CRA99 HOW A HIDDEN OVARIAN TUMOR STOLE A WOMAN’S BREATH?

Vijayan Munusamy¹, Kuan Woon Pang², Izazul Bin Hussin², Rama Krishna², Kalai Selvi ², Mohd Falah. Rushin Maria Dass², Thanikachalam³

Universiti Malaya Medical Center, Kuala Lumpur, Malaysia¹
Hospital Columbia Asia²
Innoquest Pathology³

A 39-year-old woman with prior cerebral thrombosis presented with a dramatic two-month illness featuring progressive dyspnea, orthopnea, and alarming 8 kg weight loss. The shocking discovery of a massive right pleural effusion - with 6,790 mL of fluid drained - launched an intensive diagnostic quest. The exudative, lymphocytic-predominant effusion defied explanation, with tuberculosis and malignancy ruled out (negative GeneXpert, benign cytology). The breakthrough came when imaging revealed an imposing 15.3 cm left adnexal mass. Contrast-enhanced CT unveiled a solid-cystic ovarian tumor with ascites but no metastasis, pointing to Meigs' syndrome.

Definitive laparotomy exposed a substantial 125 × 100 × 65 mm (400g) ovarian fibroma. Like magic, its removal completely resolved the pleural effusion, confirming this fascinating diagnosis. The case exemplifies Meigs' classic triad (benign ovarian tumor, ascites, pleural effusion) - a master of disguise that mimics malignancy or tuberculosis.

This clinical detective story underscores crucial lessons:
(1) Meigs' syndrome remains an underrecognized cause of refractory pleural effusions
(2) pelvic imaging is mandatory in unexplained effusions
(3) timely recognition prevents unnecessary invasive procedures.

The rapid postoperative resolution highlights how cure often lies in identifying the correct culprit.