Meigs Syndrome

Consider a clinical scenario: A female patient presents with abdominal distension, dyspnea, and an identified ovarian mass. These findings may initially raise concern for a malignant process. However, they could instead point towards Meigs Syndrome—a rare, benign condition that closely mimics the presentation of ovarian cancer. This article provides a comprehensive overview of Meigs Syndrome, including its characteristic triad, etiopathogenesis, clinical manifestations, diagnostic approach, and management strategies.

ONCOLOGYRESPIRATORY

Rishwin A R

3/13/20252 min read

What is Meigs Syndrome?

Meigs Syndrome is a rare medical condition characterized by a triad of:

Benign ovarian tumor (most commonly a fibroma)
Ascites (fluid accumulation in the abdomen)
Pleural effusion (fluid accumulation in the chest cavity)

The magic? Once the tumor is removed, the ascites and pleural effusion vanish like they were never there. It’s one of those medical mysteries that both baffle and fascinate clinicians.

Causes of Meigs Syndrome

1. Benign Ovarian Tumor

Most commonly, a fibroma, but can also be a thecoma or granulosa cell tumor.

2. Fluid Accumulation

The exact mechanism is not fully understood, but it is believed that the tumor irritates the peritoneal surfaces causing fluid to collect.
Lymphatic obstruction and vascular permeability also play a role in fluid build-up.

3. Pleural Effusion

Fluid from the abdomen may move into the chest cavity through diaphragmatic lymphatics or defects, resulting in pleural effusion (usually right-sided).

Symptoms of Meigs Syndrome

The symptoms can be sneaky because they mimic more dangerous conditions:

Abdominal distension (due to ascites)
Shortness of breath (from pleural effusion)
Pelvic or lower abdominal pain (mass effect from the ovarian tumor)
Weight loss or fatigue (occasionally)

Many patients are understandably worried about ovarian cancer when these symptoms appear.

Diagnosis of Meigs Syndrome

Clinical Examination

Abdominal bloating
Decreased breath sounds on the affected side (usually right)
Palpable pelvic mass

Imaging Studies

Ultrasound: Identifies the pelvic mass
CT/MRI: More detailed assessment of the mass, ascites, and pleural effusion

Fluid Analysis

Ascitic and pleural fluid: Typically exudative but may be transudative; importantly, they are negative for malignant cells.

Tumor Markers

CA-125 may be elevated, which can confuse the diagnosis (often associated with ovarian cancer)

Final Diagnosis

Confirmed after surgical removal of the tumor and resolution of ascites and pleural effusion.

Treatment of Meigs Syndrome

Surgical Management

Surgical removal of the ovarian tumor is the definitive treatment.
Most commonly done via laparotomy or laparoscopy.

Postoperative Outcome

Complete resolution of ascites and pleural effusion, typically within weeks.

Follow-Up

Regular monitoring to ensure no recurrence, although true Meigs Syndrome does not typically recur once the tumor is removed.

Prognosis

The prognosis is excellent. Once the tumor is excised, patients generally have a full recovery. It’s a relief for both patients and clinicians when the "cancer scare" turns out to be a benign, treatable condition.

FAQs About Meigs Syndrome

1. Is Meigs Syndrome cancer?

No. Meigs Syndrome involves a benign ovarian tumor, most often a fibroma, and is not cancerous.

2. How is Meigs Syndrome diagnosed?

Diagnosis is clinical and radiological, confirmed by resolution of ascites and pleural effusion after tumor removal.

3. Can CA-125 be elevated in Meigs Syndrome?

Yes. CA-125 can be elevated, which may initially raise concern for ovarian cancer.

4. What’s the treatment for Meigs Syndrome?

Surgical removal of the ovarian tumor is the definitive treatment.

5. What is Pseudo-Meigs Syndrome?

Pseudo-Meigs Syndrome mimics Meigs Syndrome but is associated with other types of tumors, including malignant ones.