Meigs syndrome and elevated CA-125 levels, clinical mimicry with ovarian cancer. A case report

Background: Meigs syndrome is a rare gynecological condition characterized by the triad of a benign ovarian tumor (commonly fibroma), ascites, and pleural effusion, all of which resolve after surgical removal of the tumor. First described by Meigs in 1937, this syndrome occurs in only 1–2% of ovarian fibroma cases. Although CA-125 is typically associated with epithelial ovarian cancer, mild to moderate elevation can be observed in Meigs syndrome due to factors such as peritoneal irritation and mesothelial cell activity.

This case report presents a 47-year-old woman with progressive abdominal distension and dyspnea. Imaging revealed a large right ovarian mass, ascites, and a right pleural effusion. CA-125 levels were significantly elevated at 565 U/mL. Following a radical hysterectomy with right oophorectomy, histopathology confirmed a benign ovarian fibroma. Postoperatively, the patient's ascites and pleural effusion resolved completely.

Meigs syndrome should be considered in the differential diagnosis of patients presenting with ascites, pleural effusion, and an ovarian mass, even with elevated tumor markers like CA-125 since these findings do not always indicate malignancy. Understanding this rare syndrome is essential, as surgical removal of the benign tumor results in full resolution of symptoms and favorable outcomes, avoiding unnecessary aggressive oncologic treatment.

Keywords: Meigs syndrome, CA-125