UNILATERAL EXUDATIVE PLEURAL EFFUSION AS THE SOLE PRESENTING FEATURE OF A CLEAR CELL OVARIAN CARCINOMA

Abstract

SESSION TITLE: Medical Student/Resident Disorders of the Pleura Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pleural effusions are usually a manifestation of a pleuropulmonary or systemic disease. Pleural fluid analysis often provides insight into the underlying etiology, however, a thorough extrathoracic evaluation is needed in some cases for a definitive diagnosis. CASE PRESENTATION: We present the case of a 48-year-old female with a multinodular goiter who presented with exertional shortness of breath and cough over a 8-week duration. Chest radiograph showed complete opacification of the right hemithorax. Computed tomography of the chest revealed a large right-sided pleural effusion with complete collapse of the right lower and middle lobes, partial collapse of the right upper lobe and mediastinal shift to the left. Also noted was a heterogeneous enlargement of the left thyroid gland, with significant retrosternal extension into the superior mediastinum. A small-bore chest tube was inserted and 3 liters of serosanguinous pleural fluid was drained. Pleural fluid studies were consistent with an exudative effusion with lymphocytic predominance. Infectious workup including tuberculosis was negative. Fluid cytology was negative for malignant cells. Given the significant retrosternal extension of her goiter, the possibility of chylothorax was raised, which was rebutted by the pleural fluid appearance and normal triglycerides levels. Thyroid function tests and autoimmune markers were negative. An abdomino-pelvic ultrasound was performed, with the clinical possibility of an occult malignancy, as a possible etiology. This showed a left adnexal lesion, which prompted further characterization, by magnetic resonance imaging. The findings were compatible with epithelial ovarian/fallopian tube neoplasm. Laparoscopic left salpingo-oophorectomy was performed and pathology confirmed clear cell ovarian carcinoma. DISCUSSION: Clear cell ovarian carcinoma is a subtype of epithelial ovarian carcinoma, the most common type of malignant ovarian neoplasms. It often presents in perimenopausal women in their fifth or sixth decade of life. Epithelial ovarian cancer frequently presents with subacute pelvic or abdominal symptoms; however, it may present acutely with nonpelvic manifestations including bowel obstruction, venous thromboembolism, or malignant pleural effusion. Given the absence of abdominal and pelvic symptoms on clinical presentation, this case would have been missed if pelvic ultrasound was not performed. CONCLUSIONS: In conclusion, an unexplained exudative pleural effusion in a young female should warrant a high degree of clinical suspicion and further evaluation to rule out an abdominal or gynecological malignancy. Reference #1: Stéphane Beaudoin and Anne V. Gonzalez. Evaluation of the patient with pleural effusion. CMAJ March 12, 2018 190 (10) E291-E295 Reference #2: Rubins JB, Colice GL. Evaluating pleural effusions. How should you go about finding the cause? Postgrad Med. 1999 May 1;105(5):39-42, 45-8 Reference #3: Xavier Matias-Guiu and Colin J R Stewart. Endometriosis-associated Ovarian Neoplasia. Pathology, 2018-02-01, Volume 50, Issue 2, Pages 190-204 DISCLOSURES: No relevant relationships by Abdulaziz Alonazi, source=Web Response No relevant relationships by Shine Raju, source=Web Response No relevant relationships by Nadine Zahar, source=Web Response