Meigs Syndrome

Excerpt

Meigs syndrome is characterized by benign ovarian tumors that present with ascites and pleural effusions. Approximately 1% of ovarian tumors have this presentation, and due to their similar clinical features, differentiating Meigs syndrome from malignant tumors can be challenging. This syndrome was first reported by Joe Vincent Meigs in 1937 in a series of 7 cases where patients presented with an ovarian fibroma and associated ascites and hydrothorax. Although the association between benign ovarian tumors and pleural effusion (analogous with the finding of hydrothorax) had been reported in earlier cases, Meigs was the first to describe the resolution of ascites and pleural effusion after surgical removal of the tumor and an otherwise benign postoperative course.

In 1954, Meigs officially established the following diagnostic criteria for Meigs syndrome:

1. Presence of a benign ovarian tumor, such as fibroma, thecoma, granulosa cell tumor, or Brenner tumor

2. Ascites

3. Pleural effusion

4. Resolution of ascites and pleural effusion following tumor removal

Pericardial effusion is not included in the definition of Meigs syndrome; however, there have been case reports of patients with unexplained persistent pericardial effusion that resolved after the removal of a benign ovarian tumor.

Meigs syndrome typically presents in postmenopausal women with dyspnea, dry cough, and painful abdominal distension. Physical examination may reveal adnexal masses, diminished breath sounds, and signs of ascites. Meigs syndrome most commonly affects postmenopausal women; however, when identified in younger individuals, it should prompt considerations of Gorlin syndrome, a familial cancer syndrome.

Diagnostic evaluation involves a thorough history, physical examination, and imaging to confirm the presence of a pelvic mass and exclude malignancies. Laboratory studies and fluid analysis are also crucial in the diagnostic process. The resolution of ascites and pleural effusion after tumor removal confirms the diagnosis.

Treatment primarily involves the surgical removal of the ovarian mass. In young women desiring fertility preservation, a unilateral salpingo-oophorectomy is preferred, whereas postmenopausal women may undergo total abdominal hysterectomy with bilateral salpingo-oophorectomy. For patients unsuitable for surgery, symptomatic treatment options include paracentesis, thoracentesis, and the placement of indwelling catheters for fluid management.