Clear-cell borderline tumor with pseudo-Meigs' syndrome: a case report and review of the literature.

BACKGROUND: Ovarian clear-cell borderline tumor is a rare epithelial tumor that predominantly has been identified in post-menopausal patients. Patients may become symptomatic due to mass effect, and treatment requires complete surgical excision. However, development of ascites and pleural effusions associated with clear-cell borderline tumor has not yet been reported.

CASE DESCRIPTION: We present the experience of a 68-year-old patient with complaints of increasing abdominal swelling, difficulty breathing, productive cough, and an abdominal mass. Physical exam was most notable for a large mobile mass that was separate from the uterus. Computed tomography scans appreciated a 26-cm, solid, multi-lobulated mass arising from the left ovary and a right-sided pleural effusion with left mediastinal shift and ascites. No pulmonary embolism was identified. CA-125 was 645 U/mL and carcinoembryonic antigen (CEA) was 1.6 U/mL. Taken together, her findings appeared consistent with a Meigs' syndrome-like picture and she underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, omental biopsy, and pelvic washings. No gross evidence of metastatic disease was appreciated intraoperatively, and no residual disease was appreciated at the conclusion of the case. Her pathology was ultimately classified as clear cell borderline tumor. Post-operatively, her initial symptoms completely resolved, and she was discharged with routine follow-up per the recommendations of our institution's Multi-Disciplinary Gynecologic Oncology Tumor Board.

CONCLUSIONS: Clear-cell borderline tumors can be associated with development of pseudo-Meigs' syndrome, which ultimately resolves following complete excision of the tumor. Patients generally can be closely monitored in the outpatient setting and do not require further therapy.