ABSTRACT
O objetivo deste estudo é descrever o caso de mulher com síndrome de Meigs e apresentar a revisão narrativa sobre o tema. Paciente do sexo feminino, 30 anos, nulípara, encaminhada ao hospital por massa anexial e história prévia de drenagem de derrame pleural. Evoluiu com instabilidade hemodinâmica por derrame pleural hipertensivo à direita, sendo submetida a drenagem torácica, com citologia do líquido negativa. Após, foi submetida a laparotomia: realizada salpingo-ooforectomia esquerda. A congelação e a análise histopatológica diagnosticaram fibroma ovariano. A citologia ascítica foi negativa. CA-125 elevado, presença de derrames cavitários e exame de imagem suspeito podem mimetizar um cenário de neoplasia maligna de ovário em estágio avançado. Entretanto, na síndrome de Meigs clássica, o tratamento é cirúrgico, sendo o diagnóstico obtido por meio da análise histopatológica do tumor ovariano. O manejo da síndrome de Meigs clássica é cirúrgico e, após a remoção do tumor, o derrame pleural e a ascite desaparecem.
To describe a case of Meigs syndrome and present a narrative review of the condition. Female patient, 30 years old, nulliparous, referred to the hospital due to an adnexal mass and a previous drainage of pleural effusion. She developed hemodynamic instability due to a hypertensive right pleural effusion being submitted to chest drainage, with negative cytology of the fluid. She underwent laparotomy: Left salpingo-oophorectomy was performed and frozen section and histopathological analysis diagnosed an ovarian fibroma. Ascites cytology was negative. Elevated CA-125, presence of cavitary effusions, suspicious imaging exam can mimic a scenario of ovarian cancer at an advanced stage. However, in classical Meigs syndrome, treatment is surgical, and the diagnosis is obtained through histopathological analysis of the ovarian tumor. Classical Meigs syndrome' management is surgical. After tumor removal, pleural effusion and ascites resolve.
Subject(s)
Humans , Female , Adult , Meigs Syndrome/surgery , Meigs Syndrome/diagnosis , Case Reports , Weight Loss , Anorexia/complications , Women's Health , Pelvic Pain , Cough/complications , Dyspnea/complications , Fatigue/complications , Abdomen/physiopathologyABSTRACT
Resumen El síndrome de Meigs (SM) es la asociación de ascitis, derrame pleural y neoplasias ovárica benigna, en el pseudo-Meigs se agrega CA-125 elevado. Presentamos el caso de una mujer de 67 años con masa anexial derecha, marcadores tumorales negativos. Se realiza ooforectomía, reportan cistoadenofibroma seroso. Doce semanas posteriores con distensión abdominal, pérdida de peso, tomografía abdominal con carcinomatosis peritoneal, antígeno CA-125 de 1,063.4 U/l. Segunda visión laparoscopia, sin neoplasia, corroborada por histopatología. Realizar un diagnóstico de SM es sencillo, no así cuando se presenta un caso atípico de pseudo-Meigs. Los artículos mencionan mejoría significativa posterior al manejo quirúrgico.
Abstract Meigs syndrome (MS) is the association of ascites, pleural effusion and benign ovarian neoplasms, the pseudo-Meigs (PMS) adds elevated CA-125. We present the case of a 67-year-old female with a right adnexal mass, negative tumor markers, performed ororectomy reported serous cystadenofibroma. 12 weeks later with abdominal distension, weight loss, abdominal tomography with peritoneal carcinomatosis, CA -125 antigen of 1063.4U/L. Second laparoscopic view, without neoplasia, corroborated by histopathology. Making a diagnosis of MS is simple, but not when an atypical case of Pseudo-Meigs is presented. The articles mention significant improvement after surgical management.
