1
|
Wang N. Editorial: Case reports in breast cancer : 2022. Front Oncol 2023; 13:1330225. [PMID: 38162508 PMCID: PMC10755864 DOI: 10.3389/fonc.2023.1330225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Nan Wang
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
2
|
Lin XY, Zhou XJ, Yang SP, Zheng JX, Li ZJ. Pseudo-Meigs' syndrome secondary to breast cancer with ovarian metastasis: a case report and literature review. Front Oncol 2023; 13:1091956. [PMID: 37223687 PMCID: PMC10200991 DOI: 10.3389/fonc.2023.1091956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Ovarian metastasis of breast cancer with pseudo-Meigs' syndrome (PMS) is extremely rare. Only four cases of PMS secondary to breast cancer with ovarian metastasis have been reported to date. In this report, we present the fifth case of PMS caused by ovarian metastasis of breast cancer. On the 2nd of July 2019, a 53-year-old woman presented to our hospital with complaints of abdominal distension, irregular vaginal bleeding, and chest distress. Color Doppler ultrasound examination revealed a mass approximately 109×89 mm in size in the right adnexal area, accompanied by multiple uterine fibroids and a large amount of pelvic and peritoneal effusions. The patient had no common symptoms and showed no signs of breast cancer. The main manifestations were a right ovarian mass, massive hydrothorax, and ascites. Lab workup and imaging revealed raised CA125 (cancer antigen 125) levels and multiple bone metastases. At first the patient was misdiagnosed with ovarian carcinoma. After the rapid disappearance of oophorectomy hydrothorax and ascites, and decreased CA125 levels, from 1,831.8u/ml to normal range. According to the pathology report, breast cancer was finally diagnosed. The patient underwent endocrine therapy (Fulvestrant) and azole treatment after oophorectomy. At the 40-month follow-up, the patient was still alive and doing well.
Collapse
Affiliation(s)
- Xiang-Ying Lin
- Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Xiao-Jun Zhou
- Department of Clinical Laboratory, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Shi-Ping Yang
- Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Jia-Xuan Zheng
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Zhao-Jun Li
- Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| |
Collapse
|
3
|
Clinical laboratory features of Meigs' syndrome: a retrospective study from 2009 to 2018. Front Med 2020; 15:116-124. [PMID: 32651935 DOI: 10.1007/s11684-019-0732-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 10/31/2019] [Indexed: 10/23/2022]
Abstract
Meigs' syndrome (MS), a rare complication of benign ovarian tumors, is easily misdiagnosed as ovarian cancer (OC). We retrospectively reviewed the clinical laboratory data of patients diagnosed with MS from 2009 to 2018. Serum carbohydrate antigen 125 and HE4 levels were higher in the MS group than in the ovarian thecoma-fibroma (OTF) and healthy control groups (all P < 0.05). However, the serum HE4 levels were lower in the MS group than in the OC group (P < 0.001). A routine blood test showed that the absolute counts and percentages of lymphocytes were significantly lower in the MS group than in the OTF and control groups (all P < 0.05). However, these variables were higher in the MS group than in the OC group (both P < 0.05). The neutrophil-to-lymphocyte ratio (NLR) was also significantly lower, whereas the lymphocyte-to-monocyte ratio was higher in the MS group than in the OC group (both P < 0.05). The NLR, platelet-to-lymphocyte ratio, and systemic immune index were significantly higher in the MS group than in the OTF and control groups (all P < 0.05). The hypoxia-inducible factor-1 mRNA levels were also significantly higher, whereas the glucose transporter 1, lactate dehydrogenase, and enolase 1 mRNA levels were lower in peripheral CD4+ T cells obtained preoperatively in a patient with MS than those in patients with OTF, patients with OC, and controls (all P < 0.05). The expression of these four glucose metabolism genes was preferentially restored to normal levels after the tumor resection of MS (P < 0.001). These clinical laboratory features can be useful in improving the preoperative diagnostic accuracy of MS.
Collapse
|
4
|
Tarlovskaya EI, Kamardina NA, Mazalov KV. [Demons-Meigs syndrome or cardiomyopathy: a difficult case of a differential diagnosis]. ACTA ACUST UNITED AC 2019; 59:64-68. [PMID: 31995727 DOI: 10.18087/10.18087/cardio.n447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/21/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022]
Abstract
The article presents an overview of the data related to Demons-Meigs syndrome and the clinical situation associated with a complex differential diagnosis between myocarditis with the formation of secondary cardiomyopathy and Demons-Meigs syndrome. A variety of clinical symptom complexes that are associated with Demons-Meigs syndrome is discussed. The concepts of classical and non-classical, full and incomplete Demons-Meigs syndrome are considered. The current views on the pathogenesis of the syndrome and the mechanism of the formation of ascites and pleural effusion are given.
