Large Twisted Ovarian Fibroma Associated With Meigs' Syndrome, Abdominal Pain and Severe Anemia Treated by Laparoscopic Surgery

Antonio Macciò; Clelia Madeddu; Paraskevas Kotsonis; Michele Pietrangeli; Anna Maria Paoletti


BMC Surg. 2014;14(38) 

In This Article


Ovarian fibromas belong to the group of sex cord-stromal cell tumors and are the most common benign solid tumors of the ovary, accounting for 1–4% of all benign ovarian tumors.[1,2] The most frequent symptoms are abdominal discomfort and pain, but many patients do not experience any specific symptoms. These solid tumors are often difficult to diagnose based on preoperative ultrasonography findings and are commonly misdiagnosed as uterine myomas. They are also sometimes misdiagnosed as malignant ovarian tumors because of accompanying ascites and an increased serum CA-125 level.[3] Ovarian fibromas account for the majority of benign tumors causing Meigs' syndrome, which is a rare but well-known syndrome defined as the triad of benign solid ovarian tumor, ascites and pleural effusion.[4]

Almost all cases of ovarian fibroma can be cured by surgical excision.[3] However, the optimal approach for the management of ovarian fibromas has not been sufficiently investigated. Surgeons may be reluctant to remove the tumor laparoscopically as it can be difficult to safely remove the excised tumor from the abdominal cavity. However, recent advancements in operative instruments and techniques have resulted in laparoscopic surgery becoming increasingly popular among gynecological surgeons.

We report a patient with a large twisted ovarian fibroma associated with Meigs' syndrome, abdominal pain and severe anemia that was treated by laparoscopic surgery. This case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach and the adverse impact that Meigs' syndrome can have on the patient's condition, especially if it is associated with acute pain and severe anemia.