ABSTRACT
Meigs' syndrome (MS), a rare complication of benign ovarian tumors, is easily misdiagnosed as ovarian cancer (OC). We retrospectively reviewed the clinical laboratory data of patients diagnosed with MS from 2009 to 2018. Serum carbohydrate antigen 125 and HE4 levels were higher in the MS group than in the ovarian thecoma-fibroma (OTF) and healthy control groups (all P < 0.05). However, the serum HE4 levels were lower in the MS group than in the OC group (P < 0.001). A routine blood test showed that the absolute counts and percentages of lymphocytes were significantly lower in the MS group than in the OTF and control groups (all P < 0.05). However, these variables were higher in the MS group than in the OC group (both P < 0.05). The neutrophil-to-lymphocyte ratio (NLR) was also significantly lower, whereas the lymphocyte-to-monocyte ratio was higher in the MS group than in the OC group (both P < 0.05). The NLR, platelet-to-lymphocyte ratio, and systemic immune index were significantly higher in the MS group than in the OTF and control groups (all P < 0.05). The hypoxia-inducible factor-1 mRNA levels were also significantly higher, whereas the glucose transporter 1, lactate dehydrogenase, and enolase 1 mRNA levels were lower in peripheral CD4
Subject(s)
Female , Humans , Carcinoma, Ovarian Epithelial , Fibroma , Laboratories , Meigs Syndrome/diagnosis , Ovarian Neoplasms , Retrospective StudiesABSTRACT
Ovarian cancer is the presence of one or multiple tumors, which appears in one or both ovaries. These tumors are usually classified as epithelial and non-epithelial. Sex cord-stromal tumors are a group of benign and malignant neoplasms that develop from the sexual cord. Many are functional and therefore have hormonal secretions. Meigs syndrome is defined by the presence of pleural effusion and ascites in association with an ovarian tumor. We present a case of a 55 years old patient who was admitted due to a pelvic tumor, exudative pleural effusion that was difficult to manage, and ascites. A benign ovarian stromal tumor associated with elevated Ca 125 was diagnosed. After the management of the effusions, a 20x20x10 cm ovarian tumor resection was performed by laparotomy, and a transoperative report of a thecoma/fibroma type stromal tumor was received. Meigs syndrome occurs in 1% of ovarian tumors, being very rare before the third decade of life, the pathogenesis of ascites and pleural effusion could be related to the imbalance of hydrostatic forces between arterial flow and lymphovenous drainage culminating in a stromal transudate. Treatment of this syndrome should be focused on tumor debulking surgery and symptomatic treatments such as chest tubes and pleurodesis.
ABSTRACT
Serosal fibroid of uterus are usually asymptomatic but rarely; it may present with atypical symptoms to simulate malignancy and needs extensive evaluation. Authors are reporting a case of 26 years old P1L1 female with history of asymptomatic multiple intramural fibroids since 6 years came with complained of progressively increasing abdominal distension and mild pain abdomen from 2-3 months. On evaluation, she had ascites, pleural effusion and raised Ca-125. MR imaging of pelvis revealed moderate ascites and pedunculated serosal fibroid in addition to intramural fibroids with normal bilateral ovaries. She was evaluated to rule out uterine sarcoma and tuberculosis but diagnosis of them could not be established. Finally, conclusion of Pseudo-Meigs syndrome was made. Myomectomy of single pedunculated fibroid relieved her symptoms. Though, subserosal fibroids are benign in pathology, timely surgery is must to avoid morbidity and mortality owing to massive ascites and pleural effusion.
ABSTRACT
RESUMEN Definimos síndrome de Meigs como la triada de tumor ovárico benigno, derrame pleural y ascitis, una condición clínica rara que se resuelve con la resección del tumor. Estas mismas características pueden presentarse en el síndrome de pseudoMeigs que se asocia a tumores malignos, que agregan un aumento importante de los niveles del marcador CA-125. Es conocido por muchos años, pero su fisiopatología aún no está clara. Se presenta un caso de síndrome pseudo-Meigs y se hace una breve revisión bibliográfica de sus características más importantes.
