Background: Uterine leiomyoma are commonly diagnosed in women of reproductive age. However, these benign tumors may present with clinical signs and symptoms that are consistent with ovarian carcinoma.
Case: A 47-year-old gravida 0 presented with a large pelvic mass, ascites, bilateral pleural effusions, and an elevated CA 125 worrisome for ovarian carcinoma. Exploratory laparotomy revealed a 20,120 g pelvic mass, with 2 L ascites, and pelvic and periaortic lymphadenopathy. Final pathology was consistent with a benign giant leiomyoma. Postoperative course was complicated by reaccumulation of pleural effusion requiring therapeutic thoracentesis and diuretics. Patient had return to full activity with 50 pound weight loss at 8 weeks after surgery.
Conclusion: Elevated CA 125 levels and ascites are often associated with ovarian carcinoma, but it is also important to keep benign processes in the differential diagnosis when considering malignancy.