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International Journal of Surgery Case... Nov 2023Ovarian fibrosarcoma is a rare cancer. In the literature, there have been very few occurrences of fibrosarcoma with ascites. The presence of ascites complicates the...
INTRODUCTION
Ovarian fibrosarcoma is a rare cancer. In the literature, there have been very few occurrences of fibrosarcoma with ascites. The presence of ascites complicates the diagnosis further, and is associated with a poor prognosis and has been linked to chemoresistance and metastasis. We present this case of an ovarian fibrosarcoma with ascites to provide a comprehensive overview of the clinical presentation, diagnostic evaluation and management of this pathology, which remains a challenge given the rarity of this entity.
PRESENTATION OF CASE
We report the case of a 60-year-old woman who was referred to our unit, because of abdominal bloating, sporadic pelvic pain and abdominal distension. Ultrasound showed a heterogeneous mass over the right adnexa with ascites. Serum tumour markers were within normal limits. During surgery, a total abdominal hysterectomy plus bilateral adnexectomy was performed. The final histopathological findings showed a well-differentiated fibrosarcoma. The patient was followed up regularly and no recurrence was seen 2 years after surgery.
DISCUSSION
Ovarian fibrosarcomas are uncommon cancers with no known risk factors. Diagnosis can be difficult, especially in the presence of ascites, and other diagnostic options should be considered. Pathological and immunohistochemistry investigations are required for a clear diagnosis. Early metastases and resistance to adjuvant chemotherapy characterize the prognosis of ovarian fibrosarcoma with ascites.
CONCLUSIONS
Ovarian fibrosarcoma with ascites is a rare and challenging ovarian disease, highlighting the need for postoperative pathology to make a clear diagnosis, complete cytoreductive surgery and individual consideration of adjuvant radiochemotherapy should be included in the management.
PubMed: 37871372
DOI: 10.1016/j.ijscr.2023.108938 -
F1000Research 2022Meigs's syndrome is characterized by a triad of ovarian fibroma, ascites, and pleural effusion which can be managed surgically. Pleural effusion and ascites are usually...
Meigs's syndrome is characterized by a triad of ovarian fibroma, ascites, and pleural effusion which can be managed surgically. Pleural effusion and ascites are usually transudative. Ovarian fibroma is an uncommon tumor. We herein report a case of Meigs's syndrome in a 61-year-old woman who presented with complaints of abdominal pain for two-three months along with decreased appetite and constipation. On examination, there was decreased air entry in the right side of the chest, generalized abdominal distention, and a firm irregular mass was felt which was mobile and extending from upper border of symphysis pubis to just above the umbilicus on abdominal palpation. Chest X ray showed right sided pleural effusion, ultrasonogram (USG) abdominal and pelvis showed gross ascites, and a very large complex right ovarian cyst was confirmed by computed tomography (CT) scan. She underwent staging laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy and omental resection for biopsy. Biopsy showed right ovarian fibroma.
PubMed: 38817953
DOI: 10.12688/f1000research.122368.1 -
World Journal of Surgical Oncology Nov 2016Meigs' syndrome is defined as the co-existence of benign ovarian fibroma or fibroma-like tumor, ascites, and pleural effusion. In contrast, pseudo-Meigs' syndrome is...
BACKGROUND
Meigs' syndrome is defined as the co-existence of benign ovarian fibroma or fibroma-like tumor, ascites, and pleural effusion. In contrast, pseudo-Meigs' syndrome is defined as the co-existence of other ovarian or pelvic tumors, ascites, and pleural effusion. In Meigs' and pseudo-Meigs' syndromes, ascites and pleural effusion resolve promptly after the complete resection of the ovarian or pelvic tumor(s). Secondary ovarian tumors from colorectal gastrointestinal metastases rarely cause pseudo-Meigs' syndrome; only 11 cases of pseudo-Meigs' syndrome secondary to colorectal cancers have been reported in the literature. Therefore, the prognosis and etiology of pseudo-Meigs' syndrome caused by ovarian metastasis from colorectal cancers remain unclear.