ABSTRACT Meigs' syndrome is defined as the triad of benign ovarian tumor, pleural effusion and ascites, a rare clinical condition that is treated with tumor resection. Same characteristics may occur in cases of malignant tumors, that add a notable increase in antigen CA-125 serum levels, constituting the pseudo-Meigs syndrome. They have been known for many years, but their pathophysiology remains unclear. We report the case of a pseudo-Meigs syndrome, and a brief bibliography review of the most important characteristics of these syndromes is performed.
ABSTRACT
Resumen Antecedentes: La sospecha clínica de tuberculosis peritoneal debe coexistir en todo paciente con dolor abdominal de causa desconocida; sobre todo si se acompaña de fiebre, ascitis y distensión abdominal. Caso clínico: Paciente de 23 años, con ascitis, derrame pleural y una masa pélvica; concentración elevada de Ca- 125 (875 U/mL), y síntomas sugerentes de cáncer de ovario avanzado. Los estudios de laboratorio y gabinete sugirieron una tumoración proveniente del ovario izquierdo. En la laparotomía diagnóstica se encontraron lesiones compatibles con tuberculosis peritoneal, por lo que se obtuvo una biopsia de la lesión, con resultado positivo de la enfermedad. Se prescribió tratamiento antituberculoso y, posteriormente, se efectuó un nuevo procedimiento quirúrgico debido a la persistencia de la tumoración pélvica y datos de abdomen agudo, en la que se encontró un cistoadenofibroma. Luego de su extirpación la paciente se recuperó por completo. Conclusión: La tuberculosis peritoneal es una enfermedad poco frecuente e inespecífica, al igual que la manifestación de tumores ováricos, por lo que representan un reto diagnóstico.
Abstract Background: Clinical suspicion of peritoneal tuberculosis must coexist in all patients with abdominal pain of unknown cause; especially if accompanied by fever, ascites and abdominal distension. Clinical case: A 23- year-old patient with ascites and pleural effusion, pelvic mass, elevated Ca 125 (875 U/mL), symptoms suggestive of advanced ovarian cancer, laboratory and cabinet studies were conducted, finding that the tumor comes from the left ovary, a diagnostic laparotomy in which lesions suggestive of peritoneal tuberculosis were found, so biopsies were taken, upon finding the result of positive pathology, antituberculous treatment was given and then underwent surgical treatment again for persisting pelvic mass and acute abdomen data, finding a cystoadenofibroma, which when removed, eventually the patient recovered completely. Conclusion: Peritoneal tuberculosis is a rare and nonspecific disease, as is the manifestation of ovarian tumors, which is a diagnostic challenge.
ABSTRACT
Meigs' syndrome is a fibroma associated with ascites and/or pleural effusion and several cases have been reported in association with elevated serum cancer antigen (CA) 125 level. We report here on a 72-year-old woman who presented with palpable huge pelvic mass. Abdomen and pelvic computed tomography showed a heterogenous huge pelvic mass measuring 210×110 mm with large amount of ascites. No pleural effusion was detected on chest X-ray. CA 125 level was 327 IU/mL. The patient underwent laparotomy during which a mass measuring 210×110 mm was detected in her right ovary with 1,000 mL of ascites. Histology showed ovarian fibroma. We performed total abdominal hysterectomy with bilateral salpingo-oophorectomy. Postmenopausal woman with ovarian tumor, ascites, and elevated CA 125 may indicate malignant ovarian tumor, but Meigs' syndrome must be considered as differential diagnosis.
