EP23.50: Ovarian fibroma with large volume ascites: a case report

The incidence of ovarian fibroma is approximately 6% of all ovarian tumours. Meig's syndrome is a rare occurrence with this type of tumour, accounting for less than 2% of cases and can mimic malignancy. We present a case of a 34 year-old nulliparous Caucasian woman diagnosed with Meig's syndrome after presenting with a two-week history of abdominal pain and distension. A transvaginal ultrasound scan (TVS) confirmed a 10cm left sided unilocular-solid tumour with cystic spaces and colour Doppler score 2 with the appearances suggestive of ovarian fibroma. Extensive ascites was noted in the pelvis. A CT chest/abdomen/pelvis confirmed these findings along with bilateral pleural effusions. Ca 125 level was grossly elevated at 1413k units/L and cytology from the ascitic drainage was negative. Although imaging suggested a benign fibroma, the presence of massive ascites and raised tumour markers was suspicious for malignancy. She underwent a laparotomy, left salpingo-oophorectomy and peritoneal biopsies. Histology confirmed a benign ovarian fibroma with sclerosing peritonitis and secondary infarction. The ascites and pleural effusions resolved completely post-procedure without the need for further treatment. This case illustrates how benign conditions of the pelvis with associated adverse features can be challenging to diagnose as they can mirror malignancy. The ultrasound features aided being able to differentiate between a benign and malignant ovarian mass, which limited patient anxiety and expedited treatment. Having an awareness of the additional features seen with fibroma is important when assessing patients with these ultrasound findings. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.