Collapse
Affiliation(s)
- E I Tarlovskaya
- IFM FSBEI HE "Privolzhsky Research Medical University" MOH Russia
| | - N A Kamardina
- Clinical Hospital №4 of the Federal health care institution Volga district medical centre of Federal medical-biological agency
| | - K V Mazalov
- Clinical Hospital №4 of the Federal health care institution Volga district medical centre of Federal medical-biological agency
| |
Collapse
|
5
|
Abstract
Supplemental Digital Content is available in the text
Collapse
Affiliation(s)
- Ting Li
- Department of Rheumatology, Wenjiang District People's Hospital, Chengdu, Sichuan 610000, China
| | - Qi-Bing Xie
- Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| |
Collapse
|
6
|
Systemic Lupus Erythematosus With Lupus Nephritis Presented With Recurrent Massive Ascites: A Case of Pseudo-Pseudo Meigs Syndrome. Arch Rheumatol 2019; 34:243-244. [PMID: 31497775 DOI: 10.5606/archrheumatol.2019.7034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 11/08/2018] [Indexed: 12/22/2022] Open
|
7
|
Sidana A, Kadakia M, Friend JC, Krane LS, Su D, Merino MJ, Srinivasan R. Determinants and prognostic implications of malignant ascites in metastatic papillary renal cancer. Urol Oncol 2016; 35:114.e9-114.e14. [PMID: 27914873 DOI: 10.1016/j.urolonc.2016.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/21/2016] [Accepted: 10/31/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To describe the incidence of ascites in metastatic papillary renal cell cancer (pRCC), identify the factors associated with its development and evaluate its prognostic effect on the survival of these patients. METHODS A retrospective evaluation of the medical records of patients with metastatic pRCC seen at National Cancer Institute (2000-2014) was undertaken. Logistic regression to identify predictors of the development of malignant ascites and Kaplan-Meier analysis to estimate survival was done. RESULTS Overall, 106 consecutive patients with metastatic pRCC were identified; sufficient data were available in 100 patients to enable assessment of ascites. Further, 20% had evidence of malignant ascites. Median age at diagnosis of ascites was 48.0 years (26.1-76.6 years) and median time to development of ascites from initial diagnosis of metastatic disease was 16.0 (0-73.3) months. There was no significant difference in the incidence of ascites between patients with hereditary and sporadic pRCC (P = 0.803) or among patients with different subtypes of pRCC (P = 0.456). Elevated platelet-lymphocyte ratio predicted development of malignant ascites in our cohort (P = 0.009). Median overall survival was shorter for patients who developed ascites [25.0 (10.2-39.8) months] compared with patients who did not develop this complication [42.5 (30.5-54.4) months, P = 0.041]. CONCLUSION To our knowledge, this is the first systematic evaluation of the incidence, predictors, and prognostic effect of ascites in metastatic pRCC. Malignant ascites is a common manifestation of metastatic pRCC and is associated with a shorter overall survival. An elevated platelet-lymphocyte ratio predicts a higher risk of developing malignant ascites.
Collapse
Affiliation(s)
- Abhinav Sidana
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
| | - Meet Kadakia
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Julia C Friend
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Louis S Krane
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Daniel Su
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Maria J Merino
- Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Ramaprasad Srinivasan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| |
Collapse
|
8
|
Ting Y, Yang LI, Juan Z, Xing W, Feng YX. Ovarian thecoma with massive pleural effusion in postmenopausal women: A case report. Mol Clin Oncol 2016; 4:1003-1005. [PMID: 27284435 DOI: 10.3892/mco.2016.853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/18/2016] [Indexed: 11/06/2022] Open
Abstract
Previous clinical reports of benign ovarian thecoma, associated with hydrothorax, are rare. The present study presents the case of a 58-year-old women exhibiting right massive pleural effusions and elevated cancer antigen (CA)125, and a pelvic ultrasound revealed a hypoechoic mass. An exploratory laparotomy was subsequently performed. During the surgery, the left ovary measured 20×15×15 cm and had a smooth surface with no excrescences or papillary projections. The patient underwent right salpingo-oophorectomy. Pathological diagnosis was determined as benign ovarian thecoma. The chest radiograph revealed no pleural effusion 6 days following the surgery. The present case demonstrated a benign ovarian thecoma, associated with massive hydrothorax and elevated CA125, which mimicked an ovarian malignancy.
