Pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from transverse colon cancer

Abstract

Pseudo-Meigs' syndrome associated with colorectal cancer is extremely rare. We report here a case of pseudo-Meigs' syndrome secondary to metachronous ovarian metastases from colon cancer. A 65-year-old female with a history of surgery for transverse colon cancer and peritoneal dissemination suffered from metachronous ovarian metastases during treatment with systemic chemotherapy. At first, neither ascites nor pleural effusion was observed, but she later complained of progressive abdominal distention and dyspnea caused by rapidly increasing ascites and pleural effusion and rapidly enlarging ovarian metastases. Abdominocenteses were repeated, and cytological examinations of the fluids were all negative for malignant cells. We suspected pseudo-Meigs' syndrome, and bilateral oophorectomies were performed after thorough informed consent. The patient's postoperative condition improved rapidly after surgery. We conclude that pseudo-Meigs' syndrome should be included in the differential diagnosis of massive or rapidly increasing ascites and pleural effusion associated with large or rapidly enlarging ovarian tumors.

Keywords: Ascites; Colon cancer; Ovarian metastasis; Pleural effusion; Pseudo-Meigs’ syndrome.

Figure 1

Computed tomography of the abdomen. A: The examination performed 22 d before admission showed bilateral enlarged ovaries with solid and cystic components (arrows). Ascites was not visible; B and C: The examination performed 26 d after admission revealed massive ascites and pleural effusion and rapid enlargement of ovarian tumors (arrows).

Figure 2

Pathological analysis. A, B: Cross-sectional views of the left and right ovarian tumors, respectively. The left ovarian tumor measured 90 mm × 55 mm, and the right ovarian tumor measured 30 mm × 30 mm. Both tumors contained solid and cystic components; C, D: Microscopic views of the left and right ovarian tumors, respectively, showing moderately differentiated adenocarcinoma.

Figure 3

Line graphs showing changes in body weight and abdominal girth. Note that the body weight increased more than 4 kg before the emergence of ascites and that both the body weight and abdominal girth did not change for 3 d after surgery but thereafter decreased rapidly. CT: Computed tomography; US: Ultrasound.