CASE PRESENTATION
We report here a rare case of pseudo-Meigs' syndrome caused by ovarian metastases from sigmoid colon cancer with long-term survival. A 47-year-old woman presented with abdominal distention of 1-month duration. She developed acute dyspnea 2 weeks after the initial presentation. Colonoscopy and computed tomography revealed sigmoid colon cancer with an ovarian metastasis, along with massive ascites and bilateral pleural effusion. Emergency operation, including bilateral oophorectomy and sigmoidectomy, was performed. Subsequently, ascites and bilateral pleural effusion resolved rapidly. Curative hepatic resection was performed for liver metastases 29 months after the first operation, and as of this writing, the patient is alive with no evidence of a disease 78 months after the first operation. In general, colorectal cancer with ovarian metastasis is hard to cure, and long-term survival in patients with colorectal cancer with pseudo-Meigs' syndrome is rare. Our experience suggests that curative resection for pseudo-Meigs' syndrome caused by ovarian metastasis from colorectal cancer may offer long-term survival.
CONCLUSIONS
Our experience suggests that pseudo-Meigs' syndrome can occur in a patient with colorectal cancer after metastasis to the ovaries, causing massive ascites and pleural effusion. Aggressive treatment, including R0 resection, for this disease if allowed by the patient's general condition may offer long-term survival.
Topics: Adenocarcinoma; Ascites; Biopsy; CA-125 Antigen; Carcinoembryonic Antigen; Colectomy; Colonoscopy; Diagnosis, Differential; Drainage; Female; Humans; Hysterectomy; Immunohistochemistry; Keratin-20; Keratin-7; Laparotomy; Meigs Syndrome; Middle Aged; Omentum; Ovarian Neoplasms; Ovariectomy; Pleural Effusion; Prognosis; Sigmoid Neoplasms; Syndrome; Tomography, X-Ray Computed
PubMed: 27842595
DOI: 10.1186/s12957-016-1040-0 -
Oncology Letters Dec 2022Ovarian collision tumors are uncommon and reports of their radiological appearance are even less frequent. The present study reported the world's first case of an...
Ovarian collision tumors are uncommon and reports of their radiological appearance are even less frequent. The present study reported the world's first case of an ovarian collision tumor consisting of an ovarian sclerosing stromal tumor and a mature cystic teratoma and its imaging presentation. When a cystic solid ovarian mass combined with ascites and elevated CA125 is encountered it is frequently diagnosed as a malignant tumor, but the present case was a benign tumor. Therefore, when encountering similar cases, clinicians should not limit the diagnosis to malignant tumors to avoid rashly expanding the surgery and causing unnecessary harm to the patient. The combination of computed tomography, magnetic resonance imaging and pathology findings presented in the current study enable radiologists to learn about this disease and further assist clinicians in developing the best treatment plan.
PubMed: 36420070
DOI: 10.3892/ol.2022.13563 -
SAGE Open Medical Case Reports 2022Demons syndrome is defined by hydrothorax and ascites associated with a benign genital tumor that resolves after resection of the tumor. However, Demons syndrome with...
Demons syndrome is defined by hydrothorax and ascites associated with a benign genital tumor that resolves after resection of the tumor. However, Demons syndrome with pericardial effusion has never been reported. Intensive care unit-acquired weakness is a neurological sequela to sepsis/systemic inflammatory response syndrome, or multi-organ failure. A 47-year-old, nulligravid, Japanese woman, was transferred to our hospital for refractory heart failure and a ruptured ovarian tumor. She had an 11-cm left ovarian tumor with ascites, hydrothorax, and pericardial effusion; she was intubated for pulmonary hypertension and admitted to the intensive care unit for septic shock. Four days later, a left salpingo-oophorectomy was performed for Demons syndrome with pericardial effusion. The histological diagnosis indicated a serous cystadenoma with fibrotic changes. Following surgery, ventilator weaning was delayed due to intensive care unit-acquired weakness. The association between Demons syndrome and pericardial effusion should be recognized to ensure early treatment and for preventing sequalae from the disease.
PubMed: 35083047
DOI: 10.1177/2050313X211069315 -
Oxford Medical Case Reports Apr 2019[This corrects the article DOI: 10.1093/omcr/omy136.][This corrects the article DOI: 10.1093/omcr/omy136.].
[This corrects the article DOI: 10.1093/omcr/omy136.][This corrects the article DOI: 10.1093/omcr/omy136.].
PubMed: 31110774
DOI: 10.1093/omcr/omz018 -
Journal of Surgical Case Reports Mar 2023Meigs' syndrome is defined as a secondary triad of ascites, pleural effusion and benign ovarian tumor, usually fibroma. While pseudo-Meigs' syndrome is a rare condition...