Collapse
Affiliation(s)
- Yang Ting
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - L I Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Zhao Juan
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Wei Xing
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yang Xiao Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| |
Collapse
|
9
|
Kyo K, Maema A, Shirakawa M, Nakamura T, Koda K, Yokoyama H. Pseudo-Meigs’ syndrome secondary to metachronous ovarian metastases from transverse colon cancer. World J Gastroenterol 2016; 22:4604-4609. [PMID: 27182170 PMCID: PMC4858642 DOI: 10.3748/wjg.v22.i18.4604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/02/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
Pseudo-Meigs’ syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs’ syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female with a history of surgery for transverse colon cancer and peritoneal dissemination suffered from metachronous ovarian metastases during treatment with systemic chemotherapy. At first, neither ascites nor pleural effusion was observed, but she later complained of progressive abdominal distention and dyspnea caused by rapidly increasing ascites and pleural effusion and rapidly enlarging ovarian metastases. Abdominocenteses were repeated, and cytological examinations of the fluids were all negative for malignant cells. We suspected pseudo-Meigs’ syndrome, and bilateral oophorectomies were performed after thorough informed consent. The patient’s postoperative condition improved rapidly after surgery. We conclude that pseudo-Meigs’ syndrome should be included in the differential diagnosis of massive or rapidly increasing ascites and pleural effusion associated with large or rapidly enlarging ovarian tumors.
Collapse
|
10
|
Okuda K, Noguchi S, Narumoto O, Ikemura M, Yamauchi Y, Tanaka G, Takai D, Fukayama M, Nagase T. A case of Meigs' syndrome with preceding pericardial effusion in advance of pleural effusion. BMC Pulm Med 2016; 16:71. [PMID: 27160723 PMCID: PMC4862177 DOI: 10.1186/s12890-016-0241-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Meigs’ syndrome is defined as the presence of a benign ovarian tumor with pleural effusion and ascites that resolve after removal of the tumor. The pathogenesis of the production of ascites and pleural effusion in this syndrome remains unknown. Aside from pleural effusion and ascites, pericardial effusion is rarely observed in Meigs’ syndrome. Here, we report the first case of Meigs’ syndrome with preceding pericardial effusion in advance of pleural effusion. Case presentation An 84-year-old Japanese non-smoking woman with a history of lung cancer, treated by surgery, was admitted due to gradual worsening of dyspnea that had occurred over the previous month. She had asymptomatic and unchanging pericardial effusion and a pelvic mass, which had been detected 3 and 11 years previously, respectively. The patient was radiologically followed-up without the need for treatment. Two months before admission, the patient underwent a right upper lobectomy for localized lung adenocarcinoma and intraoperative pericardial fenestration confirmed that the pericardial effusion was not malignant. However, she began to experience dyspnea on exertion leading to admission. A chest, abdomen, and pelvis computed tomography scan confirmed the presence of right-sided pleural and pericardial effusion and ascites with a left ovarian mass. Repeated thoracentesis produced cultures that were negative for any microorganism and no malignant cells were detected in the pleural effusions. Pleural fluid accumulation persisted despite a tube thoracostomy for pleural effusion drainage. With a suspicion of Meigs’ syndrome, the patient underwent surgical resection of the ovarian mass and histopathological examination of the resected mass showed ovarian fibroma. Pleural and pericardial effusion as well as ascites resolved after tumor resection, confirming a diagnosis of Meigs’ syndrome. This clinical course suggests a strong association between pericardial effusion and ovarian fibroma, as well as pleural and peritoneal fluid. Conclusions In female patients with unexplained pericardial effusion and an ovarian tumor, clinicians should consider the possibility of Meigs’ syndrome. Although a malignant disease should be suspected in all patients with undiagnosed pleural and/or pericardial effusion, Meigs’ syndrome is curable by tumor resection and should be differentiated from malignancy.
