Rawan Obeidat, Timothy J Perren and Samir A Saidi
The association of struma ovarii with Pseudo-Meigs’ syndrome and elevation of CA 125 has been reported in literature. Here we report a 55-year-old with benign struma ovarii who presented with ascites, small left pleural effusion, suspicious left ovarian mass and elevated serum CA 125 level. Repeated cytology tests were negative for malignancy. The radiologic appearance was highly suggestive of an ovarian malignancy and due to her overall state of illness the patient received 3 cycles of chemotherapy. Chemotherapy had no impact on the rate of accumulation of ascites, CA 125 level or the size of the ovarian mass highlighting the need to reconsider the initial diagnosis. Diagnostic left oophorectomy revealed struma ovarii and was followed by resolution of the ascites and normalization of the serum CA 125. No recurrence of the ascites or of the tumor has been observed during the 5 months follow-up. Struma ovarii or other dermoid variants should be considered in the differential diagnosis in patients with ascites, pleural effusions and elevated CA125 level but with negative cytology. Diagnostic laparoscopic oophorectomy should also be considered within the standard protocol for diagnosis of indeterminate adnexal masses.