•Am J Med Su g – Oc obe 2025; 21 (2). 5-8
www.amjmedsu g.o g DOI 10.5281/zenodo.17314450
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
Meigs synd ome and ele a ed CA-125 le els, clinical
mimic y wi h o a ian cance . A case epo
Monica I zel Rami ez Diaz M.D.
Edia do To es Delgado M.D.
Jose I an Rod iguez Mu ua M.D.
Jenni e Na a o Mo ales M.D.
Edga Alexis Flo es Ga cia M.D.
Al edo C uz Naje a M.D.
Julio Cesa Salaza Reza M.D.
S e any Cas o Ga cia M.D.
Pa icia Del Ca men Rosales
Gu ie ez M.D.
May a Lize h Gue eca Muñoz M.D.
Du ango, Mexico
eigs synd ome is an ex emely a e
gynaecological disease, p esen ing as
ib oma o a ib oma-like umo ( hecoma,
g anulosa cell umo , o B enne umo ) accompanied
by asci es and hyd o ho ax ha apidly esol e a e
emo al o he umo .1 This synd ome was i s
epo ed by Joe Vincen Meigs in 1937 in a se ies o 7
cases whe e pa ien s p esen ed wi h an o a ian
ib oma and associa ed asci es and hyd o ho ax.2
O a ian ib omas cons i u e he majo i y o he benign
umo s seen in Meigs synd ome.3 Fib omas ep esen
app oxima ely 4% o o a ian umo s and Meigs
synd ome occu s in only 1% o 2% o hese cases, hus
is a a e condi ion.4 CA-125 (cance an igen-125), is a
human glycop o ein employed o he diagnosis and
ollow-up o di e en cance his o ypes: i s ,
epi helial o a ian cance .5 Commonly, i is sligh ly
aised in Meigs Synd ome, al hough in he scien i ic
li e a u e, a alue abo e 1000 IU/mL is a e.6 The
p esen wo k is a case epo o Meigs Synd ome wi h
ele a ed CA-125 le els.
Case epo
A 47-yea -old woman wi h no ch onic
illnesses, G2 P2, and no his o y o smoking o
alcoholism, began expe iencing an inc ease in
abdominal ci cum e ence h ee yea s ago. Two mon hs
ago, she p esen ed wi h p og essi e dyspnea, which
occu ed wi h mode a e o mild exe ion. A
ho acoabdominal compu ed omog aphy scan showed
igh pleu al e usion wi h igh lung collapse (Figu e
1), a complex igh o a ian mass measu ing 20 x 17
cm wi h ee luid, and an image sugges i e o a Sis e
Ma y Joseph´s node (Figu e 2). Du ing he
hospi aliza ion, 3 ho acocen esis e acua o s we e
pe o med, ex ac ing a o al o 4 li e s. Tumo ma ke
le els we e: CEA 1.6 ng/mL, e e ence le els <5.0
ng/mL, hCG <1.2 mIU/mL, Ca 19-9 5.2 U/mL,
e e ence le els <37 U/mL, AFP 2.6 ng/mL, e e ence
le els 0.89-8.78 ng/mL, CA-125 wi h ele a ed le els
o 565, e e ence le els o <35 U/mL.
M
Backg ound: Meigs synd ome is a a e gynecological condi ion cha ac e ized
by he iad o a benign o a ian umo (commonly ib oma), asci es, and
pleu al e usion, all o which esol e a e su gical emo al o he umo .
Fi s desc ibed by Meigs in 1937, his synd ome occu s in only 1–2% o
o a ian ib oma cases. Al hough CA-125 is ypically associa ed wi h
epi helial o a ian cance , mild o mode a e ele a ion can be obse ed in
Meigs synd ome due o ac o s such as pe i oneal i i a ion and meso helial
cell ac i i y.
This case epo p esen s a 47-yea -old woman wi h p og essi e abdominal
dis ension and dyspnea. Imaging e ealed a la ge igh o a ian mass, asci es,
and a igh pleu al e usion. CA-125 le els we e signi ican ly ele a ed a 565
U/mL. Following a adical hys e ec omy wi h igh oopho ec omy,
his opa hology con i med a benign o a ian ib oma. Pos ope a i ely, he
pa ien 's asci es and pleu al e usion esol ed comple ely.
Meigs synd ome should be conside ed in he di e en ial diagnosis o pa ien s
p esen ing wi h asci es, pleu al e usion, and an o a ian mass, e en wi h
ele a ed umo ma ke s like CA-125 since hese indings do no always
indica e malignancy. Unde s anding his a e synd ome is essen ial, as
su gical emo al o he benign umo esul s in ull esolu ion o symp oms
and a o able ou comes, a oiding unnecessa y agg essi e oncologic
ea men .