Collapse
Affiliation(s)
- Kenichi Okuda
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Satoshi Noguchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Narumoto
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masako Ikemura
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Goh Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daiya Takai
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| |
Collapse
|
11
|
Etiology of Ascites and Pleural Effusion Associated with Ovarian Tumors: Literature Review and Case Reports of Three Ovarian Tumors Presenting with Massive Ascites, but without Peritoneal Dissemination. Case Rep Obstet Gynecol 2015; 2015:414019. [PMID: 26858849 PMCID: PMC4697079 DOI: 10.1155/2015/414019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/06/2015] [Accepted: 10/18/2015] [Indexed: 12/15/2022] Open
Abstract
Borderline ovarian tumors are benign but relatively large tumors that are often initially mistaken as ovarian cancers. We report three cases of stage I borderline ovarian tumors having massive ascites that we (preoperatively) suspected of being advanced ovarian cancer. The three patients (35, 47, and 73 years old) reported feeling fullness of the abdomen before consulting their gynecologist. By CT scan, they were diagnosed with a pelvic tumor accompanied by massive ascites, the diameters of which were 11, 20, and 11 cm, respectively. Postsurgical pathology showed all were stage I borderline ovarian tumors without dissemination; two were mucinous and one was serous. The amount of ascites was 6,300, 2,600, and 3,600 mL, respectively, and was serous in all. Cytodiagnosis of the ascites found that one was positive for tumor cells and two were negative. After resection of the mass, the ascites disappeared in all three cases. No pleural effusion was present at any time. The literature is reviewed concerning ascites and pleural effusions linked to ovarian tumors, and a supposition is forwarded of why pleural effusion presents sporadically in these cases.
Collapse
|
12
|
Park JW, Bae JW. Postmenopausal Meigs' Syndrome in Elevated CA-125: A Case Report. J Menopausal Med 2015; 21:56-9. [PMID: 26046039 PMCID: PMC4452815 DOI: 10.6118/jmm.2015.21.1.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/08/2015] [Accepted: 03/20/2015] [Indexed: 12/24/2022] Open
Abstract
Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated cancer antigen 125 (CA-125) in Meigs' syndrome is an unusual clinical condition reported in few cases. We report here on a 61-year-old woman who presented with dyspnea; in imaging assessment, a heterogeneous pelvic mass measuring 12 × 11 cm with ascitic fluid was reported. Pleural effusion was detected on Chest X-ray. Aspiration of pleural fluid showed no evidence of malignancy. CA-125 level was 347 IU/mL. The patient underwent laparotomy during which a mass measuring 12 × 11 cm was detected in her left adnexa. Histology showed ovarian thecoma. The mass was resected, and, after that, the symptoms disappeared and CA-125 level reached 19 IU/mL. The patient had experienced no problem after 12 months of follow up. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA-125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.
Collapse
Affiliation(s)
- Jung-Woo Park
- Department of Obstetrics and Gynecology, Dong-A University, College of Medicine, Busan, Korea
| | - Jong Woon Bae
- Department of Obstetrics and Gynecology, Dong-A University, College of Medicine, Busan, Korea
| |
Collapse
|
13
|
Wong WSF. A case of pseudo-Meigs syndrome mismanaged as peritoneal carcinomatosis. Gynecol Minim Invasive Ther 2014. [DOI: 10.1016/j.gmit.2014.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
14
|
Park EK, Lee SG, Byon IS, Lee SH, Lee SJ, Nam YJ, Park JH, Kim GT, Park YE, Park SH, Lee JW, Lee JH, Baek SH. A Case of Tjalma Syndrome Coincidentally Accompanied by an Ovarian Teratoma Successfully Treated with Intravenous Immunoglobulin-G Adjunctive Therapy. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Eun-Kyoung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seung-Geun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ik Soo Byon
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sun-Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seong-Jun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yoon-Jeong Nam
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ji-Hye Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Geun-Tae Kim
- Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Young-Eun Park
- Division of Rheumatology, Department of Internal Medicine, Malgeunsem Hospital, Changwon, Korea
| | - Seong-Hu Park
