Ovarian Granulosa Cell Tumor presenting as Meigs' Syndrome with elevated CA125
A 69-year-old Korean woman was admitted to our hospital complaining of abdominal fullness and dyspnea. Her family and medical histories were unremarkable. On physical examination, there was dullness to percussion, with decreased breath sounds in the lower half of the right lung field, a huge palpable mass in the lower abdomen, and on a rectovaginal examination a large, smooth solid mass was palpated on the left adnexa.\nLaboratory data on admission were within normal limits. A chest X-ray () and CT scan () showed massive right pleural effusion, and ultrasonography, CT and MRI scans revealed a 6×10×12 cm in sized intrapelvic huge solid mass, including cystic components involving both adnexae and the uterus, and a moderate amount of intra-abdominal fluid collection (, ). The MRI and CT scans showed no evidence of a metastatic disease involving the lymph nodes, bone or abdominal organs. The serum CA125 concentration was 82.49 U/mL (normal, 0~35 U/mL). The serum levels of carcinoembrionic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were normal. A cytological examination of both the ascites and pleural fluid showed no signs of malignant cells. An explorative laparotomy was performed based on the suspicion of ovarian cancer. Serous ascites, a moderately enlarged uterus and a large right ovarian mass were found, but there were no signs of metastatic spread. A total abdominal hysterectomy (TAH) was performed, with a bilateral salpingo-oophorectomy (BSO), partial omentectomy and pelvic lymph nodes sampling. During the operation, the ovarian tumor ruptured in the pelvic cavity and 2,500 mL of serous ascites were drained during the laparotomy. Due to the right pleural effusion, a trocar tube was inserted into the right thorax, with a total of 650 ml of serous fluid collected.\nThe specimens of the left ovary and salpinx, macroscopically, showed a previously ruptured fragile, with numerous grayish brown ovary tissues. Necrosis or hemorrhage was not found. Microscopically, this neoplasm was composed of diffuse sheets of round to oval cells. The nuclei of this tumor were pale and round and oval or angular and have occasional nuclear grooves (). The totally removed uterus measured 7×4×2.2 cm in size, and showed adenomyosis and senile endometrium. The right ovary and salpinx were grossly clean, but no definitive lesion was found. The resected partial omentum showed no malignant findings. Resected left and right pelvic lymph nodes were no tumor in 13 lymph nodes. A cytological examination of the ascites drained during the operation showed no sign of malignant cells. The final diagnosis of the left ovarian mass was that of a granulosa cell tumor. The pathologic stage of the tumor was designated as T1cNOMO and IC, according to the TNM stage and to the International Federation of Gynecologists and Obstetricians (FIGO) staging system, respectively.\nThe hydrothorax and ascites rapidly resolved in the early postoperative period (), and the trocar tube was removed on the seventh postoperative day. Four cycles of postoperative chemotherapy were planned due to the tumor rupturing during the operation. The adjuvant chemotherapy consisted of CAP (cyclophosphamide 500 mg/m2, adriamycin 50 mg/m2 and cisplatin 50 mg/m2 on day 1) regimen. Each cycle was repeated every 28 days. The patient had an uneventful postoperative course. The serum CA125 level declined, and had normalized 2 months after surgery.