Keywo ds: Meigs synd ome, CA-125
Gene al Su ge y
Case
Repo
F om
he
In e nal Medicine Depa men a New Gomez Palacio Hospi al.
Gomez Palacio
,
Du ango
.
Recei ed on
Oc obe 4
, 2025.
Accep ed on
Oc obe
7
, 2025.
Published on Oc obe 10, 2025.
Rami ez Diaz MI. e al. Am J Med Su g - Oc obe 2025; 21 (2). 5-8
www.amjmedsu g.o g DOI 10.5281/zenodo.17314450
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
Figu e 1. Ches CT scan showing igh pleu al e usion.
The Oncosu ge y se ice pe o med a adical
hys e ec omy plus igh oopho ec omy, e ealing a
igh o a ian umo (Figu e 3) (Figu e 4). The 1,027 g
o a ian sample is sen o his opa hology cha ac e ized
by ound, spindle-shaped cells wi hin collagenous
s oma. A e he su gical p ocedu e, he pa ien 's
pleu al e usion and asci es esol ed and is cu en ly
being moni o ed by he Oncosu ge y se ice.
Discussion
Meigs synd ome is diagnosed wi h he iad o
asci es, pleu al e usion, and an o a ian umo , which
is usually benign, occu ing oge he .7 Demons
desc ibed a synd ome based on nine pa ien s wi h
benign o a ian cys s who we e cu ed o hei asci es
and pleu al e usion by emo al o he cys .8 Howe e ,
his synd ome was no named un il 1937 when Joe
Vincen Meigs along wi h Cass published a se ies o
se en pa ien s p esen ing wi h a iad o indings:
Asci es, hyd o ho ax, and ib oma o he o a y
cha ac e ized by he esolu ion o symp oms wi h
abla ion o he umo .7 Pe ica dial e usion is no
included in he de ini ion o Meigs synd ome;
howe e , he e ha e been case epo s o pa ien s wi h
unexplained pe sis en pe ica dial e usion ha
esol ed a e he emo al o a benign o a ian umo .9
Meigs synd ome is diagnosed in associa ion
wi h app oxima ely 1% o o a ian umo s, mos o
which a e ound o be benign o a ian ib oma on inal
his ologic analysis.4 Abou 10% o 15% o women wi h
o a ian ib omas ha e asci es, and 1% ha e
hyd o ho ax.10 App oxima ely 70% o pleu al e usions
a e igh -sided, 15% le -sided, and 15% a e bila e al.11
The e iology o asci es and pleu al e usion in Meigs
synd ome is subjec o deba e and la gely emains o
be elucida ed. The e a e se e al hypo heses ega ding
he mechanism unde lying he gene a ion o pe i oneal
luid. I p obably occu s by means o a ansuda i e
mechanism h ough he su ace o he umo ha
Figu e 2. Abdominal CT scan showing a igh o a ian mass.
exceeds he eso p i e capaci y o he pe i oneum.12
O he po en ial explana ions include ho mone
s imula ion, obs uc ion o lympha ic low by he
umo , and elease o in lamma o y cy okines and
g ow h ac o s by umo cells. The di ec cause o
pleu al luid o ma ion is hough o in ol e
ansloca ion o asci es o he ho acic ca i y ia
diaph agma ic po es.13
The mos common his ological ypes in he
scien i ic li e a u e a e cellula ib oma, ib o-
hecoma, ib oma, hecoma, and g anulosa cell
umo s.6 Al hough a ious cases o Meigs Synd ome
wi h ele a ed CA-125 se um le els ha e been
desc ibed o e he yea s, only 1% o o a ian ib omas
o ib osa comas ha e p esen ed wi h asci es and
pleu al e usion. Fo ha eason, Meigs synd ome is
conside ed a e in ha speci ic con ex .8,14
CA-125, commonly used as a umo ma ke , is
a s ong independen p ognos ic ac o o epi helial
o a ian cance .15 Despi e he sensi i i y o CA-125 in
he de ec ion o o a ian cance , i s speci ici y is
known o be subop imal. Many o he condi ions
(neoplas ic o non-neoplas ic) can also cause an
ele a ion o CA-125 le els, including endome iosis,
ci hosis, u e ine ib oids, p egnancy, o a ian cys s,
and pel ic in lamma o y disease.16
In a de e mina ion o CA125 le els o 988
women wi h benign gynecological diso de s, Nilo e
al., obse ed he CA125 le el o be mo e han 65
IU/ml in 1% on a single de e mina ion and only 0.5%
on wo sequen ial de e mina ions.17 O he epo s o
CA125 assessmen in pa ien s wi h benign s omal
umo s wi hou asci es desc ibe le els less han 35
IU/ml.18 Howe e , in pa ien s wi h asci es wi h o
wi hou hyd o ho ax, CA125 le els a e much highe .
