Precise preoperative diagnosis of struma ovarii with pseudo-Meigs' syndrome mimicking ovarian cancer with the combination of 131 I scintigraphy and 18 F-FDG PET: case report and review of the literature

J Ovarian Res. 2018 Feb 2;11(1):11. doi: 10.1186/s13048-018-0383-2.

Abstract

Background: Struma ovarii is a rare ovarian neoplasm that often appears malignant on conventional imaging. Pseudo-Meigs' syndrome with ascites, pleural effusion, and elevated serum CA 125 levels is much rarer and leads to misdiagnosis of ovarian cancer and unnecessary extended surgery.

Case presentation: A 50-year-old woman with abdominal distention and dyspnoea was referred to our hospital. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) showed a polycystic ovarian tumor with a solid component, pleural effusion, and massive ascites with negative cytology. Her serum CA 125 level was 1237 U/ml, indicating the presence of ovarian cancer. Based on increased uptake of 131I but no uptake of 18F-FDG in the tumor, the preoperative diagnosis was struma ovarii with pseudo-Meigs' syndrome, which was confirmed histologically. She had no evidence of ascites and pleural effusion six months after surgery.

Conclusions: To date, there have been no systematic reviews focused on preoperative diagnosis with imaging modalities. The combination of 131I scintigraphy and 18F-FDG PET/CT in addition to conventional imaging modalities can provide the precise preoperative diagnosis of struma ovarii with pseudo-Meigs' syndrome mimicking ovarian cancer, leading to the appropriate treatment strategy.

Keywords: 131I scintigraphy; 18F–FDG PET; Pseudo-Meigs’ syndrome; Struma ovarii.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Biopsy
  • Diagnosis, Differential
  • Female
  • Fluorodeoxyglucose F18*
  • Histocytochemistry
  • Humans
  • Iodine Radioisotopes*
  • Meigs Syndrome / diagnosis*
  • Meigs Syndrome / pathology
  • Middle Aged
  • Multimodal Imaging / methods
  • Ovarian Neoplasms / diagnosis*
  • Ovarian Neoplasms / pathology
  • Positron Emission Tomography Computed Tomography*
  • Preoperative Care
  • Radionuclide Imaging*
  • Struma Ovarii / diagnosis*
  • Struma Ovarii / pathology

Substances

  • Iodine Radioisotopes
  • Iodine-131
  • Fluorodeoxyglucose F18