- The presence of triad consisting of solid benign ovarian mass, associated with ascites and pleural effusion that resolve after the resection of the adnexal mass define Meigs' syndrome.
- Histologically, the benign ovarian tumor may be a fibroma, thecoma, cystadenoma, or granulosa cell tumor.of which ovarian fibromas are the most common cause of Meigs syndrome.
The most likely pathogenesis of peritoneal and pleural effusions ascribes filtration of interstitial fluid in the peritoneum through the tumor capsule, and diffusion to the pleural space, usually at the right side, through diaphragmatic lymphatic vessels and apertures, as well as through intercellular gaps and small areas where muscular tissue of the diaphragm is replaced by areolar tissue.
Pseudo-Meigs' syndrome :
- It is a condition characterized by ascites and pleural effusion caused by pelvic tumors other than solid benign ovarian tumors.
- The pseudo-Meigs syndrome is clinically important because it resembles metastatic pelvic cancer. Especially in patients with malignant ovarian tumors, cytologic examination of the body cavity effusions is essential to differentiate between reactive process and metastatic tumor spread. While detection of malignant cells is a marker of metastatic disease and a sign of bad prognosis, benign effusions of pseudo-Meigs syndrome affect neither disease stage nor the patient's prognosis. Determination of the presence or absence of tumor spread is based primarily on cellular morphology study, but if distinction between reactive mesothial and cancer cells is difficult, immunocytochemistry may be necessary.
- At this point, must be underlined that an ovarian mass combined with pleural and peritoneal effusions not always represents an advanced malignancy, even with elevation of CA 125 value. There are some benign pelvic lesions causing pseudo-Meigs syndrome, which are associated with elevated levels of this tumor marker, such as struma ovarii, ovarian cystadenomas, uterine leiomyomas and broad ligament leiomyomas
- CA 125 levels decline to the normal range after tumor resection.
Atypical Meigs :
Ii is characterized by a benign pelvic mass with right-sided pleural effusion but without ascites . As in Meigs syndrome, pleural effusion resolves after removal of the pelvic mass.
Pseudo-pseudo Meigs syndrome:
- It is a term that describes patients with ascites, pleural effusion, and enlarged ovaries secondary to systemic lupus erythematosus.
- The ovaries in pseudo-pseudo Meigs syndrome may be enlarged, but without evidence of a tumor.
- Ascites in pseudo-pseudo Meigs syndrome is usually exudative, and may be associated with activated mesothelial cells in systemic lupus erythematosus .