No ably, he exac mechanisms ha lead o CA-125
ele a ion in pa ien s wi h Meigs synd ome emain
unclea . Some s udies ha e shown ha meso helial
cells om asci es in pa ien s wi h Meigs synd ome a e
able o syn hesize CA-125.19
Rami ez Diaz MI. e al. Am J Med Su g - Oc obe 2025; 21 (2). 5-8
www.amjmedsu g.o g DOI 10.5281/zenodo.17314450
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
Figu e 3. In aope a i e iew showing he igh o a ian umo .
Su gical emo al o he o a ian mass h ough
lapa o omy o wi h minimally in asi e echniques,
such as lapa oscopy, wi h an in aope a i e issue
sample sen o ozen sec ion his ologic con i ma ion
is cu a i e.20 In pos menopausal women, a o al
abdominal hys e ec omy wi h bila e al salpingo-
ooph ec omy is ecommended.21 Remo al o he umo
esul s in he esolu ion o asci es and pleu al e usion
and no maliza ion o CA-125 in Meigs and pseudo-
Meigs synd ome.22
Conclusion
In pa ien s wi h an o a ian mass, pleu al
e usion, and asci es, a ho ough in es iga ion is
wa an ed o exclude o a ian cance . Howe e , i is
no necessa ily caused by a malignan condi ion, as in
his case i was associa ed wi h a benign condi ion
such as Meigs synd ome. The e o e, i is impo an o
unde s and his associa ion, as i leads o an excellen
p ognosis wi h he emo al o he mass.
Con lic s o in e es s
The au ho s ha e no con lic s o in e es s.
Re e ences
1. Rike , Da id MD, FCCP; Goba, Daniel MD. O a ian
Mass, Pleu al E usion, and Asci es: Re isi ing Meigs
Synd ome. Jou nal o B onchology & In e en ional
Pulmonology 20(1):p 48-51, Janua y 2013. | DOI:
10.1097/LBR.0b013e31827ccb35.
2. Meigs JV, Cass JW. Fib oma o he o a y wi h asci es
and hyd o ho ax. Am J Obs e Gynecol. 1937;33:249–
267.
Figu e 4. Mac oscopic sample o o a ian mass o 1,027 g.
3. MEIGS JV. Pel ic umo s o he han ib omas o he
o a y wi h asci es and hyd o ho ax. Obs e Gynecol.
1954 May;3(5):471-86. PMID: 13154792.
4. Ag ano D, May D, Jameson C, Knowles GK. Pleu al
e usion and a pel ic mass. Pos g ad Med J. 1998
May;74(871):265-7. doi: 10.1136/pgmj.74.871.265.
PMID: 9713603; PMCID: PMC2360906.
5. Boni ácio VDB. O a ian Cance Bioma ke s: Mo ing
Fo wa d in Ea ly De ec ion. Ad Exp Med Biol.
2020;1219:355-363. doi: 10.1007/978-3-030-34025-
4_18. PMID: 32130708.
6. Viei a SC, Pimen el LH, Ribei o JC, de And ade Ne o
AF, de San ana JO. Meigs' synd ome wi h ele a ed CA
125: case epo . Sao Paulo Med J. 2003 Sep
1;121(5):210-2. doi: 10.1590/s1516-
31802003000500007. Epub 2003 No 5. PMID:
14666294; PMCID: PMC11110621.
7. Lu ie S. Meigs' synd ome: he his o y o he eponym.
Eu J Obs e Gynecol Rep od Biol. 2000 Oc ;92(2):199-
204. doi: 10.1016/s0301-2115(99)00289-4. PMID:
10996681.
8. B un JL. Demons synd ome e isi ed: a e iew o he
li e a u e. Gynecol Oncol. 2007 Jun;105(3):796-800. doi:
10.1016/j.ygyno.2007.01.050. Epub 2007 Ap 11.
PMID: 17433421.
9. Giana akis M, Ve ma B, Ve ma N, Ma waha C, Polla d
R, Kondapaneni M, Si aj A, Siddiqi NI. Ra e Va ian o
Meigs Synd ome Associa ed Wi h Pe ica dial E usion.
JACC Case Rep. 2023 Jun 14;18:101927. doi:
10.1016/j.jaccas.2023.101927. PMID: 37545678;
PMCID: PMC10401126.
10. Taniguchi Y, Nishikawa H, Maeda N, Te ada Y.
B ea hlessness, pleu al e usions, ib omas, and Meigs
synd ome: look beyond he ches and don' delay!