Subject(s)
Aged , Female , Humans , Abdomen , Ascites , CA-125 Antigen , Diagnosis, Differential , Fibroma , Hysterectomy , Laparotomy , Meigs Syndrome , Ovary , Pleural Effusion , ThoraxABSTRACT
Retrospective analyses were conducted for the clinical data of two cases with pseudoMeigs' syndrome at our hospital.Both had respiratory symptoms,such as cough and dyspnea.Radiological examinations revealed ascites,pleural effusion and pelvic mass.The definite pathological diagnosis was pelvic malignant tumor.After surgical tumor removal,ascites and pleural effusion disappeared without recurrence.Along with reviewed cases from PubMed in the last decade,a total of 49 cases had pseudoMeigs' syndrome.The age range was 11-73 years.Their clinical manifestations include dyspnea (78％),abdominal distension (69％),cough (14％),abdominal pain (12％),fatigue (10％),weight loss (6％) chest pain (4％),fever (4％),abdominal mass (4％),and oliguria (2％).CA125 was commonly elevated.The primary tumors in pelvic cavity accounted for 78％.And ovarian metastasis from colon cancer was one of the most common in metastatic tumor.
ABSTRACT
Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated cancer antigen 125 (CA-125) in Meigs' syndrome is an unusual clinical condition reported in few cases. We report here on a 61-year-old woman who presented with dyspnea; in imaging assessment, a heterogeneous pelvic mass measuring 12 x 11 cm with ascitic fluid was reported. Pleural effusion was detected on Chest X-ray. Aspiration of pleural fluid showed no evidence of malignancy. CA-125 level was 347 IU/mL. The patient underwent laparotomy during which a mass measuring 12 x 11 cm was detected in her left adnexa. Histology showed ovarian thecoma. The mass was resected, and, after that, the symptoms disappeared and CA-125 level reached 19 IU/mL. The patient had experienced no problem after 12 months of follow up. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA-125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.
Subject(s)
Female , Humans , Middle Aged , Ascites , Ascitic Fluid , Diagnosis, Differential , Dyspnea , Follow-Up Studies , Laparotomy , Meigs Syndrome , Pleural Effusion , Thecoma , ThoraxABSTRACT
Antecedentes: La asociación entre cáncer y embarazo es infrecuente, con una incidencia entre 0,02-0,1 por ciento ocupando el cáncer de ovario (CAO) el tercer lugar entre las neoplasias ginecológicas más frecuentemente asociada a la gestación, con tasas entre 1/10.000 a 1/100.000 embarazos. Objetivo: Divulgar un caso clínico de interés para la comunidad médica. Caso clínico: Gestante de 22 años que consulta por presentar dolor abdominal, vómitos, disnea y aumento de circunferencia abdominal. Presenta tumoración parauterina que alcanzaba a hipocondrio derecho, e ingresa con diagnostico de embarazo interrumpido de 12 semanas, tumoración de ovario; síndrome de pseudo Meigs y anemia. Mediante ecografía transabdominal se confirma lesión en fosa ilíaca y flanco derecho multilobulada de 17,3 x 9,9 x 13,7 cm, concordante con imágenes de RMN donde se aprecia como una tumoración ovárica sólido-quística. Se práctica laparotomía y la biopsia por congelación diagnosticó tumor ovario de células germinales (disgerminoma). Se procede a practicar histerectomía total con feto obitado in útero, más salpingo-ooforectomía bilateral. Egresando en buenas condiciones y actualmente en quimioterapia. Conclusión: La coincidencia de CAO durante el embarazo es rara, siendo los digerminomas los tumores malignos más frecuentemente diagnosticados.
Background: The association between cancer and pregnancy is infrequent, with an incidence of 0.02 to 0.1 percent; occupying ovarian cancer (OCA) in third place among the most common gynaecological malignancies associated with pregnancy, with rates between 1/10,000 to 1/100,000 pregnancies. Aim: To disseminate clinical case of interest to the medical community. Case report: A 22 years old pregnant who consulted for abdominal pain, vomiting, dyspnoea and increased abdominal girth. Who has an anexial tumour reaching right upper quadrant, which was admitted with diagnosis of interrupted pregnancy of 12 weeks, ovary's tumour, pseudo Meigs' syndrome and anaemia. Transabdominal ultrasound confirmed space occupying lesion in the right lower quadrant and flank multilobed of 17.3 x 9.9 x 13.7 cm, with concordance in MRI which is seen as a mixed ovarian tumour. Laparotomy was practice and the frozen biopsy was diagnosed as ovarian germ cell tumour (dysgerminoma). It proceeds to total hysterectomy with death fetus in uterus, with bilateral salpingo oophorectomy. Withdrawal in good condition and currently under chemotherapy regimen. Conclusion: The coincidence of OCA during pregnancy is rare, the dysgerminoma are the most frequently diagnosed malignancy.
