18F-FDG PET/CT features of Meigs syndrome induced by ovarian sex cord stromal tumors: a retrospective clinical study

The objective of this study was retrospectively to analyze the clinical characteristics and 18F-FDG PET/CT findings in Meigs syndrome (MS) patients. A total of 21 patients with MS induced by ovarian stromal tumors and 69 patients with pseudo-MS caused by ovarian cancer (OC-PMS) were subjected to evaluation using 18F-FDG PET/CT. Visual and semi-quantitative methods were employed to analyze the PET/CT findings. Visual analysis included recording whether the density of the primary tumor was uniform, whether there were cystic changes and calcifications, and the location of serous fluid accumulation. Semi-quantitative analysis involved the measurement of the tumor size, SUVmax, and SUVmean. No significant difference was observed in the size and density of primary tumors between the MS group and the OC-PMS group. However, the SUVmax and SUVmean of tumors in the MS group were found to be significantly lower than those in the OC-PMS group. The amount of serous cavity effusion caused by ovarian sex cord stromal tumors was found to be unrelated to the size of the tumor, SUVmax, and SUVmean but was positively correlated with the level of Ca125. MS patients have both benign ovarian tumors and ascites and/or pleural effusion, which may be accompanied by elevated Ca125 levels. This should be considered as one of the differential diagnoses for ovarian cancer. Understanding the PET/CT features of MS can facilitate the attainment of an accurate diagnosis before surgery.

Struma ovarii with synchronous ascites and elevated CA125 level: a retrospective cohort study

BACKGROUND

Benign struma ovarii (SO) with synchronous ascites and elevated CA125 level is extremely rare that the incidence, clinical characteristics, and risk factors remain unclear.

METHODS

We conducted a retrospective study of patients with SO treated in our hospital between 1980 and 2022. Logistic regression was used to identify potential risk factors for SO patients presenting with ascites and elevated CA125 levels. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the identified risk factors.

RESULTS

A total of 21 patients with synchronous ascites and elevated CA125 levels were identified in 229 patients with SO, the crude incidence rate was 9.17%, and four patients (1.75%) had pseudo-Meigs' syndrome. Ascites were completely involuted within 1 month postoperatively and the serum CA125 level decreased to normal between 3 d and 6 weeks after surgery. Multivariate logistic regression showed that age ≥49 years (OR 3.71, 95% CI 1.29 - 10.64, p = 0.015), tumor size ≥10.0 cm (OR 8.79, 95% CI 3.05 - 25.35, p < 0.001), and proliferative SO (OR 11.16, 95% CI 3.01 - 41.47, p < 0.001) were the independent risk factors for patients presenting ascites and elevated CA 125 level. The ROC curve revealed that the predictive performance for age and tumor size was unsatisfactory with an area under the curve (AUC) was 0.646 and 0.682, respectively. Linear regression demonstrated that the serum CA125 level has a moderate positive correlation with the volume of ascites (log2CA125 = 0.6272*log2ascites + 2.099, p = 0.0001, R2 = 0.5576).

CONCLUSIONS

Less than one-tenth of patients with SO would present ascites and elevated CA125 levels, while age ≥49 years, tumor sizes ≥10 cm, and the presence of proliferative SO were the risk factors.

A challenging case of pseudo Meigs syndrome: A case report

Meigs Syndrome is a rare condition characterised by Ovarian fibroma, ascites and pleural effusion. Pseudo Meigs is called so because it mimics Meigs but occurs with tumours other than fibromas. The objective of this case report is to shed light on the diverse presentations of Ovarian carcinomas. We herein report a rare case of Pseudo Meigs syndrome in a 32-year-old female patient parity one and no miscarriage and who had right-sided ovarian mass, gross ascites and right-sided pleural effusion with cancer antigen 125 value of 518.5 IU/L. Clinical Diagnosis was that of Meigs Syndrome. The patient underwent laparotomy for surgical staging and large right-sided ovarian mass with draining of nine litres of ascitic fluid and total abdominal hysterectomy and bilateral salpingo-oophorectomy. The histopathology report showed that it was Endometroid Adenocarcinoma FIGO Grade 3. Definitive diagnosis was that of Pseudo Meigs Syndrome. The case was a diagnostic challenge and difficult to manage. The diverse presentation of ovarian carcinomas makes them difficult to diagnose and clinicians should have a high index of suspicion while managing such cases.

