High-Grade Serous Ovarian Carcinoma Presenting With Massive Pleural Effusion in the Absence of Ascites: A Case Report and Review of the Literature

Abstract

Pleural effusion as an initial presentation of malignancy poses significant diagnostic challenges, particularly when linked to gynecologic cancers. We discuss the case of a 53-year-old female who presented with progressive dyspnea and a massive right-sided pleural effusion. Cytological analysis of the pleural fluid revealed malignant cells and immunohistochemical staining confirmed high-grade serous carcinoma (HGSC) of ovarian origin. Remarkably, there was no evidence of peritoneal carcinomatosis, ascites, or ovarian mass. PET-CT identified additional metastatic foci in the cul-de-sac. The patient was treated with systemic chemotherapy using carboplatin and paclitaxel, complemented by palliative management for recurrent effusion. This report highlights the critical importance of a multidisciplinary approach integrating clinical, pathological, and imaging findings to address atypical presentations of ovarian cancer.