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Roecker ZA, Young MR, Han C. Rapidly progressing ascites in a pregnancy with a massive fibroid: A case report and review of pseudo-Meigs syndrome. Int J Gynaecol Obstet 2024. [PMID: 38736303 DOI: 10.1002/ijgo.15604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/20/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
Meigs syndrome is a classic triad of ascites, pleural effusions, and an ovarian fibroma with resolution following excision. Pseudo-Meigs syndrome presents similarly but is caused by a pelvic mass other than an ovarian fibroma, such as a fibroid. We present a case report of a 33-year-old gravida 2 para 0-0-1-0 woman with a massive, pedunculated fibroid who developed rapid onset of ascites and edema beginning at 5 weeks of gestation. Malignant, cardiac, renal, hepatic, and rheumatologic causes were ruled out. Her symptoms resolved following myomectomy and delivery via cesarean. Pseudo-Meigs syndrome was suspected. Pseudo-Meigs syndrome is a diagnosis of exclusion and requires surgical management for resolution. Pregnancy may be an inciting factor. Myomectomy may be done safely at the time of cesarean.
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Affiliation(s)
- Zoe A Roecker
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marisa R Young
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chanhee Han
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
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2
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Omori G, Arihara Y, Abe T, Takada K, Suzuki N, Shibuya R, Ikeda Y, Yamada M, Ono M, Fujita M, Sugita S, Maeda M. A Case of Atypical Pseudo-Meigs' Syndrome without Pleural Effusion due to Ovarian Metastasis from Sigmoid Colon Cancer. Intern Med 2022; 62:1487-1493. [PMID: 36223922 DOI: 10.2169/internalmedicine.0157-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of atypical pseudo-Meigs' syndrome without pleural effusion. A 46-year-old woman was diagnosed with an ovarian tumor and sigmoid colon cancer with massive ascites. She underwent surgical resection of the sigmoid colon and bilateral salpingo-oophorectomy. The pathological diagnosis was sigmoid colon cancer with ovarian metastasis. A few days after the operation, the massive ascites disappeared. Immunostaining for vascular endothelial growth factor (VEGF) suggested its overproduction was involved in the development of the ascites. Although cases of pseudo-Meigs' syndrome without pleural effusion are rare, reporting such cases will facilitate the choice of more appropriate treatment strategies in future.
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Affiliation(s)
- Ginji Omori
- Department of Gastroenterology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
| | - Yohei Arihara
- Department of Gastroenterology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Japan
| | - Tomoyuki Abe
- Department of Gastroenterology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
| | - Kohichi Takada
- Department of Medical Oncology, Sapporo Medical University School of Medicine, Japan
| | - Norito Suzuki
- Department of Gastroenterology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
| | - Ryo Shibuya
- Department of Gastroenterology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
| | - Yuki Ikeda
- Department of Gastroenterology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
| | - Michiko Yamada
- Department of Gastroenterology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
| | - Michihiro Ono
- Department of Gastroenterology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
| | - Miri Fujita
- Department of Pathology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Japan
| | - Masahiro Maeda
- Department of Gastroenterology, Social Medical Corporation Steel Memorial Muroran Hospital, Japan
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3
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Abdelgawad M, Barghuthi L, Davis T, Omar M, Kamel OM, Gibbons J, Ragoza Y, Ismael H. Large uterine leiomyoma presenting as pseudo-Meigs’ syndrome with an elevated ca125: a case report and literature review. J Surg Case Rep 2022; 2022:rjac253. [PMID: 35685293 PMCID: PMC9173737 DOI: 10.1093/jscr/rjac253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Ascites, pelvic mass and elevated CA-125 in females carry a grim prognosis, likely an ovarian carcinoma. However, more benign etiologies such as Meigs’ and pseudo-Meigs’ syndrome must be considered. Pseudo-Meigs’ syndrome presenting with an elevated CA-125 is rare and presents a diagnostic challenge. Medline and PubMed were queried for pseudo-Meigs’ syndrome cases. We present a 35-year-old female patient who presented with abdominal swelling and weight gain. Imaging demonstrated a 29-cm large intraabdominal mass with significant ascites with elevation of CA-125. Surgical resection was performed, and pathology identified uterine leiomyoma. Twenty-one cases of pseudo-Meigs’ syndrome were identified in the literature. Most patients presented with abdominal distention, and some also reported dyspnea. All patients, including our case, were treated surgically. No recurrence reported among these cases. Surgery is the mainstay for radical treatment in pseudo-Meigs’ syndrome. Resolution of the ascites and hydrothorax occurs following resection of the tumor.
