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Meigs Syndrome Workup

  • Author: Klaus-Dieter Lessnau, MD, FCCP; Chief Editor: Warner K Huh, MD  more...
 
Updated: Mar 24, 2016
 

Laboratory Studies

CBC count

This study provides information about hemoglobin, hematocrit, and platelet levels. A low hemoglobin count requires further workup, including reticulocyte count, total iron-binding capacity, and iron and ferritin levels. Anemia in patients with Meigs syndrome is most likely due to iron deficiency. Anemia can be corrected emergently by blood transfusion in patients undergoing surgery for Meigs syndrome. Anemia can be treated with iron supplementation postoperatively.

Basic metabolic profile

Studies of sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, and glucose levels are included. These electrolytes are checked before the patient undergoes surgery. If necessary, corrections of these electrolytes are made.

Prothrombin time

Prothrombin time is checked before surgery. If elevated, it is a marker of coagulopathy. Elevated prothrombin time is corrected before surgery, either by administering vitamin K to the patient or by transfusing fresh frozen plasma.

Serum cancer antigen 125 test

Other than serum electrolytes and CBC count, the study of interest is the serum cancer antigen 125 (CA-125) test. Tumor marker serum levels of CA-125 can be elevated in Meigs syndrome, but the degree of elevation does not correlate with malignancy. In fact, a normal CA-125 level does not exclude the possibility of malignancy.[15] The CA-125 level is not used as a screening test. Immunohistochemical studies suggest that serum CA-125 elevation in patients with Meigs syndrome is caused by mesothelial expression of the antigen rather than by fibroma.[1] The highest reported level of CA-125 after laparotomy is 1808 U/mL. This would be a false-positive result.

Physiologic sources of CA-125 are fetal coelomic epithelium and its derivatives, including the following:

  • Müllerian epithelium
  • Pleura
  • Pericardium
  • Peritoneum

Pathologic conditions related to an elevated CA-125 level include the following:

  • Pelvic inflammatory disease (PID)
  • Peritoneal damage or regeneration (eg, abdominal surgery)
  • Ovarian malignancy
  • Endometriosis

In 1992, Lin et al conducted a study to determine whether the ovarian fibroma was the source of serum CA-125 elevation. Using an immunohistochemical technique specific for the tumor marker, they localized CA-125 expression in the omentum and peritoneal surfaces rather than in the fibroma.[16]

Papanicolaou test

Papanicolaou test findings are normal.

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Imaging Studies

Chest radiography confirms pleural effusion.

Abdominal and pelvic ultrasound confirms the ovarian mass and ascites.

CT scan of the abdomen and pelvis

CT scanning confirms ascites and ovarian, uterine, fallopian tube, or broad ligament mass.

No signs of distant metastasis are observed.

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Procedures

Paracentesis

Ascitic fluid is mostly transudative. Findings are negative for malignant cells but can be positive for reactive mesothelial cells.

Thoracentesis

Pleural fluid is usually transudative. Findings can be exudative and negative for malignant cells.

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Histologic Findings

Ovarian tumors are divided into the following histologic subgroups, and Meigs syndrome can be observed with any of the benign tumors.

Coelomic epithelial tumors

These tumors, which originate from the coelomic epithelium, constitute 80-85% of all ovarian tumors.

  • Serous cystadenoma and mucinous cystadenoma: 15-20% are malignant.
  • Endometrioid type and clear cell: 95-98% are malignant.
  • Brenner tumor: 2% are malignant.

Germ cell tumors

These tumors originate from the germ cell and constitute 10-15% of all ovarian tumors. All are malignant except mature teratomas and gonadoblastomas, which are always benign.

  • Mature teratoma
  • Immature teratoma
  • Dysgerminoma
  • Gonadoblastoma
  • Endodermal sinus
  • Embryonal carcinoma
  • Nongestational choriocarcinoma

Gonadal-stromal cell tumors

Gonadal-stromal cell tumors constitute 3-5% of all tumors.

  • Granulosa cell
  • Fibroma: Fewer than 5% are malignant.
  • Thecoma: Fewer than 5% are malignant.
  • Sertoli-Leydig cell: Fewer than 5% are malignant.
  • Lipid cell type: 30% are malignant.
  • Gynandroblastoma: 100% are malignant.
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Contributor Information and Disclosures
Author

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Rajeshwari Chavda, MD Consulting Staff, Emergency Care Group of Northwest

Disclosure: Nothing to disclose.

Mir Omar Ali, MD Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital, New York University

Mir Omar Ali, MD is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Lalit K Kanaparthi, MD Attending Physician, North Florida Lung Associates

Lalit K Kanaparthi, MD is a member of the following medical societies: American College of Chest Physicians, American Medical Association, American Thoracic Society

Disclosure: Nothing to disclose.

Dora E Izaguirre, MD Primary Care Physician; Researcher, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Dora E Izaguirre, MD is a member of the following medical societies: American Heart Association, American Medical Association, American Public Health Association, Colegio Medico de Honduras

Disclosure: Nothing to disclose.

Jesus Lanza, MD Fellow in Pulmonary and Critical Care Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Warner K Huh, MD Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Senior Scientist, Comprehensive Cancer Center, University of Alabama School of Medicine

Warner K Huh, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Surgeons, Massachusetts Medical Society, Society of Gynecologic Oncology, American Society of Clinical Oncology

Disclosure: I have received consulting fees for: Merck; THEVAX.

Acknowledgements

Ayesha Akhter, MD Consulting Staff, Department of Internal Medicine, Columbia Tech Center, Vancouver Clinic

Disclosure: Nothing to disclose.

Jeffrey B Garris, MD Chief, Assistant Professor, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Tulane University School of Medicine

Jeffrey B Garris, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Urological Association, Association of Professors of Gynecology and Obstetrics, Louisiana State Medical Society, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

References
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Chest radiograph showing left-sided pleural effusion.
 
 
 
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