Pseudo-Meigs' syndrome caused by a Krukenberg tumour of gastric cancer

A 50-year-old woman who presented with a one-month history of abdominal fullness and dyspnoea was admitted to our hospital. Esophagogastroduodenoscopy showed the scirrhous-type gastric cancer on the greater curvature of the gastric body. Computed tomography revealed bilateral large ovarian tumours with massive right pleural effusion and ascites. A repeated cytological examination of pleural effusion and ascites revealed no malignant cells. The definitive diagnosis of pseudo-Meigs' syndrome was made by confirming the fact that pleural effusion and ascites disappeared after bilateral oophorectomy. Resection of ovarian tumours may also lead to long-term survival, even in the patients with pseudo-Meigs' syndrome caused by gastric cancer.

[Demons-Meigs syndrome: information on a new case and review of the literature]

Demons-Meigs syndrome is a benign tumor of the ovary. It is very rare and its physiopathology remains obscure. We report a case of Demons-Meigs syndrome in a woman aged 51 years. It was discovered following a right pleural effusion syndrome with ascites and an abdominopelvic mass. Rate of serum CA 125 was 412IU/mL. Surgical exploration revealed ascites of one litre with no suspicious peritoneal lesion and an ovarian fibrothecoma of 70 mm. There were no post-operative complications and three months later, the level of CA 125 was negative with a total drainage of effusions.

Synchronous adult-type granulosa cell tumor of the ovary with ovarian fibroma: a case report

The coexistence of two different types of sex-cord stromal tumors, with various clinical symptoms, is extremely rare. We report a case of a 73-year-old woman showing coexistence of adult-type granulosa cell tumor in one ovary with ovarian fibroma in the other. Simultaneously, she was affected by Meigs' syndrome and simple endometrial hyperplasia without nuclear atypia. The different clinical symptoms of the disease according to the available literature are discussed.

Meigs' syndrome and virilizing ovarian fibrothecoma complicating pregnancy. A case report and review of the literature

BACKGROUND

A half of virilizing ovarian tumors in pregnancy are malignant. The risk of cancer increases with ascites and hydrothorax. Our case shows that such tumor can be benign with good outcome.

CASE

Primigravida in 30 weeks with advanced hirsutism (from 15 weeks), vomiting, epigastric pain, dyspnoea, ascites, hydrothorax, ovarian mass and high level of serum testosterone was operated. After the tumorectomy (fibrothecoma) we performed cesarean section (placental abruption suspected). The female fetus had no signs of virilization. In mother all symptoms and effusions resolved.

CONCLUSION

Meigs' syndrome in pregnancy leads to acute clinical symptoms and needs the surgical intervention with the risk of placental abruption. Virilization of mother was the first symptom of ovarian tumor but the female fetus was protected of hyperandrogenism.

[Pseudo-Meigs syndrome, a rare variant]

The pseudo- Meigs syndrome is defined as a pelvic tumour, other than the ovarian fibroma complicated with ascites and hydrothorax that can be recovered after the tumour is surgically extirpated. The uterine leiomyoma is an extremely rare cause of this syndrome, only 24 cases have been recorded so far, most of them presenting hydropic degeneration or necrosis. The case exposed by us, a 50- year old obese,with nanism woman, presented clinical, biological and imaging characteristics of the syndrome; moreover, she had arterial high blood pressure for more than five years, fact that didn't need postoperative treatment. She was sent to the ER because she had severe respiratory insufficiency, arterial high blood pressure, tachycardia and, at the clinical examination, she presented massive right hydrothorax, ascites, and pelvic tumour. The biologic explorations (the benign cytology in the pleural liquid and ascites, CA-125 with ten times the normal value) and the imagery completed the picture of a Meigs/ pseudo-Meigs syndrome that implied the laparotomy. The H-P examination and the postoperative evolution confirmed the diagnosis. We presented this case in order to emphasize both its rarity and its real positive and differential diagnosis problems.

Meigs syndrome and gliomatosis peritonei: a case report and review of literature

To the best of our knowledge, pseudo-Meigs syndrome (PMS) has never been described in the setting of gliomatosis peritonei (GP), both arising from an ovarian teratoma. We present a case of ovarian teratoma with both these rare findings. The case is unique as it presents two rare manifestations of ovarian teratoma in the same patient; there are many cases in the literature where both these manifestations have been described in different patients. The case is also rare because lymph node involvement along with gliomatosis was found. We review the literature for these two rare complications of ovarian teratoma.

