An Unusual Bilateral Presentation of Meigs' Syndrome in a Postmenopausal Woman: A Case Report.

Meigs' syndrome is a rare benign condition characterized by the triad of an ovarian tumor, ascites, and pleural effusion, often mimicking advanced ovarian malignancy. We report the case of a nulliparous woman in her late seventies who presented with a four-month history of progressive dyspnea, abdominal pain, and urinary frequency. Imaging revealed large bilateral solid adnexal masses measuring 17 cm and 15 cm, with no ascites detected initially. Tumor markers, including CA-125 (14 U/mL), were within normal limits. Magnetic resonance imaging demonstrated well-defined, non-enhancing solid masses without diffusion restriction, suggestive of benign ovarian stromal tumors. The Risk of Malignancy Index was 126, indicating low malignant potential. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Intraoperatively, two distinct ovarian tumors measuring approximately 8 cm each were identified, along with 300 mL of clear ascitic fluid, representing interval development not detected on prior imaging. Histopathological examination confirmed bilateral ovarian fibromas. Cytology of ascitic fluid was negative for malignancy. Postoperatively, ascites and pleural effusions resolved completely, confirming the diagnosis of bilateral Meigs' syndrome. At follow-up, the patient remained asymptomatic with no evidence of recurrence. This case highlights the diagnostic challenge of distinguishing Meigs' syndrome from ovarian malignancy, particularly in the presence of large bilateral masses. Integration of imaging characteristics, tumor markers, and risk stratification tools is essential to guide appropriate management and avoid unnecessary aggressive treatment.