Meigs Syndrome Masquerading as Ovarian Malignancy: A Radiological and Cytological Diagnostic Challenge in a Young Woman

Registration ID: IJNRD_307277

Published ID: IJNRD2505470

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Dr. Koganti Devika, Dr. Pulagam Sindhura, Dr. Rama Krishna Rao Baru, Dr. Suneetha Pentyala, Dr. Sree Divya

Keywords: Meigs syndrome, adnexal mass, ovarian tumor, ascites, pleural effusion, CT abdomen.

Abstract Introduction: Meigs syndrome is a rare benign condition defined by the triad of an ovarian tumor, ascites, and pleural effusion—all resolving after tumor resection. It may mimic advanced ovarian malignancy, especially in the presence of elevated tumor markers and hemorrhagic ascitic fluid. Keywords: Meigs syndrome, adnexal mass, ovarian tumor, ascites, pleural effusion, CT abdomen. Case Presentation: We report a 35-year-old woman who presented with abdominal pain. Imaging revealed a large left adnexal mass, moderate ascites, and minimal bilateral pleural effusion. Laboratory investigations showed a markedly elevated serum CA-125 level of 125.2 U/mL and ESR of 122 mm/hr. Ascitic fluid was hemorrhagic with cytological atypia but no malignant cells. Culture showed no bacterial growth. Postoperative histopathology confirmed a benign ovarian tumor. Complete resolution of fluid collections supported the diagnosis of Meigs syndrome. Conclusion: This case illustrates how imaging and fluid analysis can differentiate Meigs syndrome from malignancy, thereby preventing overtreatment. Elevated CA-125 and cytological atypia in ascitic fluid do not rule out this benign diagnosis. Keywords: Meigs syndrome, ovarian fibroma, CA-125, ascites, pleural effusion, adnexal mass Introduction Meigs syndrome refers to a triad of benign ovarian tumor, ascites, and pleural effusion that completely resolves after tumor removal [1]. Though typically associated with ovarian fibromas, similar presentations may occur with other benign tumors, often termed pseudo-Meigs syndrome [2,3]. Because patients may present with systemic inflammatory markers, elevated tumor markers such as CA-125, and hemorrhagic ascitic fluid, Meigs syndrome can closely mimic advanced epithelial ovarian cancer [4]. It is therefore critical to distinguish these entities using radiological, biochemical, and cytological evaluation. Case Presentation A 35-year-old woman presented with complaints of diffuse lower abdominal pain and bloating for five days. She denied weight loss, fever, or previous gynecological procedures. Laboratory Findings: • ESR: 122 mm/hr (elevated) • Serum CA-125: 125.2 U/mL (normal <35 U/mL) • Liver and renal function tests: Normal • Complete blood count: Within normal limits Imaging Findings: CECT Abdomen and Pelvis: • A large, well-defined iso- to hyperdense mass (13 × 9.2 × 13 cm) in the right iliac fossa, arising from the left adnexa. • Moderate free fluid in the peritoneal cavity. • Minimal bilateral pleural effusion and right lower lobe basal consolidation. • No evidence of metastatic implants, lymphadenopathy, or solid organ metastasis. Ultrasound correlation confirmed a solid-cystic left adnexal mass. The left ovary was not separately visualized. Ascitic Fluid Analysis : Macroscopic examination : Hemorrhagic, cloudy fluid (2 mL received) WBC count: 1000 cells/cumm (60% neutrophils, 40% lymphocytes) Biochemistry: • Total proteins: 5.0 gm/dL • Albumin: 2.75 gm/dL Cytology: • Degenerated cells, reactive mesothelial cell clusters, and RBCs. • Cytological Impression: Atypia of undetermined significance (AUS), no overt malignancy. Culture and Sensitivity: Sterile after 48 hours of incubation Gram stain: Negative These findings were not consistent with carcinomatosis, despite the hemorrhagic nature of the fluid. Discussion The elevated CA-125 level of 125.2 U/mL initially raised clinical concern for malignancy. However, CA-125 is a nonspecific marker that can be elevated in various benign conditions including peritonitis, endometriosis, and Meigs syndrome, due to mesothelial irritation from ascitic fluid [3]. Ascitic fluid cytology showing atypia of undetermined significance (AUS) further complicated the diagnosis. Such findings can occur in benign reactive states and should not independently guide clinical decisions without supportive imaging or histopathology [5]. In this case, imaging was key: the absence of peritoneal nodules, omental caking, or lymphadenopathy pointed away from carcinomatosis. Minimal bilateral pleural effusion is often seen in Meigs syndrome, predominantly on the right side [6]. Post-surgical resolution of ascites and pleural effusion confirmed the diagnosis. Histopathology revealed a benign ovarian tumor, consistent with fibroma. Conclusion Meigs syndrome should be considered in the differential diagnosis of adnexal masses with ascites and pleural effusion, especially when imaging and cytology do not support malignancy. This case reinforces the pivotal role of radiologic-pathologic correlation and careful interpretation of elevated CA-125 and ascitic fluid cytology to avoid misdiagnosis and unnecessary treatment. Declarations Patient Consent: Obtained in written form. The patient consented to publication of anonymized data and images. Conflict of Interest: None declared. References : 1. Meigs JV. Fibroma of the ovary with ascites and hydrothorax (Meigs’ syndrome). Am J Obstet Gynecol. 1954;67(5):962–985. 2. Samanth KK, Black WC. Benign ovarian stromal tumors associated with ascites and hydrothorax (Meigs’ syndrome). Am J Obstet Gynecol. 1970;107(4):538–545. 3. Ayhan A, Gultekin M, Taskiran C, et al. CA-125 elevation in benign gynecologic conditions. Int J Gynecol Cancer. 2006;16(3):1190–1194. 4. Al-Brahim N, Ayoola A, Khatib R, et al. Benign ovarian fibroma mimicking malignancy: elevated CA-125 and hemorrhagic ascites. Int J Gynecol Pathol. 2005;24(3):243–245. 5. Saqi A, Ramzy I, Nguyen GK. Cytologic diagnosis of atypia of undetermined significance in serous effusions. Diagn Cytopathol. 2007;35(1):32–37. 6. Suginami R, Matsubara S, et al. Mechanism of pleural effusion in Meigs syndrome. Chest. 1985;88(4):626–628.

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Dr. Koganti Devika, Dr. Pulagam Sindhura, Dr. Rama Krishna Rao Baru, Dr. Suneetha Pentyala, & Dr. Sree Divya (May-2025). Meigs Syndrome Masquerading as Ovarian Malignancy: A Radiological and Cytological Diagnostic Challenge in a Young Woman. INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT, 10(5), e657-e660. https://ijnrd.org/papers/IJNRD2505470.pdf

Volume 10 Issue 5, May-2025

Pages : e657-e660

Paper Reg. ID: IJNRD_307277

Published Paper Id: IJNRD2505470

Research Area: Humanities All

Author Type: Indian Author

Country: Nellore, Andhra Pradesh , India

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