Unraveling a Rare Gynecological Mystery Giant Ovarian Serous Cystadenoma Masquerading as Pseudo Meigs Syndrome

Introduction:

In the ever-evolving field of gynecological research, unique clinical cases can provide profound insights. One such rare case explores a massive ovarian serous cystadenoma that mimicked malignancy due to its association with ascites and pleural effusion clinically recognized as Pseudo-Meigs Syndrome. This intriguing scenario was successfully managed in a low-resource setting, reminding clinicians of the importance of differential diagnoses.

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Case Summary

• An 18-year-old girl presented with progressive abdominal distension, mild abdominal pain, and shortness of breath.
• Clinical examination and imaging revealed a giant right adnexal mass (18×19 cm) with moderate ascites and pleural effusion.
• CA-125 was mildly elevated (54.5 U/ml).
• Surgical intervention via right salpingo-oophorectomy was performed.
• Histopathology confirmed a benign serous cystadenoma.
• Postoperative imaging showed complete resolution of effusions, confirming Pseudo-Meigs Syndrome.

Understanding Pseudo Meigs Syndrome

Pseudo-Meigs syndrome refers to non-fibroma ovarian tumors serous cystadenomas, teratomas accompanied by pleural effusion and ascites. Unlike true Meigs syndrome (which involves fibromas), this condition can mimic malignancy.

• Right-sided pleural effusion is most common due to transdiaphragmatic movement of fluid.
• VEGF (vascular endothelial growth factor) may play a role in increased capillary permeability.
• Differential diagnosis includes tuberculosis, ovarian malignancies, and heart or liver diseases.

External Reference

According to the American College of Obstetricians and Gynecologists (ACOG), prompt surgical intervention and histopathological examination are critical in managing adnexal masses that mimic malignancy but are benign in origin.

Further Reading and Resources

Read the full case report with clinical and pathological images here:
https://doi.org/10.29328/journal.cjog.1001078

Clinical Significance

• Timely identification of benign tumors can prevent unnecessary anxiety and overtreatment.
• CA-125, although elevated, should be interpreted with caution in young women with benign conditions.
• Surgical removal results in complete resolution of symptoms, supporting conservative management in young patients.

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