Pseudo-Meigs syndrome and elevated levels of tumor markers associated with benign ovarian tumors--two case reports

Elevated tumor markers for a post-menopausal woman presenting with a multilocular adnexal mass, ascites, and pleural effusion were interpreted as being highly suspicious of malignancy. This paper describes two cases of ovarian tumors presenting with all signs of malignancy. Following surgical excision of the masses, and histopathological assay, a benign pure struma ovarii and a mucinous cystadenoma were diagnosed by pathologists. The immediate and complete resolution of symptoms were achieved post-operatively, and the previously-evident abnormal tumor markers rapidly declined to the normal range, the two tumors were subsequently classified as pseudo-Meigs' syndromes.

Pseudo-Meigs' syndrome caused by secondary ovarian tumors from gastrointestinal cancer. A case report and review of the literature

BACKGROUND

Pseudo-Meigs' syndrome is a condition characterized by nonmalignant ascites and/or pleural effusion caused by pelvic tumors other than solid benign ovarian tumors. This syndrome has only rarely occurred in association with gastrointestinal cancers.

METHOD

We treated a 53-year-old woman who developed this syndrome due to ovarian metastasis from colon cancer. Diagnostic work-up for abdominal distension disclosed a sigmoid colon cancer and bilateral ovarian masses. Ultrasonography demonstrated massive ascites and a right pleural effusion. Repeated cytologic examinations of both effusions revealed no malignant cells. Laparotomy disclosed no peritoneal dissemination. A radical sigmoidectomy and hysterectomy with bilateral salpingo-oophorectomy were performed.

RESULTS

Histologic examination confirmed ovarian metastases from the colonic primary tumor. After resection, both effusions disappeared promptly, confirming a diagnosis of pseudo-Meigs' syndrome caused by sigmoid colon cancer. The patient remains alive with disease after 52 months.

CONCLUSION

Among 6 reported occurrences with gastrointestinal tumors including our case, the primary site was the colon or rectum in 5 and the stomach in 1. Two cases were due to Krukenberg tumors. Three patients with documented outcomes were alive 108, 52, and 12 months after resection. Clinicians should note that gastrointestinal cancers, especially colorectal tumors, rarely may cause pseudo-Meigs' syndrome and resection may provide long-term palliation.

[Meigs' syndrome and "Meigs' pseudo-syndrome." Report of 2 cases]

BACKGROUND

The aim of this study is to investigate similitudis and differences between the Meigs' syndrome and Meigs' pseudosyndrom. The Meigs' syndrome is an uncommon disease that is characterized by benign ovarian tumor, ascites and pleural effusion. The Meigs' pseudosyndrom is a serious disease that is characterized by malignant ovarian tumor, ascites, pleural effusion.

METHODS

We have examined two cases: a case of Meigs' syndrome that is characterized by vomit, abdominal pain, ascites, height serum Ca 125 level; a case of Meigs' pseudosyndrom that is characterized by ovarian adenocarcinoma that is diagnosticated owing to ascites and pleural effusion.

CONCLUSIONS

This study suggest that the surgical therapy have a very important role for the complete remission of the disease in the Meigs' syndrome and for the remission of ascites and pleural effusion in the Meigs' pseudosyndrom.

Meigs' syndrome: the history of the eponym

Meigs' syndrome is defined as presence of ascites with hydrothorax in association with benign ovarian tumor. The syndrome is named after Joe Vincent Meigs (1892-1963), a Harvard Medical School Professor of Gynecology. However, it was described by several authors in the 19th and the beginning of 20th centuries. Meigs and Cass deserve the credit for awakening the medical profession to the importance of the syndrome in 1937. At the end, the syndrome was coined Meigs' syndrome by Rhodes and Terrell in 1937.

Uterine leiomyoma causing massive ascites and left pleural effusion with elevated CA 125: a case report

A 51-year-old patient presented with an abdominal mass and ascites as well as a left pleural effusion. Her serum CA125 was 820 U/ml. Surgical exploration revealed a benign leiomyoma of the uterus without malignant cytology in the ascites. Postoperatively, the pleural effusion was resolved dramatically and the CA125 decreased to the normal range after 4 months post-operatively. This is an extremely rare case of pseudo-Meigs' syndrome caused by uterine leiomyoma.

[A case of Meigs' syndrome]

The described case of Meigs' [correction of Maigce] syndrome supports data on diversity of exudative pleurisies as some syndrome of manifestation of different pathological processes. Diagnosing and treatment by surgery technique of the female patient with Meigs' [correction of Magice] syndrome suggest expediency of examination by an obstetrician-gynecologist of all those women presenting with exudative pleurisy.