Leiomyoma of the ovary presenting with Meigs' syndrome

Ovarian leiomyoma is a rare tumor. Ovarian leiomyoma accompanied with Meigs' syndrome is extremely rare. We report a case of ovarian leiomyoma presenting with Meigs' syndrome, which was first noted as dyspnea in a 79-year-old woman. A whole-body examination revealed a solid mass of the ovary, accumulation of ascites and pleural effusion, and elevated serum carbohydrate antigen 125. Abdominal hysterectomy and salpingo-oophorectomy were carried out. After the surgery, ascites and pleural effusion disappeared. The pathological diagnosis of the removed tumor was leiomyoma of the left ovary. The patient has been healthy for 24 months after the surgery, with no signs of recurrence. We also review the literature on this disease and the clinicopathologic characteristics of the current case are discussed.

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

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.

Cystic struma ovarii presenting with ascites and an elevated CA-125 level. A case report

BACKGROUND

Struma ovarii is a monodermal teratoma that usually presents as a solid pelvic mass. Occasionally the lesions are cystic. Rare cases present with ascites or pseudo-Meigs' syndrome. The association of a cystic struma ovarii with ascites and an elevated CA-125 level is exceptionally rare.

CASE

A 51-year-old woman presented with ascites and a cystic pelvic mass. There was marked elevation of her CA-125 level. The clinical impression was ovarian carcinoma. Frozen section revealed a multicystic struma ovarii.

CONCLUSION

Struma ovarii can mimic ovarian carcinoma clinically, particularly if cystic and associated with ascites and an elevated CA-125 level.

Pseudo-Meigs' syndrome secondary to subserous myoma uteri: a case report

A 45 year-old Thai woman, gravida 5, para 5 presented with a huge pelvic mass as well as ascites and right pleural effusion. Right thoracocentesis was performed pre-operatively and malignant cells could not be detected on the cytological examination of the pleural fluid. Surgical exploration revealed a large pedunculated subserous leiomyoma of the uterus without malignant transformation. Total abdominal hysterectomy with bilateral salpingooophorectomy and appendectomy were performed. Both ascites and pleural effusion resolved post-operatively and did not recur during the 12-month follow-up. This case demonstrated the extremely rare case of pseudo-Meigs' syndrome caused by a subserous uterine leiomyoma.

Two cases of supernumerary ovary: one with large fibroma with Meig's syndrome and the other with endometriosis and cystic change

Reports of supernumerary ovaries are rare. We describe two such cases, one with fibroma and the other with endometriosis and cystic change. A large fibroma measuring 17.4 x 12.0 x 7.5 cm in size was found in the supernumerary ovary of the omentum in the first case of a 47-year-old married woman with Meig's syndrome. The second case was associated with endometriosis and cystic change, measuring 11 x 5 x 3 cm in size and located in the upper abdominal cavity. It was attached to the uterus of a 28-year-old pregnant woman who had neither fibroma nor Meig's syndrome. Histologically, corpus albicans and a few primordial germ cells were demonstrated, respectively. A fibroma showing a storiform pattern was found in the first case. The second case had endometriosis and a thin-walled cyst with bleeding and necrosis caused by torsion. Immunohistochemically, desmin, alpha-smooth muscle actin, c-kit, CA125, Na+/K+ATPase, overexpression of p53, myc and ras were all negative in the fibroma cells of the first case, and in the endometriosis and cyst wall of the second case. The fibroma cells were positive for vimentin and estrogen receptor, and the proliferating cell nuclear antigen was sporadically demonstrated in their nuclei. The mutation of the p53 gene at exons 5-8 was not detected by sequence analysis. Using RT-PCR, bax, bcl-2 and p16 were not detected either. Clinically, the two cases presented here did not show abnormal hormonal symptoms. They were diagnosed as abdominal tumors or masses. Based on these considerations, one might assume that supernumerary ovaries are probably more frequent than reported at present.

Cumulative dosage effect of a RAD51L1/HMGA2 fusion and RAD51L1 loss in a case of pseudo-Meigs' syndrome

