Meigs syndrome

Definition

• Meigs syndrome denotes a benign ovarian tumour, classically a fibroma, with ascites and pleural effusion.
• The criteria established by Meigs in 1954 comprise a benign ovarian tumour such as fibroma, thecoma, granulosa cell tumour or Brenner tumour, ascites, pleural effusion and regression of both effusions once the tumour is no longer present.

Classification

• If another tumour is the cause, such as other benign ovarian tumours like struma ovarii, mucinous cystadenoma or teratoma, a uterine leiomyoma or ovarian metastases, the term pseudo-Meigs syndrome is used.

Occurrence & epidemiology

Epidemiology and pathogenesis

• The syndrome affects about 1% of ovarian tumours; ascites is found in 10–15% and hydrothorax in 1% of women with ovarian fibroma.
• It is very uncommon before the third decade and increases thereafter to a peak in the seventh decade; most patients are postmenopausal.
• The exact pathogenesis is unknown; it is thought that fluid passes from the peritoneal cavity through diaphragmatic defects or lymphatic channels into the pleural space, causing an exudative effusion.

Clinical features

• Typical are dyspnoea, dry cough and painful abdominal distension; the pleural effusion is right-sided in about 70%, left-sided or bilateral in 15% each.

Diagnosis

• Examination reveals an adnexal mass, diminished breath sounds and ascites; imaging confirms the pelvic mass.
• Ultrasound shows ascites, possibly pleural effusions and a well-demarcated adnexal mass without increased vascularity.
• CA 125 may be raised; the mechanism is unclear, mesothelial expression is suspected.
• The definitive diagnosis rests on resolution of the effusions and histological confirmation of the tumour.

Keep learning in the app

Further reading (selection)

1. Meigs' and Pseudo-Meigs' syndrome (Australas J Ultrasound Med 2012, PubMed Central)
2. StatPearls: Meigs Syndrome (NCBI Bookshelf)

Cross-references