Subject(s)
Humans , Adult , Female , Pregnancy , Young Adult , Pregnancy Complications, Neoplastic , Dysgerminoma/surgery , Dysgerminoma/diagnosis , Ovarian Neoplasms/surgery , Ovarian Neoplasms/diagnosis , Hysterectomy , Meigs SyndromeABSTRACT
O tumor estromal esclerosante de ovário é uma neoplasia benigna extremamente rara, mais frequente em mulheres jovens e sem sintomas específicos na maioria dos casos. Menos de 150 casos foram descritos, dos quais 8 diagnosticados durante a gestação. Neste relato, documentamos a associação entre tumor estromal esclerosante de ovário, síndrome de Meigs e elevação dos níveis de CA-125 em gravidez a termo.
The sclerosing stromal tumor of the ovary is an extremely rare benign tumor more common in young women and without specific symptoms in most cases. Less than 150 cases have been described, of which 8 were diagnosed during pregnancy. In this report, we describe the association between sclerosing stromal tumor of the ovary, Meigs' syndrome and elevated levels of CA-125 in term pregnancy.
Subject(s)
Adolescent , Female , Humans , Pregnancy , Meigs Syndrome/complications , Meigs Syndrome/diagnosis , Ovarian Neoplasms/complications , Ovarian Neoplasms/diagnosis , Pregnancy Complications/diagnosis , Sex Cord-Gonadal Stromal Tumors/complications , Sex Cord-Gonadal Stromal Tumors/diagnosis , /blood , Meigs Syndrome/blood , Ovarian Neoplasms/blood , Pregnancy Complications/blood , Sex Cord-Gonadal Stromal Tumors/bloodABSTRACT
A 54-year-old woman with long-lasting pleural effusion developed abdominal distention due to ascites from bilateral ovarian tumors. The patient had undergone breast-conserving surgery and axillary lymph node dissection for left breast cancer in October 2000, and had developed left pleural effusion in July 2006. Cytological examination of the pleural effusion found no malignant cells. Thoracic drainage with intrathoracic administration of OK-432 (Picibanil) had failed to control the pleural effusion. Positron emission tomography taken at the abdominal distention showed bilateral ovarian tumors. After failure to control the ascites with systemic and intra-abdominal chemotherapy, bilateral oophorectomy resulted in normalization of elevated serum tumor-marker levels and the disappearance of both the ascites and pleural effusions (i.e., pseudo-Meigs' syndrome). Pathological examination showed the tumors to be estrogen receptor-positive metastatic ovarian tumors from her breast cancer. The patient remained well with no further recurrence for 40 months under aromatase inhibitor therapy.
Subject(s)
Female , Humans , Aromatase , Ascites , Breast , Breast Neoplasms , Drainage , Estrogens , Lymph Node Excision , Mastectomy, Segmental , Neoplasm Metastasis , Ovariectomy , Picibanil , Pleural Effusion , Positron-Emission Tomography , RecurrenceABSTRACT
Pseudo-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs' syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome.
Subject(s)
Humans , Acidosis, Respiratory , Anesthesia , Hypoxia , Ascites , Hydrothorax , Pleural EffusionABSTRACT
Pseudo-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs' syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome.