Uterine leiomyoma presenting with ascites and pleural fluid is referred to as pseudo-Meigs' syndrome. It is unclear whether common uterine leiomyomas and uterine leiomyomas causing pseudo-Meigs' syndrome are cytogenetically related or whether functionally different primary pathogenetic triggers are responsible for the differences in tumor phenotype. In this study, we investigated the possible involvement of RAD51LI and HMGA2 (formerly known as HMGIC) in initiation and/or progression of a huge uterine leiomyoma presenting as pseudo-Meigs' syndrome. The detailed cytogenetic and FISH analysis revealed the presence of two subclones with a complex karyotype, 46,XX,t(2;12)(q31;q21),ins(14;12)(q23-24;q15q21).ish del(12)(q15q15) (LL12NC01-142H1-,LL12NC01-27E12-),der(12)t(2;12)(LL12NC01-142H1+,LL12NC01-27E12-),der(14)ins(14;12)(q22;q15q15) (LL12NC01-142H1+,LL12NC01-27E12+,RAD51LI+), der(14)ins(14;12)(q23-q24;q15q21) (LL12NC01-142H1-, LL12NC01-27E12+) [20]/46,idem,del(14)(q21q24).ish(RAD51LI-) [6], indicating intragenic HMGA2 rearrangement and loss of one of the RAD51LI alleles in a derivative subclone with chromosome 14 deletion. Furthermore, RACE and RT-PCR analysis of the tumor cells did not reveal abnormal HMGA2 or RAD51LI transcripts. Additionally, the cellular subclone with intrachromosomal 14q21-q24/RAD51LI deletion showed an in vitro growth advantage over the subclone without the deletion. This observation supports a model in which accumulation of two independent mutations-a classical structural rearrangement involving HMGA2 and RAD51L1, in combination with a loss of the second RAD51L1 allele-might play a major role in the development of pseudo-Meigs' syndrome.

Pseudo-Meigs' syndrome caused by a hydropic degenerating uterine leiomyoma with elevated CA 125

BACKGROUND

Uterine leiomyomas rarely cause pseudo-Meigs' syndrome with elevated serum CA 125 levels.

CASE

A 39-year-old patient with a large uterine leiomyoma is described. The associated massive ascites, pleural fluid, and increased CA 125 level all seemed to be related to the uterine tumor. Hydropic degenerating leiomyomas are characterized by focal accumulation of edema and collagen deposition. Marked degrees of hydropic degeneration may have resulted in cystic degeneration, leading to large myometrial cysts. A presumed direct relation between the abundance of intratumoral fluid and presence of ascites seemed justified. The increased level of CA 125 most probably resulted from the peritoneal mechanical irritation from the large leiomyoma or from a large volume of ascites. Having accumulated a sufficient volume and pressure, the ascites finds it way through the diaphragm through intercellular gaps and diaphragmatic apertures, as well as through small bilateral areas where muscular tissue of the diaphragm is replaced by areolar tissue, resulting in the presence of pleural fluid.

CONCLUSION

The pathophysiology of a uterine leiomyoma mimicking a pelvic malignancy is described.

Meigs syndrome and "false positive" preoperative serum CA-125 levels: analysis of ten cases

Ten patients with Meigs syndrome operated on by the author were evaluated to determine the possible relationship between elevated preoperative serum CA-125 levels and tumor size and/or ascites.

[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.

[Recurrence of Demons-Meigs' syndrome. A case report]

Meigs' syndrome includes ascites, hydrothorax and benign ovarian tumor. The aim of this study was to report a recurrence of Meigs' syndrome in a 71 year old woman, which occurred 30 years after the initial operation. It seems to be the first reported case of recurrence. The high level of CA125 was suggestive of malignancy. Resection of a peritoneal recurrence of the benign fibrothecoma was followed for the second time by improvement of all the symptoms.

[Pseudo-Meigs' syndrome]

Cytologic examination of the body cavity effusions in patients with ovarian tumours is performed to differentiate between reactive processes and tumour spread. While detection of malignant cells is a marker of metastatic disease and a sign of bad prognosis, benign effusions affect neither disease stage nor the patient's prognosis. Determination of the presence or absence of tumour spread is based primarily on cellular morphology. As distinction between reactive mesothelial and cancer cells can be difficult, immunocytochemistry may be employed in equivocal cases. The case of a 42-year-old woman who presented with a large pelvic mass accompanied by ascites and hydrothorax is described. Cytomorphology of preoperative pleural fluid specimen was inconclusive. Immunocytochemical examination of cell block sections using: BerEP4, B72.3, CA 125, CD15, CEA, E-cadherin and calretinin was done. No epithelial cells were detected and diagnosis of reactive mesothelial cells was made. Laparotomy was performed and adnexal tumour removed. Borderline mucinous tumour of the ovary was diagnosed. There was no recurrence of the ascites or hydrothorax. The clinicopathologic features and terminology of pseudo-Meigs' syndrome are briefly reviewed. The role of ancillary studies in diagnosis of body cavity effusions is emphasized.