- Division of Rheumatology, Department of Internal Medicine, Young-do Hospital, Busan, Korea
| | - Joung-Wook Lee
- Division of Rheumatology, Department of Internal Medicine, Busan St. Mary's Medical Center, Busan, Korea
| | - Jun-Hee Lee
- Department of Internal Medicine, Ilsin Christian Hospital, Busan, Korea
| | - Seung-Hoon Baek
- Department of Internal Medicine, Ilsin Christian Hospital, Busan, Korea
| |
Collapse
|
15
|
Lee SY, Lee SW, Chung WT. Severe inflammation may be caused by hyperferritinemia of pseudo-pseudo Meigs' syndrome in lupus patients: two cases reports and a literature review. Clin Rheumatol 2013; 32:1823-6. [DOI: 10.1007/s10067-013-2362-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/31/2013] [Indexed: 02/07/2023]
|
16
|
Iyer R, Chow J, El-Bahrawy M, Savage P. Meigs syndrome presenting with axillary vein thrombosis and lymphadenopathy: a case report. J Med Case Rep 2013; 7:182. [PMID: 23856407 PMCID: PMC3750274 DOI: 10.1186/1752-1947-7-182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/22/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction Meigs syndrome is a rare condition, occurring in less than 1% of ovarian tumors and has the characteristic features of a benign ovarian tumor, ascites and a pleural effusion. We present a case of Meigs syndrome in a young patient presenting initially with an axillary vein thrombosis and local lymphadenopathy. Case presentation A 28-year-old Caucasian woman presented with a short history of right arm swelling and shortness of breath as a result of an axillary vein thrombosis and pulmonary embolus. The initial assessment also demonstrated right axillary and subclavian lymphadenopathy, a pleural effusion, ascites and a large ovarian mass. Serum levels of the tumor markers human chorionic gonadotropin and alpha-fetoprotein were normal and the CA-125 level was only moderately elevated. The combination of thrombosis, lymphadenopathy and an ovarian mass raised the possibility of a disseminated malignancy potentially an epithelial ovarian cancer, a germ cell tumor or an ovarian sex cord-stromal tumor. Surgery, performed after a short period of anticoagulation, demonstrated a 13.5cm ovarian cellular fibroma of low malignant potential. Postoperatively the patient made an excellent recovery and the ascites, pleural effusion and lymphadenopathy all resolved promptly. Conclusions In Meigs syndrome the classical findings of ascites, pleural effusion in combination with an ovarian mass can mimic disseminated malignancy but resolve spontaneously after surgery. In this current case, the patient also had lymphadenopathy and venous thrombosis, two other findings that are frequently associated with malignancy and was acutely unwell at presentation. It is unclear if the thrombosis and lymphadenopathy were simply coincidental or shared the same etiology as the ascites and pleural effusion. This case indicates that Meigs syndrome may on occasion present with additional findings that can further mimic disseminated malignancy and may lead to diagnostic uncertainty.
Collapse
Affiliation(s)
- Ridhima Iyer
- Department of Medical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, UK.
| | | | | | | |
Collapse
|
17
|
Naito K, Oura S, Yasuoka H, Okamura Y. A case of pseudo-meigs' syndrome associated with ovarian metastases from breast cancer. J Breast Cancer 2012; 15:474-7. [PMID: 23346179 PMCID: PMC3542858 DOI: 10.4048/jbc.2012.15.4.474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 12/05/2012] [Indexed: 11/30/2022] Open
Abstract
A 54-year-old woman with long-lasting pleural effusion developed abdominal distention due to ascites from bilateral ovarian tumors. The patient had undergone breast-conserving surgery and axillary lymph node dissection for left breast cancer in October 2000, and had developed left pleural effusion in July 2006. Cytological examination of the pleural effusion found no malignant cells. Thoracic drainage with intrathoracic administration of OK-432 (Picibanil) had failed to control the pleural effusion. Positron emission tomography taken at the abdominal distention showed bilateral ovarian tumors. After failure to control the ascites with systemic and intra-abdominal chemotherapy, bilateral oophorectomy resulted in normalization of elevated serum tumor-marker levels and the disappearance of both the ascites and pleural effusions (i.e., pseudo-Meigs' syndrome). Pathological examination showed the tumors to be estrogen receptor-positive metastatic ovarian tumors from her breast cancer. The patient remained well with no further recurrence for 40 months under aromatase inhibitor therapy.