Meigs' syndrome is defined as a secondary triad of ascites, pleural effusion and benign ovarian tumor, usually fibroma. While pseudo-Meigs' syndrome is a rare condition that is associated with benign ovarian tumor-other than fibroma-or even malignant. The case presented is a 40-year-old Saudi, nulliparous woman who was referred for precise diagnostic work-up as a case of huge pelvic-abdominal mass, tense ascites and pleural effusion. After further investigations cancer antigen-125 was found to be elevated. An abdominal CT scan revealed significant interval increase in the size of ascites, which cause huge abdominal distention, as well as a significant pleural effusion. Pathology of surgical specimens revealed a giant uterine leiomyoma, whereas the omentum excision surprisingly confirmed multiple disorganized arteries and veins, which resulted in omental arteriovenous malformation. To the best of our knowledge, this is the first reported case in the worldwide literature of two different rare conditions.
PubMed: 36937799
DOI: 10.1093/jscr/rjad080 -
Case Reports in Women's Health Oct 2022Thoracic endometriosis is an exceedingly rare condition characterized by the presence of endometriotic deposits on the diaphragm, lungs or pleural space. Patients may...
Thoracic endometriosis is an exceedingly rare condition characterized by the presence of endometriotic deposits on the diaphragm, lungs or pleural space. Patients may present with massive hemothorax, pneumothorax, hemoptysis or pulmonary nodules. It is a complex condition that often proves to be a diagnostic challenge, resulting in under-diagnosis, delays in treatment and significant morbidity in women of reproductive age. We report a case of endometriosis causing massive pleural effusion and ascites, with a left adnexal fibroid mass mimicking Meigs' syndrome in a nulliparous woman in her late 30s. The patient was successfully managed with hormonal therapy following fertility-sparing surgical treatment. This case highlights the diagnostic and therapeutic challenges associated with thoracic endometriosis because of its close resemblance to more sinister gynecological conditions. Hormonal therapy is the long-term treatment of choice in patients with thoracic endometriosis to reduce the risk of symptom recurrence and preserve fertility.
PubMed: 36246455
DOI: 10.1016/j.crwh.2022.e00452 -
Cureus Oct 2023Pseudo-pseudo Meigs' syndrome (PPMS), also known as Tjalma syndrome, is a rare complication of systemic lupus erythematosus (SLE), characterized by a triad of ascites,...
Pseudo-pseudo Meigs' syndrome (PPMS), also known as Tjalma syndrome, is a rare complication of systemic lupus erythematosus (SLE), characterized by a triad of ascites, pleural effusion, and elevated CA-125 levels. We report a case involving a 74-year-old female with a prior history of SLE who presented with recurrent bilateral pleural effusions, elevated CA-125 levels, and mild ascites. Imaging showed no evidence of any mass or malignancy. In this case, the patient's presentation aligned with the diagnostic criteria for PPMS. Additionally, all other potential causes were investigated, and no alternative pathologies better explained the patient's presentation. PPMS should be considered in the differential diagnosis when evaluating patients with this triad of symptoms and laboratory and imaging findings. Early and more accurate diagnosis can guide research into treatment modalities.
PubMed: 37946879
DOI: 10.7759/cureus.46753 -
Radiology Case Reports Dec 2023Malignant solitary fibrous tumors in the retroperitoneum are rare, and their treatment strategies have not yet been established. A 61-year-old woman with dyspnea...
Malignant solitary fibrous tumors in the retroperitoneum are rare, and their treatment strategies have not yet been established. A 61-year-old woman with dyspnea underwent laparotomy under a presumptive diagnosis of Meigs' syndrome. She underwent both adnexectomy and retroperitoneal tumor excision. The histologic diagnosis was of a fibrothecoma of both ovaries and a retroperitoneal solitary fibrous tumor that was considered malignant based on its mitotic activity. Local recurrence was observed 9 months postoperatively; re-excision was performed, and radiation therapy was administered. Four months later, metastasis to the left lung was detected, and a thoracoscopic resection was performed. Although pazopanib was administered subsequently, it was discontinued after 11 months because of proteinuria. She complained of dysphagia 3 weeks after the withdrawal of the drug, and a metastatic tumor was observed at the cranial base. Radiotherapy was initiated; however, she died of the disease 35 months after the primary surgery. Medical guidelines should be established for malignant solitary fibrous tumors to improve patient prognosis.
PubMed: 37868006
DOI: 10.1016/j.radcr.2023.09.073