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Borderline mucinous ovarian tumor presenting


as pseudo-Meigs' syndrome
Article in Journal of Obstetrics and Gynaecology Research June 2012
Impact Factor: 0.93 DOI: 10.1111/j.1447-0756.2012.01901.x Source: PubMed

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Ho-Hsiung Lin

Far Eastern Memorial Hospital

National Taiwan University

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doi:10.1111/j.1447-0756.2012.01901.x

J. Obstet. Gynaecol. Res. Vol. 39, No. 1: 434436, January 2013

Borderline mucinous ovarian tumor presenting as


pseudo-Meigs syndrome
Yueh-Yi Chen1, Sheng-Mou Hsiao1, Yao-Peng Hsu2, Ho-Hsiung Lin3 and
Ming-Chow Wei1
Departments of 1Obstetrics and Gynecology and 2Pathology, Far Eastern Memorial Hospital, Banqiao, New Taipei, and
3
Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University
Hospital, Taipei, Taiwan
jog_1901

434..436

Abstract
Borderline ovarian tumor with the initial presentation of pseudo-Meigs syndrome is rare. A 52-year-old
postmenopausal woman presented with a large ovarian tumor, ascites, and right hydrothorax. We found
elevated serum carcinoembryonic antigens (44.4 ng/mL), carbohydrate antigen (CA)-125 (269.8 U/mL), and
CA-199 (7942 U/mL). The frozen section pathology revealed a mucinous borderline ovarian tumor, and a
staging operation was performed. Final pathologic examination confirmed the diagnosis of intestinal type
ovarian mucinous borderline tumor with non-invasive cul-de-sac implants. Her pleural effusion and ascites
resolved after surgery, and she remained tumor-free after 3 years follow up. Physicians should be cautious for
the rare possibility of pseudo-Meigs syndrome in patients with pelvic tumors having the features of advanced
ovarian cancer.
Key words: borderline ovarian tumor, pleural effusion, pseudo-Meigs syndrome.

Introduction
Borderline ovarian tumor (BOT) is defined histologically by atypical epithelial proliferation without
stromal invasion.1 Fourteen to twenty-six percent
of patients with BOT were found to have ascites in
their initial presentations.2,3 However, pleural effusion
has rarely been reported in patients with BOT.4 We
report a rare case of mucinous BOT with pseudoMeigs syndrome and elevated carbohydrate antigen
(CA)-125.

Case Report
A 52-year-old postmenopausal woman, single, gravida
0, para 0, visited our outpatient clinics with the complaints of progressive dyspnea and abdominal distension within 5 months. Ultrasound examination and

computed tomographic scan of the abdomen and chest


revealed a large ovarian tumor (30 30 cm in size) with
multiple septa and mural masses, ascites and right
massive pleural effusion (Fig. 1). Laparocentesis and
thoracocentesis yielded serous clear fluid and was
negative for malignant cells. Furthermore, elevated
serum carcinoembryonic antigen (44.4 ng/mL),
CA-125 (269.8 U/mL) and CA-199 (7942 U/mL) were
found.
Exploratory laparotomy was performed and frozen
section pathology of left ovarian tumor revealed mucinous BOT. Therefore, optimal debulking surgery,
including abdominal total hysterectomy, bilateral
salpingo-oophorectomy, bilateral pelvic lymph node
dissection, infracolic omentectomy, appendectomy and
resection of cul-de-sac masses, was performed.
Final pathologic examination confirmed the diagnosis of ovarian intestinal type mucinous BOT with

Received: January 18 2012.


Accepted: February 27 2012.
Reprint request to: Dr Ming-Chow Wei, Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, No. 21, Sec. 2,
Nanya S. Rd., Banqiao Dist., New Taipei City, Taiwan. Email: smhsiao2@mail.femh.org.tw

434

2012 The Authors


Journal of Obstetrics and Gynaecology Research 2012 Japan Society of Obstetrics and Gynecology

Ovarian tumor as pseudo-Meigs syndrome

Discussion

Figure 1 Computed tomographic scan revealed a large


ovarian tumor with multiple thick septum, ascites and
hydrothorax.

Meigs syndrome was defined as the findings of ascites,


hydrothorax, benign solid ovarian tumor (including
fibroma, thecoma, granulose cell tumor and Brenner
tumor) and cure after removal of the tumor.5 In contrast, pseudo-Meigs syndrome referred to similar
clinical presentations of other pelvic tumors.6 It has
been reported that several types of pelvic tumors have
presented as pseudo-Meigs syndrome, such as mature
teratoma, struma ovarii, metastatic ovarian tumor secondary to gastrointestinal malignancy, and leiomyoma
of ovary.
There was only one case report of pseudo-Meigs
syndrome in BOT.4 In that case, no recurrence of ascites
or hydrothorax was noted after surgery in a premenopausal woman.4
The cause of the generation of ascites and pleural
effusion was unknown. The possible causes of pseudoMeigs syndrome included lymphatic obstruction by the
pelvic tumor, increased permeability of pelvic lymphatics, transdiaphragmatic passage of ascites,5 and hypersecretion of vascular endometrial growth factor from
oviducts.5,7 Therefore, further examination about some
angiogenic factors or cytokines may be helpful to reveal
the pathophysiology of pseudo-Meigs syndrome.
Patients with advanced ovarian cancer and massive
pleural effusion who are not surgical candidates may
receive neoadjuvant chemotherapy before cytoreductive surgery.8 In order to avoid unnecessary chemotherapy, despite the rare incidence of pseudo-Meigs
syndrome, it is imperative to obtain histological or
fluid cytological confirmation of malignancy before
neoadjuvant chemotherapy, which is echoed in the
study by Buttin et al.9
In conclusion, mucinous BOT-associated pseudoMeigs syndrome is relative rare. However, the physician should consider the possibility of pseudo-Meigs
syndrome in patients with pelvic tumor and concomitant ascites and hydrothorax.

Figure 2 Pathological examination revealed a left ovarian


cyst lined by low papillary structures with hyperchromatic large nuclei, a moderate amount of
apical cytoplasmic mucin, and no stromal invasion
(hematoxylineosin, 200).

Disclosure
None of the authors has anything to disclose.

References
non-invasive cul-de-sac implants (Fig. 2). The patients
postoperative course was uneventful. Her pleural
effusion and ascites were resolved; she remained
tumor-free after 3 years follow up.

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Journal of Obstetrics and Gynaecology Research 2012 Japan Society of Obstetrics and Gynecology

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Journal of Obstetrics and Gynaecology Research 2012 Japan Society of Obstetrics and Gynecology