Collapse
Affiliation(s)
- Koma Naito
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Shoji Oura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Hironao Yasuoka
- Department of Clinical and Surgical Pathology, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Yoshitaka Okamura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| |
Collapse
|
18
|
Su F, Cummings KW, Krigman H, Ranganathan P. Meigs' syndrome: a rare cause of recurrent pleural effusion in scleroderma. Rheumatol Int 2012; 33:2647-51. [PMID: 22538500 DOI: 10.1007/s00296-012-2437-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/15/2012] [Indexed: 01/13/2023]
Abstract
Meigs' syndrome represents a triad of pleural effusion, ascites, and an ovarian tumor, usually benign, occurring together. We describe here a case of Meigs' syndrome in a patient with systemic sclerosis, the first such report to our knowledge, in systemic sclerosis. A 53-year-old woman with systemic sclerosis presented with recurrent right-sided pleural effusion, which led to symptoms of shortness of breath, chest tightness, and a non-productive cough. Physical examination revealed a palpable, mobile mass in the right lower quadrant, in addition to typical physical features of scleroderma. Thoracentesis yielded exudative pleural fluid with cytology negative for malignancy. Pleural biopsy was consistent with inflammatory changes, but negative for malignancy. CT scan of the chest, abdomen, and pelvis revealed a soft tissue mass in the pelvis, which appeared to arise from the left ovary. The patient's cancer antigen 125 (CA-125) level was elevated at 222 U/mL (normal range, 0-30 U/mL). The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology of the left ovarian mass was consistent with an ovarian fibrothecoma, a benign tumor of the ovary. At her 1-month follow-up appointment, the patient had complete resolution of the right-sided pleural effusion. To date, at 10 months past the initial presentation, she has not had recurrence of pleural effusion. Although rare, Meigs' syndrome should be considered as a possible cause of recurrent serositis in women with rheumatologic diseases. Removal of the ovarian tumor leads to prompt resolution of the serositis.
Collapse
Affiliation(s)
- Feng Su
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | |
Collapse
|
19
|
A rare form of SLE: pseudo–pseudo meigs syndrome and hydrocephalus. Rheumatol Int 2012; 33:2175-6. [DOI: 10.1007/s00296-012-2420-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/11/2012] [Indexed: 02/01/2023]
|
20
|
Kawakubo N, Okido M, Tanaka R, Mitsugi K, Fukuhara M, Aishima S, Kato M, Ichimiya H. Pseudo-Meigs' syndrome associated with breast cancer metastasis to both ovaries: Report of a case. Surg Today 2010; 40:1148-51. [PMID: 21110158 DOI: 10.1007/s00595-009-4187-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 09/24/2009] [Indexed: 12/26/2022]
Abstract
A 50-year-old woman was admitted because of abdominal fullness due to bilateral ovarian tumors, pleural effusion, and ascites associated with breast cancer. Although chemotherapy and the removal of ascites were performed periodically, the ascites did not disappear. The cytology of the ascites did not indicate malignancy. Pseudo-Meigs' syndrome caused by metastasis to both ovarian tumors was suspected. The patient underwent a bilateral salpingo-oophorectomy, and the pathological diagnosis was bilateral metastatic ovarian tumors from breast cancer. The ascites and pleural effusion resolved after the surgery, with the consequent improvement of the patient's quality of life; however, she unfortunately died 4 months later due to hepatic failure caused by multiple metastases.
Collapse
Affiliation(s)
- Naonori Kawakubo
- Department of Surgery, Hamanomachi Hospital, 3-5-27 Maizuru, Chuo-ku, Fukuoka, 810-8539, Japan
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Brun GH. Syndromes et pseudosyndromes de Demons et Meigs aujourd’hui. ACTA ACUST UNITED AC 2010; 39:191-5. [DOI: 10.1016/j.jgyn.2009.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 06/24/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
|
22
|
Pseudo-pseudo Meigs syndrome developed under the leflunomide therapy. Rheumatol Int 2009; 31:521-3. [PMID: 19844717 DOI: 10.1007/s00296-009-1190-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 09/20/2009] [Indexed: 02/01/2023]
Abstract
Pseudo-pseudo Meigs syndrome or Tjalma syndrome is characterized by increased CA-125 level, pleural effusion and ascites in systemic lupus erythematosus (SLE) patients without over tumor. The disorder is relatively rare and it has been reported usually in SLE patients with impaired renal functions. Herein, we present a case of a 47-year-old female patient who developed Tjalma syndrome after administration of leflunomide for rheumatoid arthritis. Surprisingly renal functions of our patient were found in normal limits. This is the first case of Tjalma syndrome that is developed in normal renal functions and the probable role of leflunomide therapy is discussed.