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Affiliation(s)
- Mohamed Abdelgawad
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Lutfi Barghuthi
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Tyler Davis
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Mahmoud Omar
- Department of Surgery , School of Medicine, Tulane University, New Orleans, LA, USA
| | - Omar M Kamel
- Department of Surgery , School of Medicine, Tulane University, New Orleans, LA, USA
| | - Jake Gibbons
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Yury Ragoza
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Hishaam Ismael
- Department of Surgery , University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
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Magallanes Gamboa J, Notario Barba V, Vizuete Calero A, Palacios Rasal A. Síndrome de pseudo-Meigs secundario a leiomioma uterino. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wang YW, Fan Q, Qian ZX, Wang JJ, Li YH, Wang YD. Abdominopelvic leiomyoma with large ascites: A case report and review of the literature. World J Clin Cases 2021; 9:1424-1432. [PMID: 33644211 PMCID: PMC7896699 DOI: 10.12998/wjcc.v9.i6.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/08/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Leiomyoma of the uterus is relatively common, but uterine leiomyoma of the greater omentum is rare.
CASE SUMMARY Here, we report the case of a 22-year-old woman who presented with a 3 mo history of progressive abdominal distension and a hypervascular abdominopelvic mass. Due to a high serum concentration of CA125, the preoperative diagnosis was unclear. During surgery, 5 L of ascites was removed. An 18.8 cm solid mass, which was pedunculated from the uterine fundus and exhibited complex adhesion to the greater omentum, was removed. The CA125 level was reduced postoperatively, and a pathologic study confirmed that the mass was a leiomyoma that originated in the uterus.
CONCLUSION Uterine leiomyoma can share vessels with the greater omentum. This case highlights the difficulty of diagnosing pseudo-Meigs syndrome and the importance of imaging and laboratory examinations.
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Affiliation(s)
- Yi-Wei Wang
- Department of Gynecological Oncology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Qiong Fan
- Department of Gynecological Oncology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Zhao-Xia Qian
- Department of Radiology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Jin-Jin Wang
- Department of Pathology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Yu-Hong Li
- Department of Gynecological Oncology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
| | - Yu-Dong Wang
- Department of Gynecological Oncology, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai 200000, China
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Adlan AS, Chua PT, Huang KG. Laparoscopic Resection of a Subserosal Leiomyoma Presenting as Pseudo–Meigs' Syndrome. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aizura-Syafinaz Adlan
- Department of Obstetrics and Gynaecology, University Malaya Medical Centre Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Peng Teng Chua
- Department of Obstetrics and Gynaecology, Mahkota Medical Centre, Melaka, Malaysia
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkouter Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkouter Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
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Pauls M, MacKenzie H, Ramjeesingh R. Hydropic leiomyoma presenting as a rare condition of pseudo-Meigs syndrome: literature review and a case of a pseudo-Meigs syndrome mimicking ovarian carcinoma with elevated CA125. BMJ Case Rep 2019; 12:12/1/bcr-2018-226454. [PMID: 30635302 DOI: 10.1136/bcr-2018-226454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The clinical scenario of a female patient with a pelvic mass, elevated CA125 tumour marker, pleural effusion and ascites is often associated with malignancy. However, not all cases are malignant. Non-malignant diseases, such as Meigs syndrome and pseudo-Meigs syndrome, must be part of your differential. We present a 56-year-old woman with dyspnoea secondary to a right pleural effusion. After further investigations, a serum cancer antigen-125 was found to be elevated at 437.3 U/mL. CT of her abdomen and pelvis showed a large heterogeneous mass in the pelvis measuring 13.2×9.7×15.1 cm with mild ascites. She was initially thought to have ovarian carcinoma and underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with omental biopsy. Pathology from the surgical specimen revealed a hydropic leiomyoma and after removal of pelvic mass her pleural effusion and ascites completely resolved. She was ultimately diagnosed with the rare pseudo-Meigs syndrome.
