación mecánica del peritoneo por el tumor, la presión de ascitis preexistente, causan inflamación peritoneal lo que resulta en una mayor producción de líquido (4,9,10). La causa más probable de ascitis en el caso presentado es el tamaño del tumor.…”

“…El tratamiento de elección es quirúrgico mediante laparotomía exploradora, siendo útil el corte congelado en tumores ováricos para decidir el alcance de la intervención al confirmar la naturaleza benigna o maligna de la tumoración. En mujeres de edad reproductiva, la salpingooforectomía unilateral es el tratamiento de elección, mientras que, en mujeres posmenopáusicas, la histerectomía abdominal total con salpingooforectomía bilateral es preferida (4,13).…”

“…Por otro lado, el Síndrome de pseudo-Meigs se asocia con tumores pélvicos distintos a los tumores ováricos benignos descritos anteriormente, tumores de trompa uterina, metástasis ovárica de neoplasias gastrointestinales, y con menor frecuencia los leiomiomas uterinos, ascitis e hidrotórax (2,3). A nivel mundial para el año 2022, se han reportado solo 21 casos de este síndrome (4). A continuación, se presenta un caso de síndrome de pseudo-Meigs secundario a un leiomioma uterino.…”

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

“…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 ].…”

“…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 ].…”