Lance . 2020 Feb 15;395(10223):e32. doi:
10.1016/S0140-6736(20)30111-2. PMID: 32061301.
11. Neme h AJ, Pa el SK. Meigs synd ome e isi ed. J
Tho ac Imaging. 2003 Ap ;18(2):100-3. doi:
10.1097/00005382-200304000-00009. PMID:
12700485.
12. Saman h KK, Black WC 3 d. Benign o a ian s omal
umo s associa ed wi h ee pe i oneal luid. Am J Obs e
Rami ez Diaz MI. e al. Am J Med Su g - Oc obe 2025; 21 (2). 5-8
www.amjmedsu g.o g DOI 10.5281/zenodo.17314450
Copy igh 2025 © Unau ho ized ep oduc ion o his a icle is p ohibi ed.
Gynecol. 1970 Jun 15;107(4):538-45. doi:
10.1016/s0002-9378(16)33939-4. PMID: 4316407.
13. Aman F, Gab iel C, Timme man D, Ve go e I. Pseudo-
Meigs' synd ome caused by a hyd opic degene a ing
u e ine leiomyoma wi h ele a ed CA 125. Gynecol
Oncol. 2001 Oc ;83(1):153-7. doi:
10.1006/gyno.2001.6251. PMID: 11585430.
14. Cha MY, Roh HJ, You SK, Lee SH, Cho HJ, Kwon YS.
Meigs' synd ome wi h ele a ed se um CA 125 le el in a
case o o a ian ib o hecoma. Eu J Gynaecol Oncol.
2014;35(6):734-7. PMID: 25556284.
15. Moon JH, Lee HJ, Kang WD, Kim CH, Choi HS, Kim
SM. P ognos ic alue o se um CA-125 in pa ien s wi h
ad anced epi helial o a ian cance ollowed by comple e
emission a e adju an chemo he apy. Obs e Gynecol
Sci. 2013 Jan;56(1):29-35. doi:
10.5468/OGS.2013.56.1.29. Epub 2013 Jan 9. PMID:
24327977; PMCID: PMC3784109.
16. Moo e RG, Mille MC, S einho MM, Ska es SJ, Lu
KH, Lambe -Messe lian G, Bas RC J . Se um HE4
le els a e less equen ly ele a ed han CA125 in women
wi h benign gynecologic diso de s. Am J Obs e
Gynecol. 2012 Ap ;206(4):351.e1-8. doi:
10.1016/j.ajog.2011.12.029. Epub 2011 Dec 30. PMID:
22284961; PMCID: PMC3985608.
17. Nilo JM, Knapp RC, Schae zl E, Reynolds C, Bas RC
J . CA125 an igen le els in obs e ic and gynecologic
pa ien s. Obs e Gynecol. 1984 No ;64(5):703-7. PMID:
6208522.
18. Vasile SA, Schlae h JB, Campeau J, Mo ow CP.
Se um CA 125 le els in p eope a i e e alua ion o
pel ic masses. Obs e Gynecol. 1988 May;71(5):751-6.
PMID: 3162763.
19. Liou JH, Su TC, Hsu JC. Meigs' synd ome wi h ele a ed
se um cance an igen 125 le els in a case o o a ian
scle osing s omal umo . Taiwan J Obs e Gynecol.
2011 Jun;50(2):196-200. doi:
10.1016/j. jog.2011.01.011. PMID: 21791307.
20. Yada S, Toma R, Ve ma N, Khu ana N, T ia hi R.
S uma O a ii wi h Pseudo-Meigs' Synd ome and Raised
Cance An igen-125 Le els Masque ading as an O a ian
Ca cinoma Case epo and li e a u e e iew. Sul an
Qaboos Uni Med J. 2017 May;17(2):e229-e233. doi:
10.18295/squmj.2016.17.02.017. Epub 2017 Jun 20.
PMID: 28690899; PMCID: PMC5488828.
21. Ha oum S, Ja jou a P, Saade C, Na aa L. Scle osing
S omal Tumo o he O a y P esen ing as Meigs
Synd ome Du ing Childhood. Cu eus. 2022 No
16;14(11):e31562. doi: 10.7759/cu eus.31562. PMID:
36540492; PMCID: PMC9756104.
22. Nguyen P, Yazdanpanah O, Schumake B. Meigs'
Ve sus Pseudo-Meigs' Synd ome: A Case o Pleu al
E usion, Asci es, and O a ian Mass. Cu eus. 2020 Aug
12;12(8):e9704. doi: 10.7759/cu eus.9704. PMID:
32944427; PMCID: PMC7489329.
Edua do To es Delgado
In e nal Medicine Depa men
New Gomez Palacio Hospi al
Gomez Palacio Du ango, Mexico.
