Abstract | November 8, 2021

An Atypical Presentation of Meigs Syndrome with Elevated CA 125 Levels

Presenting Author: Malvika Lall, BS, Medical Student, MS4, Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, Mobile, AL, Mobile, AL

Coauthors: Malvika Lall, BS, MS4, University of South Alabama College of Medicine, Mobile, AL; R. Lee Sharma, MD, Department of Obstetrics and Gynecology, East Alabama Medical Center, Auburn, AL.

Learning Objectives

  1. Understand the diagnosis of Meigs Syndrome;
  2. Discuss the cause of Ascites in Meigs Syndrome;
  3. Identify the causes of elevated CA125.

Introduction: Meigs syndrome is characterized by the triad of an ovarian fibroma, ascites, and pleural effusion. Although not commonly seen with an elevated CA125 levels, there are reported cases of Meigs syndrome with elevated CA125 that essentially normalizes with the tumor removal. An elevated CA 125 in the presence of an ovarian mass and ascites usually indicates an ovarian malignancy with concerns for a poor prognosis. However, final diagnosis of cancer needs to be confirmed with tissue biopsy. We present a 58-year-old female with an atypical presentation of Meigs syndrome (no pleural effusion) associated with an elevated CA 125. Interestingly, the ascites resolved and CA 125 normalized after removal of the ovarian tumor. 

Case Presentation: A 58-year-old female with past medical history of hypertension, hyperlipidemia, and GERD presented to the emergency room with lower abdominal pain and low grade fever for 1 week. Pain was more localized to the right lower quadrant and associated with nausea. Vitals revealed a temperature of 100.3F, heart rate of 123/minute, blood pressure of 134/65 mmHg, oxygen saturation of 97%, and respiratory rate of 20/minute. Exam revealed tachycardia and a mildly distended abdomen with right lower abdomen tenderness without rebound or rigidity. A CT of the abdomen and pelvis showed a large pelvic mass (18.5 X 14 cm) with fluid in the right and left pericolic gutters and around the liver without any pleural effusion. These findings were confirmed on a pelvic ultrasound. Labs revealed a CA 125 of 914 (normal 0-35), a white count of 22,000 (normal 4,000-11,000), normal lactic acid (0.7), normal hemoglobin and hematocrit, normal urine analysis, normal renal and liver functions, and hyponatremia (127). 

Final/Working Diagnosis: A diagnosis of a possible ovarian carcinoma with torsion or necrosis was made and patient was referred for exploratory laparotomy and surgery. 

Management/Outcome: Patient underwent total abdominal hysterectomy with bilateral salphingo-oopherectomy for an ovarian tumor with torsion. Pathology of the ovarian tumor revealed an ovarian fibroma with no evidence of malignancy. Post operatively patient had a decrease of CA 125 to 242 as anticipated. A follow up CA 125 in 3 weeks was normal (13). 

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