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At a glance

It is an acquired disorder associated with a triad presentation consisting of benign tumors of the ovary or other female pelvic organs, ascites, and pleural effusion. Histologically, the benign ovarian tumor might be a fibroma, thecoma, cystadenoma, or granulosa cell tumor. Meigs’ Syndrome resolves after the resection of the tumor.

N.B.: Atypical Meigs’ Syndrome (Pseudo Meig’s Syndrome): It is characterized by a benign pelvic mass with right-sided pleural effusion without ascites. There are various gynecological tumors of the uterus but the leiomyoma is related to the pseudo-Meigs Syndrome. As in Meigs Syndrome, pleural effusion resolves after removal of the pelvic mass.

Synonyms

Meigs Salmon Syndrome; Demons Meig Syndrome; Meig’s Syndrome.

History

In 1934, Salmon described the association of pleural effusion with the presence of a benign pelvic tumor. In 1954, Joe Vincent Meigs (1892-1963), an American obstetrician, and John W. Cass, an American physician, described seven cases of ovarian fibromas associated with ascites and pleural effusion.

Incidence

In the United States, ovarian tumors are more prevalent in upper socioeconomic groups. Ovarian fibroma is found in 2 to 5% of surgically removed tumors and Meigs Syndrome represents 1%. The prevalence is unknown. It is seen from the third decade, with a peak in the seventh decade.

Genetic inheritance

It is an acquired disorder without genetic association.

Pathophysiology

Meigs Syndrome is characterized by the presence of ascites and pleural effusion in the presence of a benign ovarian tumor. Pseudo-Meigs Syndrome presents in a similar fashion and is associated with benign tumors of other pelvic organs. The cause of the ascites is uncertain but may be a result of mechanical irritation of the peritoneum, venous or lymphatic obstruction, or production of vasoactive substances by the tumor. The development of pleural effusions, which are usually right sided and may be massive, probably is caused by passage of ascitic fluid via transdiaphragmatic lymphatics or directly via diaphragmatic defects. Classically, the ascites and pleural effusions disappear following tumor removal. Development of ascites may be caused by release of mediators (eg, activated complements, histamines, fibrin degradation products) from the tumor, leading to increased capillary permeability.

Diagnosis

The presence of a pleural effusion and ascites in the presence of a benign pelvic tumor and the disappearance of effusions following excision of the tumor are a sine qua non in making the diagnosis. The majority of pleural effusions are exudates. Other causes of ascites and/or pleural effusions must be excluded. The presence of elevated CA125 levels usually is suggestive of ovarian malignancy. Elevated levels of CA125 have been reported in Meigs Syndrome in the absence of malignancy.

Clinical aspects

  • Meigs Syndrome: Usually presents as abdominal pain and/or distension. ...

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