Objective: To report a case of endometriosis associated with massive ascites, pleural effusion, and extremely elevated Ca-125.
Design: Case report.
Setting: University hospital.
Patient(s): A 46-year-old, white nulligravida with bilateral adnexal masses, Ca-125 of 3,504 U/mL, abdominal pain, ascites, and a pleural effusion.
Intervention(s): Chemotherapy followed by exploratory laparotomy for suspected ovarian cancer.
Main outcome measure(s): Surgical findings and histopathology.
Result(s): Intraoperative examination and histology ruled out malignancy but found stage IV endometriosis.
Conclusion(s): In rare instances advanced endometriosis may be associated with ascites, pleural effusions, and large pelvic masses. For this reason endometriosis should be included in the differential diagnosis of reproductive-age women presenting with apparent ovarian malignancy.