Meigs Syndrome Clinical Presentation

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

History

Patients with Meigs syndrome may have a family history of ovarian cancer. The chief complaints are vague and generally manifest over time; they include the following:

  • Fatigue

  • Shortness of breath

  • Increased abdominal girth

  • Weight gain/weight loss

  • Nonproductive cough

  • Bloating

  • Amenorrhea for premenopausal women

  • Menstrual irregularity

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Physical

Positive signs include the following:

  • Vital signs - Tachypnea, tachycardia

  • Lungs - Dullness to percussion; decreased tactile fremitus; decreased vocal resonance; decreased breath sounds, suggesting pleural effusion, which is mostly observed on the right side but can also be left sided

  • Abdomen - Most patients present with an asymptomatic, solid, and unilateral pelvic mass, most often left sided; the mass may be large, [6] but sometimes, no mass is felt; ascites is present, with shifting dullness and/or fluid thrill

  • Pelvis - Examination reveals a pelvic mass

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Causes

When an ovarian mass is associated with Meigs syndrome and an elevated CA-125 serum level, a malignant process may be suspected until proven otherwise histologically. A negative cytologic examination result of ascitic effusion, the absence of peritoneal implantation, and benign histology should limit surgical procedures. This decision should be made by an experienced gynecologic surgeon or a gynecologic oncologist.

Note the following:

  • Case reports exist of pseudo-Meigs syndrome associated with malignant struma ovarii and elevated CA-125 levels. [12, 13] The choice of not performing adjuvant therapy is feasible after optimal surgery and adequate staging procedure given to the usually clinical benign course and the low incidence of metastases in malignant struma ovarii. Careful patient counseling is required.

  • Struma ovarii is a rare cause of ascites, hydrothorax, elevated CA-125 levels, and hyperthyroidism. [13] This rare condition should be considered in the differential diagnosis in patients with ascites and pleural effusions but with negative cytologic test results.

  •  Liao and colleagues reported a case of right benign struma ovarii in a patient presenting with ascites and CA-125 of 3515 U/Ml, who presented complete remission of symptoms and return to normal CA-125 after surgical resection of the mass. [3]

  • The combination of ascites, pleural effusion, CA-125 level elevation, and no tumor in a patient with systemic lupus erythematosus is either a Tjalma syndrome or due to the migrated Filshie clips a pseudo-Meigs syndrome. [14]

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