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.

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 with elevated serum CA 125 levels: two case reports and review of the literature

Two cases of Meigs' syndrome in association with elevated serum CA 125 levels are reported. The significance of Meigs' syndrome lies in the fact that neither ascites nor pleural effusion is necessarily an ominous sign in women with a pelvic tumor. Although there is a strong correlation between ovarian malignancy and elevated serum CA 125 levels, several benign conditions have been found to cause a rise in CA 125 levels. It is important to remember that a pelvic neoplasm in a woman presenting with hydrothorax, ascites, and elevated CA 125 levels might be benign and that this condition can rapidly be resolved with surgical removal. Neither ultrasound examination nor computed tomography can reliably offer a preoperative diagnosis.

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.

Struma ovarii with pseudo-Meigs' syndrome: report of a case and review of the literature

A case of struma ovarii with ascites and hydrothorax is reported. This unusual rare association is labeled as pseudo-Meigs' syndrome to differentiate it from conventional Meigs' syndrome in which the ovarian tumor is a fibroma. We discuss the diagnostic problems of this condition, and present a brief review of the reported cases in the literature.

Meigs' syndrome--a case report

Bilateral ovarian fibromas combined with as and hydrothorax is a rare disorder. A case of bilateral ovarian fibromas combined with ascites and hyrothorax is presented. The ascites and hydrothorax disappeared spontaneously after removal of the ovarian tumors.

Secondary massive ovarian edema with Meig's syndrome

Primary massive ovarian edema is uncommon, particularly when it involves both ovaries before puberty. Ovarian edema secondary to a preexisting ovarian lesion is one of the postulated mechanisms. A prepubertal girl presented with bilateral massive ovarian edema with stromal hyperthecosis, which may have predisposed both ovaries to undergo partial torsion. The associations with Meig's syndrome, greatly elevated hormone levels and presence of omental and retroperitoneal nodules, raised a suspicion of malignancy.

Meigs's syndrome and ovarian thecoma in pregnancy. A case report

Ovarian thecoma is a rare tumor, accounting for less than 1% of all ovarian tumors. Thecomas occur even more infrequently during pregnancy, as evident from the fact that there are only 16 such case reports. A 16-year-old, pregnant, black woman presented with ovarian thecoma, pleural effusion and ascites at 32 weeks' gestation. To our knowledge, this was the first reported case that fulfills the criteria of Meigs's syndrome during pregnancy. Ovarian tumors in pregnancy may have very subtle clinical manifestations, making the diagnosis a challenge. Delivery by cesarean section at term is recommended in these patients for the best maternal and fetal outcome.

[Demons-Meigs syndrome. Apropos of a case. Review of the literature]

On the basis of one case, the authors discuss the clinical, paraclinical and evolutive features of Demons-Meigs syndrome. They review the literature in an attempt to define the pathogenesis of this rare syndrome.

Atypical endometrioid cystadenofibroma with Meigs' syndrome: ultrastructure and S-phase fraction

A case of an ovarian endometrioid cystadenofibroma with epithelial atypia and Meigs' syndrome is described. The patient had a large pleural effusion that resolved rapidly after extirpation of the tumor. The S-phase fraction, measured by in vitro incorporation of tritiated thymidine, was extremely low, suggesting that this unusual tumor has a limited growth potential despite its atypical features. Ultrastructurally, the epithelial component has few features described in other ovarian endometrioid tumors. The cells have deeply clefted nuclei and numerous secondary cytolysosomes, features more commonly seen in Brenner tumors; the morphologic similarities may reflect a low epithelial turnover rate. Despite a review of the literature and an analysis of the case, the authors were unable to determine the pathogenetic mechanism of Meigs' syndrome.

Primary ovarian lymphoma associated with Meigs' syndrome: a case report

A case is presented of primary undifferentiated lymphocytic lymphoma, non-Burkitt, of the right ovary associated with Meigs' syndrome. The diagnosis was based upon the findings of tumor imprint cytology, histopathology and electron microscopy. The ultrastructural observations were the most diagnostic, revealing well-developed, rough endoplasmic reticulum and dilated cisternae in the cytoplasm of the tumor cells. An association of Meigs' syndrome with a rare ovarian lymphoma has not been previously reported. The abnormal-appearing mesothelial cells in the pleural effusion were proven to be reactive and not malignant by comparison with the tumor cells demonstrated by imprint cytology of this ovarian lymphoma.

Meigs' syndrome complicated by pregnancy

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