Pseudo-Meigs’ syndrome caused by rapidly enlarging hydropic leiomyoma with elevated CA125 mimicking ovarian malignancy: A case report and literature review

Abstract Hydropic leiomyoma (HLM) is one of the rare subtypes of uterine leiomyoma. HLM is characterized by diffuse water degeneration and often secondary cystic changes. While HLM enlarged rapidly, especially with hydrothorax and ascites, they were often misdiagnosed as malignant tumors. Pseudo-Meigs’ syndrome is characterized by the presence of hydrothorax and ascites associated with pelvic masses (benign or malignant). Pseudo-Meigs’ syndrome presenting with elevated serum cancer antigen-125 (CA125) is rare and very likely misdiagnosed as a malignancy of the uterus or ovary. Pseudo-meigs’ syndrome with CA125 elevation caused by hydropic leiomyoma is rarer. Here, we reported a 45-year-old Chinese female with ascites, right hydrothorax and a rapidly enlarging pelvic mass. Preoperative abdominal and pelvic CT showed a giant solid mass in the fundus uteri, measuring 20×15×12 cm. The tumor marker CA125 was found to be elevated to 247.7 U/ml and 304.60 U/ml in serum and hydrothorax, respectively. She was initially diagnosed of uterine malignancy and underwent total abdominal hysterectomy and adhesiolysis. The final pathological diagnosis of the specimen was uterine hydropic leiomyoma with cystic changes. After the tumor removal, the ascites and hydrothorax disappeared rapidly and without recurrence. The serum CA125 dropped to 116.90 U/mL on day 7 and 5.6 U/mL on day 40. Follow-up was obtained at 6 months, 1 year, and 2 years after surgery, respectively. The patient's physical signs were all normal, with no recurrence of ascites or hydrothorax.