Collapse
|
23
|
Aggarwal BB, Gehlot P. Inflammation and cancer: how friendly is the relationship for cancer patients? Curr Opin Pharmacol 2009; 9:351-69. [PMID: 19665429 PMCID: PMC2730981 DOI: 10.1016/j.coph.2009.06.020] [Citation(s) in RCA: 268] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 06/22/2009] [Accepted: 06/23/2009] [Indexed: 02/03/2023]
Abstract
Evidence has emerged in the last two decades that at the molecular level most chronic diseases, including cancer, are caused by a dysregulated inflammatory response. The identification of transcription factors such as NF-kappaB, AP-1 and STAT3 and their gene products such as tumor necrosis factor, interleukin-1, interleukin-6, chemokines, cyclooxygenase-2, 5 lipooxygenase, matrix metalloproteases, and vascular endothelial growth factor, adhesion molecules and others have provided the molecular basis for the role of inflammation in cancer. These inflammatory pathways are activated by tobacco, stress, dietary agents, obesity, alcohol, infectious agents, irradiation, and environmental stimuli, which together account for as much as 95% of all cancers. These pathways have been implicated in transformation, survival, proliferation, invasion, angiogenesis, metastasis, chemoresistance, and radioresistance of cancer, so much so that survival and proliferation of most types of cancer stem cells themselves appear to be dependent on the activation of these inflammatory pathways. Most of this evidence, however, is from preclinical studies. Whether these pathways have any role in prevention, progression, diagnosis, prognosis, recurrence or treatment of cancer in patients, is the topic of discussion of this review. We present evidence that inhibitors of inflammatory biomarkers may have a role in both prevention and treatment of cancer.
Collapse
|
24
|
Davidson B, Espina V, Steinberg SM, Flørenes VA, Liotta LA, Kristensen GB, Tropé CG, Berner A, Kohn EC. Proteomic Analysis of Malignant Ovarian Cancer Effusions as a Tool for Biologic and Prognostic Profiling. Clin Cancer Res 2006; 12:791-9. [PMID: 16467090 DOI: 10.1158/1078-0432.ccr-05-2516] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Malignant epithelial ovarian cancer effusions are important in disease dissemination and clinical outcome. The identification of biochemical events active in effusions may improve our identification and application of targeted therapeutics. EXPERIMENTAL DESIGN Archival effusion samples for which outcome information was known were studied. Clinical variables were comparable between these groups. Two cohorts of patients with malignant effusion were assessed: those with effusion at presentation (Tap1) or at first recurrence (Tap2). Expression and activated fraction of selected signaling proteins were quantitated on serial protein microarrays using validated antibodies. Proteomic results and clinical variables were analyzed by univariate analysis followed by Cox proportional hazards model analysis. RESULTS Malignant effusions (>80% malignant cells) were distinguished from benign effusions by higher expression of AKT, activated extracellular signal-regulated kinase, activated (P < or = 0.001) and total cAMP-responsive element binding protein (P = 0.01), and JNK (P = 0.03). Malignant pleural effusions could not be differentiated from ascites by signaling profiles. Both had signal expression clusters for survival, proliferation and metastasis, and injury pathways. Cox proportional hazards model analysis revealed high p38 and pEGFR/EGFR ratio as jointly associated with poor survival in Tap1 cases (both P < or = 0.002). Phospho-JNK quantity was associated with worse outcome in Tap2 patients (P = 0.004), when taking other factors into consideration. CONCLUSIONS Proliferation, survival, and apoptosis signaling dysregulation can be identified in ovarian cancer effusion samples. Biochemical characterization of clinical effusions may provide either predictive and/or correlative information on patient outcome from which to further understand the mechanisms of effusion development and target clinical intervention.
Collapse
Affiliation(s)
- Ben Davidson
- Molecular Signaling Section, Laboratory of Pathology, National Cancer Institute, Bethesda Maryland 20892, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Reiss A, Lowenstein L, Solt I, Deutsch M. Recurrent ascites due to oral contraceptives and pregnancy. Obstet Gynecol 2006; 107:499-501. [PMID: 16449163 DOI: 10.1097/01.aog.0000171108.21956.7a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ascites during pregnancy is a rare disorder with wide differential diagnosis. CASE We report on 8 years of follow-up of a patient suffering from recurrent episodes of ascites following oral contraceptive use and during both her pregnancies. Each ascitic event resulted in spontaneous recovery. CONCLUSION The mechanism underlying our patient's fluid shift remains an enigma. We hypothesize that during her pregnancy and when oral contraceptives were administered, high levels of endogenous or exogenous sex hormones led to increased permeability and fluid displacement.
