PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.
The three cardinal features of Meigs' syndrome are:
The ovarian tumour is usually a fibroma but may be a thecoma, cystadenoma, or granulosa cell tumour. If the tumour is resected, the fluid resolves.
Meigs' syndrome is rare. It is very uncommon before 40 years of age and becomes more frequent as the years progress but there are some reports of it arising from teratomas or cystadenomas in pre-pubertal girls.
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Most features are related to ascites and pleural effusion but before the menopause there may be menstrual symptoms too.
- Dyspnoea (initially on exertion)
- Swollen abdomen with associated weight gain
- Non-productive cough
- Amenorrhoea or irregular menstruation
- Reduction in lung capacity may produce tachypnoea and tachycardia.
- Examination of the chest will reveal dullness to percussion over the effusion. There will be decreased breath sounds and decreased tactile vocal fremitus.
- The effusion tends to be right-sided but can be bilateral. There appears to be no adequate explanation for this unilaterality. A large right-sided effusion will displace the mediastinum to the left with deviation of the trachea to the left and displacement of the apex beat.
- Abdominal examination may reveal a tumour arising from the pelvis but this may be obscured by ascites. The features of ascites include a fullness of the flanks and shifting dullness.
- Pelvic examination may reveal an ovarian mass.
The main differential diagnosis is with a malignant ovarian tumour:
- They are much more common than Meigs' syndrome and tend to produce profuse ascites with a high protein content.
- Pleural effusion is less common unless due to pulmonary metastases.
Other considerations include:
- Other cancers, including colon and lung
- Metastatic breast cancer
- Nephrotic syndrome
- Congestive heart failure
- Check urine for protein.
- Routine blood tests would include FBC, U&E, LFTs, including plasma proteins.
- Cancer antigen CA 125 is often elevated both in serum and in pleural and peritoneal fluid.
- However CA 125 is not reliable and cases are described with very high CA 125 and with normal levels. It can also be normal in ovarian malignancy.
- CXR (AP and lateral) will show the degree of pulmonary effusion.
- Abdominal ultrasound will demonstrate the ascites and should outline the ovarian tumour too.
- Imaging also includes CT of the chest abdomen and pelvis, and MRI of the pelvis.
- Paracentesis and aspiration of pleural fluid:
- Helps to relieve symptoms and fluid should be sent for cytology. This is very important in distinguishing malignant ascites from Meigs' syndrome.
- The fluid tends to have the features of a transudate although sometimes it does appear to be an exudate. In ovarian carcinoma the protein content is usually high.
- Pleural and ascitic fluid should also be examined for protein, glucose, amylase, cell count, organisms and AAFB if indicated.
- If congestive heart failure is suspected, ECG will be required. Echocardiogram is indicated only if the ECG is abnormal.
- Pseudo-Meigs' syndrome is characterised by pleural effusion, ascites, and benign ovarian tumours (other than fibromas). The tumours may include those of the Fallopian tube, uterus, round ligament, colon, mature teratomas, struma ovarii or ovarian leiomyomas.
- Pseudo-pseudo Meigs' syndrome may occur in patients with systemic lupus erythematosus and enlarged ovaries.
- Atypical Meigs' syndrome consists of a benign pelvic mass with a right-sided pleural effusion, but no ascites present. This is rare. The pleural effusion resolves after resection of the tumour.
The essential management is surgical removal of the tumour. Before operation, aspiration of pleural effusion and ascites may be required to improve pulmonary function.
The operation includes full laparotomy to exclude other causes of malignancy, including bowel:
- In women of reproductive age a unilateral salpingo-oophorectomy is usually performed.
- In girls who are before the menarche, wedge resection may be preferred if feasible.
- After the menopause an operation of total abdominal hysterectomy with bilateral salpingo-oophorectomy is usual.
Within weeks to months of operation the ascites and pleural effusion resolve and the CA 125 returns to normal. Postoperative resolution of the fluid is part of the definition of the disease. As it is a benign tumour the prognosis is excellent. If there is functioning ovarian tissue, fertility should be preserved.
- In 1934 Salmon described the association of pleural effusion with benign pelvic tumours.
- In 1936 Meigs and Cass described seven cases of ovarian fibromas associated with ascites and pleural effusion.
- In 1954 Meigs proposed limiting the diagnosis of Meigs' syndrome to benign and solid ovarian tumours with ascites and pleural effusion, and the condition that removal of the tumour cures the patient without recurrence.
Joe Vincent Meigs was an American obstetrician and gynaecologist who was born in 1892 and died in 1963.
Further reading & references
- Joe Vincent Meigs; whonamedit.com
- Riker D, Goba D; Ovarian mass, pleural effusion, and ascites: revisiting Meigs syndrome. J Bronchology Interv Pulmonol. 2013 Jan;20(1):48-51. doi: 10.1097/LBR.0b013e31827ccb35.
- Agaba EI, Ekwempu CC, Ugoya SO, et al; Meigs' syndrome presenting as haemorrhagic pleural effusion. West Afr J Med. 2007 Jul-Sep;26(3):253-5.
- Feldman ED, Hughes MS, Stratton P, et al; Pseudo-Meigs' syndrome secondary to isolated colorectal metastasis to ovary: a case report and review of the literature.; Gynecol Oncol. 2004 Apr;93(1):248-51.
- Lanitis S, Sivakumar S, Behranwala K, et al; A case of Meigs syndrome mimicking metastatic breast carcinoma. World J Surg Oncol. 2009 Jan 22;7:10. doi: 10.1186/1477-7819-7-10.
- Moran-Mendoza A, Alvarado-Luna G, Calderillo-Ruiz G, et al; Elevated CA125 level associated with Meigs' syndrome: case report and review of the literature.; Int J Gynecol Cancer. 2006 Jan-Feb;16 Suppl 1:315-8.
- Iavazzo C, Vorgias G, Sampanis D, et al; Meig's or Pseudomeig's syndrome? Bratisl Lek Listy. 2007;108(3):158-60.
- Meigs JV, Cass JW; Fibroma of the ovary with ascites and hydrothorax: with a report of seven cases, Am J Obstet Gynecol 1937; 33: 249-267.
- Meigs JV; Fibroma of the ovary with ascites and hydrothorax: A Further report. Ann Surg. 1939 Oct;110(4):731-54.
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Dr Hayley Willacy
Dr Colin Tidy
Dr John Cox