The New England Journal of MedicineMeigs’ Syndrome

Meigs’ syndrome, characterized by the triad of a benign ovarian tumor, ascites, and pleural effusion, can closely mimic ovarian cancer but resolves following tumor excision, offering crucial insights into differential diagnoses and patient management.

A 51-year-old woman presented with a two-month history of dyspnea and was found to have pleural effusions and a pelvic mass originating from the left ovary. The mass was identified as a benign ovarian fibroma associated with Meigs’ syndrome. This case illustrates the importance of recognizing Meigs’ syndrome, which can present similarly to ovarian cancer, yet resolves completely with the excision of the benign tumor.

Key Points:

• Patient Presentation: A previously healthy 51-year-old woman presented with a two-month history of dyspnea.
• Physical Examination: Diminished breath sounds at both lung bases and a firm, nontender pelvic mass originating from the left ovary.
• Imaging Findings: Chest radiograph showed pleural effusions, more pronounced on the right side. CT of the abdomen revealed a pelvic mass and perihepatic ascites.
• Laboratory Results: CA-125 level was elevated at 1794.0 IU/mL (normal <35.0 IU/mL).
• Pleural Fluid Analysis: Sterile exudate with negative cytologic findings.
• Surgical Findings: Exploratory laparotomy identified a left ovarian tumor, with no peritoneal metastases.
• Histopathological Analysis: The tumor was a solid, smooth fibroma.
• Cytologic Testing: Ascitic fluid tested negative for malignancy.
• Diagnosis: Meigs’ syndrome, characterized by the triad of a benign ovarian tumor, ascites, and pleural effusion.
• Postoperative Outcome: Symptoms, pleural effusions, and ascites resolved three weeks after tumor excision.

Tumor marker serum levels of CA-125 can be elevated in Meigs syndrome, but the degree of elevation does not correlate with malignancy. (Medscape)

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