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Affiliation(s)
- Mehrnoosh Pauls
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heather MacKenzie
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ravi Ramjeesingh
- Medicine, QE2 Health Science Center, Halifax, Nova Scotia, Canada
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Dong R, Jin C, Zhang Q, Yang X, Kong B. Cellular leiomyoma with necrosis and mucinous degeneration presenting as pseudo-Meigs' syndrome with elevated CA125. Oncol Rep 2015; 33:3033-7. [PMID: 25891047 DOI: 10.3892/or.2015.3912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/02/2015] [Indexed: 11/05/2022] Open
Abstract
Pseudo-Meigs' syndrome is a syndrome rarely caused by leiomyomas. Elevated CA125 usually suggests malignancy of the ovary. No reported case of pseudo-Meigs' syndrome presenting with necrosis and mucinous degeneration of uterine cellular leiomyomas (CLs) and an elevated CA125 level was found upon a PubMed search. A 37-year-old woman presenting with massive ascites, bilateral pleural effusions and a pelvic mass measuring 20 x 18 x 10 cm is described. The pre-operative serum CA125 was 920.4 U/ml. After total abdominal hysterectomy and partial omentumectomy, the final pathologic diagnosis was CL with focal hemorrhage, necrosis and mucinous degeneration. The ascites and pleural effusion disappeared, and the CA125 level returned to normal in one month. Benign leiomyoma accompanied by pseudo-Meigs' syndrome and elevated serum CA125 can mimic a pelvic malignancy.
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Affiliation(s)
- Ruiying Dong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Chengjuan Jin
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Qing Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Yonehara Y, Yanazume S, Kamio M, Togami S, Tasaki T, Douchi T. Concentrated ascites re-infusion therapy for pseudo-Meigs' syndrome complicated by massive ascites in large pedunculated uterine leiomyoma. J Obstet Gynaecol Res 2014; 40:1944-9. [PMID: 25056475 DOI: 10.1111/jog.12448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/09/2014] [Indexed: 01/24/2023]
Abstract
Pseudo-Meigs' syndrome accompanied by massive ascites in uterine leiomyoma is rare. We encountered a rare case of a 37-year-old, nulliparous woman with a lower abdominal tumor and severe abdominal distention due to massive ascites. Serum cancer antigen 125 and vascular endothelial growth factor levels were elevated to 1007.9 U/mL and 103 pg/mL, respectively. She was tentatively diagnosed with ovarian cancer. Emergency concentrated ascites re-infusion therapy was performed to improve dyspnea, abdominal pain, and her preoperative respiratory condition. Concentrated ascites re-infusion therapy eliminated dyspnea and abdominal discomfort without decreasing serum albumin levels. The patient underwent laparotomy, which revealed a fist-sized pedunculated uterine leiomyoma arising from the right uterine fundus. Myomectomy was performed. Pseudo-Meigs' syndrome mimics advanced ovarian cancer due to massive ascites and markedly elevated serum cancer antigen 125 and vascular endothelial growth factor levels. Concentrated ascites re-infusion therapy was effective in improving the subjective symptoms of pseudo-Meigs' syndrome and the patient's preoperative condition.
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Affiliation(s)
- Yukie Yonehara
- Department of Obstetrics and Gynecology, Imamura Hospital, Kagoshima, Japan
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Yip HK, Huang LW, Lin YH, Hwang JL. Massive ascites caused by a large pedunculated subserosal uterine leiomyoma that has feeding arteries from peripheral tissues and exhibits elevated CA125: a case report of atypical Pseudo-Meigs' syndrome. J OBSTET GYNAECOL 2014; 34:107. [PMID: 24359072 DOI: 10.3109/01443615.2013.832736] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- H-K Yip
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital , Taipei
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Seo MR, Sung JY, Cho HJ, Ryu HJ, Choi HJ, Park CY, Baek HJ. Ascites associated with uterine leiomyoma in a 22-year-old woman with systemic lupus erythematosus. Lupus 2014; 23:1207-10. [PMID: 24972898 DOI: 10.1177/0961203314540763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ascites in systemic lupus erythematosus (SLE) patients has a variety of etiologies, which usually require different treatment options. Our case was a 22-year-old patient with an unusual combination of ascites, uterine leiomyoma and SLE. The patient presented with painless ascites of an inflammatory nature. However, the ascites was not related to peritonitis and SLE disease activity. The ascites disappeared following laparotomy and tumor resection without additional medication. Gynecologic benign tumors including uterine leiomyoma can be the cause of ascites in SLE patients. Clinicians should be aware of that possibility in case painless ascites occurs in females with SLE.
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Affiliation(s)
| | | | | | | | | | - C-Y Park
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Republic of Korea
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