Large Uterine Leiomyoma with Elevated Ca-125 And Ascites; A Case Report of an Atypical Pseudo-Meigs Syndrome

Introduction: Atypical Pseudo-Meigs syndrome, a rarely documented condition, involves ascites caused by pelvic tumours other than benign ovarian growths, with symptoms resolving after tumour removal. It presents with an elevated CA-125 levels, but crucially, no pleural effusion. Case Presentation: We report on a 50-year-old woman with seven years of progressive abdominal swelling. Examination showed a distended, non-tender abdomen with a mobile, 36-week sized pelvic mass and ascites. Imaging confirmed an intra-abdominal mass with moderate ascites, while a chest X-ray showed normal lung parenchyma with no pleural effusion. Her serum CA-125 was significantly elevated (150 U/ml). Following counselling, she underwent an exploratory laparotomy where a total abdominal hysterectomy and bilateral salpingo-oophorectomy were done. Intra-operative findings included a large (20x18x22cm) multinodular uterine leiomyoma with cystic degeneration, one litre of non-bloody ascitic fluid, and atretic ovaries. Histopathology confirmed a benign degenerated leiomyoma. Post-operatively, her ascites and all symptoms completely resolved, and her CA-125 normalized within six weeks, confirming the diagnosis. Conclusion: Atypical Pseudo-Meigs syndrome, though rare and mimicking malignancy, is highly curable and should be a differential diagnosis for patients presenting with a pelvic mass, abdominal distention, ascites, and elevated CA-125 without pleural effusion. This case also highlights the need to consider benign aetiologies in malignancy-mimicking presentations.