Struma ovarii with synchronous ascites and elevated CA125 level: a retrospective cohort study

Figures & data

Table 1. The clinical characteristics of so patients and those with ascites and elevated CA125 levels (N = 21).

Variables	SO with ascites and elevated CA125 levels (N = 21)	Overall SO cohort (N = 229)
Age (y)	50.2 ± 13.4/54.0 (23–70)	44.1 ± 14.7/43.0 (17–92)
Mass size (cm)	9.5 ± 3.9/10.2 (4.0–15.0)	7.4 ± 4.5/4.5 (1.8–25.0)
Elevated tumor makers
CA125	17	47
CA125 + CA19-9	4	20
Serum CA125 level (U/mL)	411.7 (37.1–2263.5)	219.5 (35.8–2263.5)
Preoperative diagnosis
Benign	7 (33.3%)	174 (76.0%)
Suspected malignant	10 (47.6%)	10 (4.4%)
Obvious malignant	4 (19.0%)	45 (19.6%)
Ascites volume (mL)	1472.4	949.6
Surgery
Ovarian cystectomy	3 (14.3%)	93 (40.6%)
USO	5 (23.8%)	50 (21.8%)
BSO	3 (14.3%)	10 (4.4%)
Hysterectomy with BSO	8 (38.1%)	67 (29.3%)
Staging surgery	2 (9.5%)	9 (3.9%)

SO: struma ovarii; USO: unilateral salpingo-oophorectomy; BSO: bilateral salpingo-oophorectomy

The age and mass size were displayed as ‘mean/median (range)’.

Table 2. Logistics regression to identify potential risk factors for patients with ascites and elevated CA125 levels (N = 229).

Variables	Group A (n = 21)	Group B (n = 208)	p Value	Logistic regression analysis
				OR	95% CI	p Value
Age (y)^a	50.2 ± 13.4	43.5 ± 14.7	0.047
< 49	7 (33.3%)	132 (63.5%)	0.007		Ref.
≥ 49	14 (66.7%)	76 (36.5%)	–	3.71	1.29–10.64	0.015
Mass size (cm)^a	9.5 ± 3.9	7.2 ± 4.6	0.027
< 10.0	10 (47.6%)	179 (86.1%)	<0.001		Ref.
≥ 10.0	11 (52.4%)	29 (13.9%)		8.79	3.05–25.35	<0.001
Ascites (mL)	1472.4	339.8	0.115
Side of location			1.000
Left	9 (42.9%)	86 (42.0%)	–	–	–	–
Right	12 (57.1%)	119 (58.0%)
Pure SO^a			0.072	–	–	–
No	4 (19.0%)	81 (38.9%)
Yes	17 (81.0%)	127 (61.1%)	–	–	–	–
Proliferative SO^a			<0.001
No	15 (71.4%)	199 (95.7%)	–	–	Ref.	–
Yes	6 (28.6%)	9 (4.3%)		11.16	3.01–41.47	<0.001
Coexisted tumor			0.718	–	–	–
No	20 (95.2%)	192 (92.3%)
Yes	1 (4.8%)	16 (7.7%)	–	–	–	–

^aFactors assigned to multivariate logistic regression analysis.

Ref.: reference; OR: odds ratio; CI: confidence interval; SO: struma ovarii

Note: age and mass size were classified as categorical variables in multivariate logistic regression.

Figure 1. The ROC curve revealed the predictive performance of age and mass size.

Table 3. The summary of four patients with pseudo-Meigs’s syndrome and elevated CA125 levels.

No.	Age (y)	Manifestations, imaging findings, and elevated tumor makers	Intraoperative frozen pathology	Treatment and paraffin pathology	Clinical outcomes
1	53	Abdominal distention, intermittent dyspnea; US (plenty of blood flow signals) and PET/CT revealed 8.0*5.4*6.7 cm left ovarian solid-cystic mass, massive ascites (10.1 cm deep) and mild hydrothorax, suspected ovarian malignancy; CA125 1076.0 U/mL	Left SO	Laparotomy BSO (4000 mL clarified faint yellow ascites, cytological negative); SO with follicle adenomatous hyperplasia (Ki-67 3%)	NED at 9 months, US showed no ascites and hydrothorax 1 month after surgery
2	56	Abdominal distention; US/CT showed 15.6*10.0*8.0 cm solid-cystic mass, with plenty blood flow signals in solid portion; ascites (6.2-cm deep); moderate bilateral hydrothorax, suspected left ovarian carcinoma; CA125 358.6 U/mL, CA19-9 54.0 U/mL	Left SO	TAH + BSO (3000 mL faint yellow, clear ascites, cytological negative); SO (Ki-67 1%)	NED at 64 months, US showed no ascites and hydrothorax 2 weeks later
3	65	Chest distress, abdominal distension; US, CT, and PET/CT showed bilateral adnexal solid-cystic mass, 4.6/4.0 cm; massive hydrothorax and ascites (8-cm deep), suspected epithelial ovarian cancer; CA125 1031.0 U/mL	Left SO	Thoracentesis and drainage (3000 mL); abdominocentesis (total 10,000 mL faint yellow ascites, cytological negative) Laparoscopic BSO; SO	NED at 56 months, US showed no ascites and hydrothorax 2 weeks later
4	28	Abdominal distention; US/CT identified a 11.5*7.5*13.1 cm and 6-cm solid-cystic mass, suspected teratoma could not be excluded; massive ascites (9-cm deep) and mild-moderate bilateral hydrothorax; CA125 582.0 U/mL, CA19-9 233.7 U/mL	Mature cystic teratoma (left ovary)	Abdominocentesis (drainaging 4000 mL yellow ascites, cytological negative); laparotomy LSO; Mature teratoma with SO (adenomatous hyperplasia)	NED at 16 months, US showed no ascites and hydrothorax 4 weeks later

US: ultrasonography; SO: struma ovarii; B (R/L) SO: bilateral (right/left) salpingo-oophorectomy; TAH: total abdominal hysterectomy; NED: no evidence of disease

Figure 2. Intraoperative view of one patient with synchronous pseudo-Meigs’ syndrome and elevated serum CA125 level (Case 4). (a) CT scan identified an 11.5*7.5*13.1 cm solid-cystic pelvic mass and massive ascites. (b) The mass was of left ovary origin with a smooth surface and plenty of blood vessels. (c) The cutting surface of the ovarian tumor revealed a cystic-solid structure with lipids and hair. (d) The cutting surface of the solid portion was in dark red, yellowish color.

Figure 3. The pathology of the four patients with synchronous pseudo-Meigs’ syndrome and elevated serum CA125 level (HE staining, 100X). (a) Case 1; (b) Case 2; (c) Case 3; (d) Case 4.

Data availability statement

All data generated or analyzed during this study are included in this published article and the Supplementary Information Files. The datasets used and/or analyzed during this study can be obtained from the corresponding author upon reasonable request.