[Meigs' syndrome: its clinical picture and treatment]

Meigs' syndrome is a rare clinical entity characterised with ovarian benign tumour, ascites and hydrothorax. Between January '94-September '98 we observed three patients with: ovarian neoformation, light (1 patient), moderate (2 patients) monolateral pleural effusion, moderate (2 patients) and considerable (1 patient) ascites. In all patients the preoperative evaluation (sero-haematologic routine, Ca 125 and other oncologic markers, chest X-ray, abdominal and pelvic ultrasonography, total-body Tc, cytological analysis of pleural and abdominal effusion) was suggestive for malignancy but not confirmed it. So an explorative laparotomy with histological extemporary analysis was performed. The results were: 1 fibrothecomas, 1 fibroma, 1 ovarian inflammation with cystic luteinization areas and fibromatosis uterine. All three patients had a good postoperative course. The symptomatology and the effusions disappeared 7-10 days after operation. The first two cases were diagnosed as classic Meigs' syndrome, the third one, instead, as a pseudo-Meigs's syndrome. In conclusion the A.A., according to literature and their experiences, underline: 1) an ovarian mass with pleural and abdominal effusion not always represents an advanced malignancy; 2) even if elevated Ca 125 value is usually associated to a ovarian malignancy, there are some benign lesions in which we observed elevated level of this marker 3) the removal of the ovarian mass is the only resolutive treatment for these patients.

[The lung and benign diseases of the ovary]

Two main benign diseases of the ovary which can simulate advanced stage cancer of the ovary are described. The first is Meigs' syndrome, a triad of benign ovarian tumor, usually an ovarian fibroma, ascitis, and pleural effusion with complete disappearance of serous exsudative effusions with surgical resection of the ovarian tumor. The second is ovarian hyperstimulation syndrome following ovulation induction with exogenous gonotropins for the treatment of infertility. This syndrome associates significant ovarian enlargement, hyperestrogenism and latent or clinically patent serous exsudative effusions; it usually resolves with suggestive measures and rest.

Genital tuberculosis with peritonitis mimicking Meigs' syndrome: a case report

A 19-year-old girl presented with genital tuberculosis (TB) complicated with peritonitis and pleural effusion. In addition to oligomenorrhea, her initial presentation included symptoms of intermittent high fever, exertional dyspnea, productive cough and body weight loss. Acid-fast bacilli were identified by sputum culture. She continued to suffer from persistent abdominal discomfort and body weight loss after eight months of anti-TB treatment. Finally, exploratory laparotomy was performed under the suspicion of Meigs' syndrome or TB peritonitis. Operative findings included diffusely granulomatous change over the peritoneum, ovaries, endometrium, intestine and liver. Histologic examination of the ovaries and endometrium showed caseous necrosis associated with Langhan's giant cells and epithelial cells. Acid-fast stain revealed numerous acid-fast bacilli. She was discharged after two months of anti-TB treatment. Anti-TB therapy was continued for one year after discharge. During 3 years of post-discharge follow up, she was free of abdominal discomfort and had given birth to two healthy children.

Leiomyoblastoma of the colon presenting as pseudo-Meigs' syndrome

Leiomyoblastomas are rare smooth-muscle tumours, most commonly arising from the stomach wall. We describe a case of leiomyoblastoma of the colon presenting with the pseudo-Meigs>> syndrome.

[Deimons-Meigs syndrome and elevated CA-125: diagnosis of ovarian cancer and therapeutic implications]

Regarding a original observation of the Deimons-Meigs syndrome, the authors have derived, from a review of the literature, the main clinicals and etiopathogenics characteristics, and tried to discuss the terms and conditions of a therapeutic treatment appropriate to such a situation.

Meigs' syndrome with elevated CA125: case report and review of the literature

A 51-year-old woman presented with acute ascites and hydrothorax is reported. Pelvic ultrasound showed two pelvic solid masses and serum CA125 level was elevated (577 IU/ml). Pathology revealed bilateral ovarian fibromas. We present this case of Meigs' syndrome and discuss its diagnostic problems and a review of the literature.

[True and pseudo-Meigs' syndrome]

In this paper two cases were reported. The first case concerns the truth Meigs syndrome at 70-year old woman, who was admitted into gynaecological clinic because of quickly increasing abdominal circumference, metrorrhagia and liquid in pleural cavity. In this woman benign ovarian neoplasm-thecoma was detected. The second case concerns pseudo Meigs syndrome at 57-year old woman, who was operated because of ovarian cancer. In this patient recurrent ascites was observed. In this case radical surgery and chemotherapy was performed.

Pseudo-Meigs' syndrome caused by paraovarian fibroma

Meigs' syndrome includes an ovarian tumor, usually fibroma, associated with hydrothorax and ascites. It is accepted that uterine tumors, like fibromas, can also be associated with ascites and hydrothorax, but this is extremely rare. The mechanism of formation of peritoneal and pleural effusion is not well documented. The most likely pathogenesis ascribes the fluid formation to the filtration of interstitial fluid in the peritoneal through the tumor capsule, and the diffusion to the pleural space through the diaphragm lymphatic vessels at the foramen of Bochdalek. Paraovarian fibromas are also extremely rare neoplasms, probably of paramesonephric origin. It has been hypothesised that they can develop by proliferation of connective tissue cells around the Wolfian remnants. In this article, probably for the first time, a case of paraovarian fibroma with ascites and hydrothorax is presented.

