Laboratory Studies
Complete blood cell count
The complete blood cell (CBC) count 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. [16] 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:
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Müllerian epithelium
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Pleura
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Pericardium
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Peritoneum
Pathologic conditions related to an elevated CA-125 level include the following:
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Pelvic inflammatory disease (PID)
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Peritoneal damage or regeneration (eg, abdominal surgery)
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Ovarian malignancy
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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. [17]
Papanicolaou test
Papanicolaou test findings are normal.
Imaging Studies
Chest radiography confirms pleural effusion.
Abdominal and pelvic ultrasound confirms the ovarian mass and ascites.
Computed tomography (CT) scanning of the abdomen and pelvis confirms ascites and the presence of an ovarian, uterine, fallopian tube, or broad ligament mass.
No signs of distant metastasis are observed.
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.
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.
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Serous cystadenoma and mucinous cystadenoma: 15-20% are malignant.
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Endometrioid type and clear cell: 95-98% are malignant.
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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.
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Mature teratoma
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Immature teratoma
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Dysgerminoma
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Gonadoblastoma
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Endodermal sinus
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Embryonal carcinoma
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Nongestational choriocarcinoma
Gonadal-stromal cell tumors
Gonadal-stromal cell tumors constitute 3-5% of all tumors.
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Granulosa cell
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Fibroma: Fewer than 5% are malignant.
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Thecoma: Fewer than 5% are malignant.
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Sertoli-Leydig cell: Fewer than 5% are malignant.
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Lipid cell type: 30% are malignant.
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Gynandroblastoma: 100% are malignant.
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Chest radiograph showing left-sided pleural effusion.