Subject(s)
Humans , Acidosis, Respiratory , Anesthesia , Hypoxia , Ascites , Hydrothorax , Pleural EffusionABSTRACT
Pseudo-Meigs' syndrome is a syndrome that includes hydrothorax and ascites secondary to ovarian tumors other than solid benign fibroma. In this report, we present the case of a 29-years-old female who complained of abdominal distension with peripheral edema during her third trimester. Two solid masses of 15 cm dimension in the left abdomen and 7 cm dimension in the right abdomen were detected by ultrasound and chest X-ray revealed right pleural effusion. Magnetic resonance imaging (MRI) confirmed the ovarian masses and ascites. As the patient had regular uterine contractions, we decided to perform emergency cesarean section because of previous cesarean section history. A laparotomy was performed and pathologists confirmed the presence of a metastatic adenocarcinoma. Four days following the surgery, gastroduodenoscopy revealed a huge ulcerofungating mass was visible in greater curvature of stomach. The final diagnosis was metastatic adenocarcinoma from gastric cancer. Although pseudo-Meigs' syndrome is very rare, it should be carefully considered when evaluating female complaining with ascites in ovarian tumor.
Subject(s)
Female , Humans , Pregnancy , Abdomen , Adenocarcinoma , Ascites , Cesarean Section , Edema , Emergencies , Fibroma , Hydrothorax , Laparotomy , Magnetic Resonance Imaging , Pleural Effusion , Pregnancy Trimester, Third , Stomach , Stomach Neoplasms , Thorax , Uterine ContractionABSTRACT
Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated CA 125 in Meigs'syndrome is unusual clinical condition reported in few cases. We report here, a 49-year-old postmenopausal woman with right ovarian fibrothecoma with ascites, right pleural effusion and high serum levels of CA 125. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA 125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.
Subject(s)
Female , Humans , Middle Aged , Ascites , Diagnosis, Differential , Meigs Syndrome , Ovary , Pleural EffusionABSTRACT
Pseudo-Meigs' syndrome is a rare condition that includes hydrothorax and/or ascites secondary to ovarian neoplasms other than benign primary tumors. A 67-year-old woman presented with ascites, hydrothorax, left ovarian mass and elevated CA-125 level. The mass was removed and revealed serous cystadenocarcinoma. The immediate and complete resolution of symptoms and rapid decline of CA-125 level to normal value was achieved post-operatively. One month after surgery, she had no evidence of ascites or pleural effusion. We report Pseudo-Meigs' syndrome associated with ovarian serous cystadenocarcinoma and elevated CA-125 level.
Subject(s)
Aged , Female , Humans , Ascites , Cystadenocarcinoma, Serous , Hydrothorax , Ovarian Neoplasms , Pleural Effusion , Reference ValuesABSTRACT
Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with an ovarian fibroma, which spontaneously resolve soon after the removal of the tumor. Pseudo-Meigs' syndrome is rare syndrome associated with struma ovarii, yolk sac tumor, ovarian carcinoma, leiomyoma, Brenner tumor and tuberculosis which is combined with the same clinical feature. The cause and pathophysiology of Pseudo-Meigs' syndrome are uncertain. The diagnosis is done by characteristic clinical finding. We present a case of Pseudo-Meigs' syndrome with Brenner tumor with brief review of the literatures.
Subject(s)
Female , Ascites , Brenner Tumor , Diagnosis , Endodermal Sinus Tumor , Fibroma , Hydrothorax , Leiomyoma , Meigs Syndrome , Struma Ovarii , TuberculosisABSTRACT
Pseudo-Meigs' syndrome is a rare condition that includes hydrothorax and/or ascites secondary to ovarian neoplasms other than benign primary tumors. A 67-year-old woman presented with ascites, hydrothorax, left ovarian mass and elevated CA-125 level. The mass was removed and revealed serous cystadenocarcinoma. The immediate and complete resolution of symptoms and rapid decline of CA-125 level to normal value was achieved post-operatively. One month after surgery, she had no evidence of ascites or pleural effusion. We report Pseudo-Meigs' syndrome associated with ovarian serous cystadenocarcinoma and elevated CA-125 level.