Collapse
Affiliation(s)
- Ari Reiss
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
| | | | | | | |
Collapse
|
26
|
|
27
|
Ovarian Thecoma with Meigs Syndrome Mimicking Malignancy in Postmenopausal Women. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
28
|
Qaisar S, Osman F, Pitt M. Resolution of pericardial effusion after removal of ovarian fibroma--a Meigs'-like syndrome. J R Soc Med 2005. [PMID: 15994592 DOI: 10.1258/jrsm.98.7.313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sohail Qaisar
- Department of Cardiology, Birmingham Heartlands and Solihull Hospital NHS Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | | | | |
Collapse
|
29
|
Tjalma WAA. Ascites, pleural effusion, and CA 125 elevation in an SLE patient, either a Tjalma syndrome or, due to the migrated Filshie clips, a pseudo-Meigs syndrome. Gynecol Oncol 2005; 97:288-91. [PMID: 15790480 DOI: 10.1016/j.ygyno.2004.12.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Indexed: 12/25/2022]
Abstract
BACKGROUND The combination ascites, pleural effusion, and elevated CA 125 are usually associated with a malignancy. CASE A 38-year-old SLE patient consulted her physician for shortness of breath. On clinical examination, she had a tender abdomen and reduced breathing sounds. X-ray and computed tomography of the chest showed pleural effusion. An adjustment of her SLE maintenance therapy was performed. Vaginal ultrasound and computed tomography of the abdomen revealed massive ascites and an intracavitair myoma of 2 cm, but no obvious mass in the pelvis. CA 125 was 887 U/ml. A laparoscopy was performed showing ascites and 2 Filshie clips embedded in the peritoneum of the vesicouterine pouch, but no sign of malignancy. Both clips were removed. The cytology of the aspirated ascites showed sings of acute inflammation. Within 10 weeks, the pleural effusion was resolved and the CA 125 normalized. CONCLUSION The combination of ascites, pleural effusion, CA 125 elevation, and no tumor in an SLE patient is either a Tjalma syndrome or due to the migrated Filshie clips a pseudo-Meigs syndrome.
Collapse
Affiliation(s)
- Wiebren A A Tjalma
- Department of Gynecology and Gynecological Oncology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
| |
Collapse
|
30
|
Barak V, Elchalal U, Edelstein M, Kalickman I, Lewin A, Abramov Y. Interleukin-18 levels correlate with severe ovarian hyperstimulation syndrome. Fertil Steril 2004; 82:415-20. [PMID: 15302292 DOI: 10.1016/j.fertnstert.2004.03.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2003] [Revised: 03/08/2004] [Accepted: 03/08/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the involvement of interleukin-18 (IL-18) in the pathophysiology of severe ovarian hyperstimulation syndrome (OHSS), and study its use as a marker of disease and its correlation to capillary hyperpermeability. DESIGN Prospective controlled study. SETTING An IVF unit in a tertiary medical center. PATIENT(S) Twenty-four patients with OHSS in an IVF program, two control groups: group 1, 40 healthy age-matched women without ovulation-induction treatment; group 2, 19 women who received the same ovulation-induction regimen without experiencing OHSS. INTERVENTION(S) Blood samples were obtained at three times: during acute OHSS, on significant clinical improvement, after complete resolution. Ascitic and pleural fluids were obtained by therapeutic paracentesis. Serum, peritoneal, and pleural fluids were analyzed for IL-18 and IL-6, and blood for hematocrit, white blood cell count, and E(2) levels. MAIN OUTCOME MEASURE(S) Hematocrit white blood cell count, serum, peritoneal, pleural fluid levels of IL-18, IL-6, E(2) in severe OHSS. RESULT(S) Significantly higher IL-18 levels were detected in serum, peritoneal, and pleural fluids of patients with severe OHSS as compared with both control groups. Serum IL-18 dropped significantly on transition to the diuretic phase and resolution. A statistically significant correlation between serum IL-18 and hyperpermeability characteristics (white blood cell count, hematocrit), serum E(2), and IL-6 levels was recorded. CONCLUSION(S) This is the first study suggesting a role of IL-18 as a marker of OHSS, with correlation to capillary hyperpermeability parameters.
Collapse
Affiliation(s)
- Vivian Barak
- Obstetrics and Gynecology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | | | | | | | | | | |
Collapse
|
31
|
Morillo M, González-Sicilia E, Martín F, Muñoz V, Calero M, Cordón J. Síndrome de Meigs con valores elevados de CA 125. Aportación de un caso y revisión de la bibliografía. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2003. [DOI: 10.1016/s0210-573x(03)77288-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|