A Case of Pseudo-Meigs' Syndrome Associated with Ovarian Metastases from Breast Cancer
A 54-year-old woman complained of abdominal fullness in February 2009. She had undergone breast-conserving surgery and axillary lymph node dissection for left breast cancer in October 2000, and had subsequently developed left pleural effusion () in July 2006. Thoracic drainage with intrathoracic administration of OK-432 had failed to control the pleural effusion, which contained no cancer cells. The patient experienced variable amounts of pleural effusion and was followed on an outpatient basis for the next 30 months.\nThe patient then developed abdominal distention with elevated serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 15-3 (). Positron emission tomography/computed tomography (PET/CT) showed bilateral ovarian tumors () with ascites. Systemic chemotherapy (weekly paclitaxel 80 mg/m2) and intra-abdominal chemotherapy (carboplatin 100 mg/m2) with repeated aspirations (4,000-8,500 mL) failed to control the ascites. Bilateral oophorectomies were performed to provide a definitive diagnosis of the ovarian tumors and to establish some therapeutic clues for controlling the ascites. The right and left ovaries were weighed 15 and 250 g (left tumor), respectively and were lobulated. No tumor dissemination was observed in the abdomen and the ascites contained no cancer cells cytologically. Pathological examination showed that the tumors were composed of solid and luminal structures () and were positive for estrogen receptor (), progesterone receptor, cytokeratin (CK)-7, and gross cystic disease fluid protein-15 (), and negative for HER2 overexpression and CK20. These pathological findings suggested that the bilateral ovarian tumors originated from the patient's breast cancer.\nThe patient was discharged 9 days after surgery. The left pleural effusion disappeared () and serum CEA and CA 15-3 levels decreased below the normal upper limit (). The patient remained well under aromatase inhibitor therapy with no further recurrence for 40 months after the oophorectomies.