[Meigs' syndrome: is it possible to make a preoperative diagnosis?]

Two cases of Meigs' syndrome are reported, one following an ovarian fibrothecoma and the other an ovarian fibroma. The benign condition was suggested prior to surgery in one of the two patients because of a solid tumor of the ovary without peritoneal implant on CT-scan, and no malignant cells in ascitic fluid and on a fine needle biopsy. To differentiate this benign pathology from a malignant process enables to avoid useless surgical procedures. Preoperative evaluation, including serum CA 125 level, ultrasound examination and CT-scan, allows rarely to suggest the Meigs' syndrome. Nevertheless, this syndrome may be suspected when faced with an important pleural effusion, a very elevated CA-125 serum level, a negative cytologic examination of the ascitic effusion and no peritoneal implant on CT-scan.

Pseudo-Meigs' Syndrome

Meigs' syndrome is defined as a hydrothorax with ascites and a pelvic tumor, both of which resolve on removal of the tumor. Pseudo-Meigs' is a variant not possessing the original tumor cell types described by Meigs. Both these syndromes should be considered in otherwise healthy women who present with either new or recurrent hydrothorax and ascites. This case concerns a 21-year-old woman who presented to the emergency department (ED) with a recurrent hydrothorax. After performing a pelvic examination that was suspicious for a pelvic mass, further evaluation by ultrasonography showed ascites and a pelvic tumor. Surgeons from the Obstetrics and Gynecology Department performed an exploratory laparotomy with removal of the tumor. Subsequently, there was no recurrence of the ascites and hydrothorax. The tumor was diagnosed histologically as a benign mature teratoma. The literature of Meigs' and Pseudo-Meigs' is reviewed, focusing on the history, pathology, and clinical characteristics. The clinical significance for the emergency physician is discussed.

Atypical Meigs' syndrome and bilateral ovarian stromal hyperplasia. A case report

BACKGROUND

Atypical Meigs' syndrome has been observed in patients with dermoid tumors, struma ovarii, uterine leiomyomata and other benign pelvic tumors except for ovarian fibromas. Meigs' and atypical Meigs' syndrome present management decisions complicated by a high index of suspicion for malignancy.

CASE

A 43-year-old woman, gravida 1, para 1, with ascites; a pleural effusion; radiologic evidence of enlarged, cystic adnexa; and a normal CA-125 level was found to have cortical stromal hyperplasia on bilateral ovarian pathologic evaluation.

CONCLUSION

This is the first case of cortical stromal hyperplasia presenting with bilateral involvement of small ovaries, ascites and a pleural effusion. Meigs' syndrome and its variants develop with clinical pictures suggestive of malignancy. Thorough evaluation and individualized treatment are necessary.

[Meigs syndrome--diagnostic difficulties]

Meigs' syndrome in 68 years woman with pleural effusion and ovarian tumour was described. The cause of the pleural liquid in Meigs' syndrome is still not clear. New views on the pathogenesis and diagnostic methods of pleural liquids causes were presented.

[Meigs' syndrome. A case report]

The authors report on a case of Meigs' syndrome in a patient admitted with vomiting, abdominal pain, peritoneal and right pleural effusion, increased serum levels of CA 125. Surgical excision was successful.

[Ascites, hydrothorax and ovarian tumor: Meigs' syndrome in a patient with small ovaries and increased CA 125 level]

In a 51-year-old woman with bilateral Brenner tumours of the ovaries and with intermittent hydrothorax and ascites, Meigs' syndrome was diagnosed. The serum CA 125 level was 620 U/ml (normal: 5-35). Bilateral ovariectomy, hysterectomy and omentectomy were carried out. The ovaries were not enlarged. Postoperatively, the pleural effusion and ascites resolved and the CA 125 level decreased to 8.4 U/ml. The pathogenesis of hydrothorax probably involves passage through the diaphragm, and the CA 125 may be produced by the peritoneal lining or by the Brenner tumours.

Cellular fibroma of the ovary with Meigs' syndrome and elevated CA-125. A case report

BACKGROUND

Cellular fibroma of the ovary is an uncommon benign tumor. When associated with Meigs' syndrome, it can produce a clinical picture similar to that of ovarian carcinoma.

CASE

A 73-year-old nulligravida was admitted to the hospital with progressive cachexia, ascites, a right pleural effusion and a 15-cm pelvic mass. The serum CA-125 level was 1,780. Due to a high suspicion of ovarian carcinoma, the patient underwent exploratory laparotomy, total abdominal hysterectomy/bilateral salpingooophorectomy and surgical staging for a frozen section diagnosis of sarcoma. Permanent histology revealed the tumor to be a cellular fibroma, and the CA-125 levels fell to normal postoperatively.

CONCLUSION

Since benign ovarian tumors may mimic carcinoma, laparotomy and appropriate surgical staging are essential for the final diagnosis.