Meigs syndrome: About an uncommon case report

Abstract

Background: Ovarian fibroma is a very unusual epithelial tumor representing less than 1% of all ovarian tumors. It can be asymptomatic and discovered during surgery or be associated with a pleural effusion preferentially located on the right side and a more or less abundant free ascites in the framework of the so-called Meigs syndrome. The challenge of management then lies in distinguishing benign from malignant since clinically, radiologically, and biologically everything points towards malignant which requires radical surgical treatment. We report here the case of a 69-year-old postmenopausal patient with a clinical form of Meigs' syndrome that strongly suggested ovarian cancer. Case presentation: We hereby report here the case of a 69-year-old patient, menopausal, gravida 4 para 3 with 3 live children delivered vaginally and one miscarriage. She presented with ascites, hydrothorax, and a solid tumor of the ovary. Serum CA 125 and HE 4 levels were very high. ROMA score was highly suggestive of malignancy. A hysterectomy with adnexectomy was performed. It was only the histological evidence of ovarian fibroma and the rapid resolution of its effusions that confirmed Meigs syndrome. Conclusion: Meigs syndrome is an anatomical-clinical entity that associates a benign tumor of the ovary, ascites, and hydrothorax. Highly elevated CA 125 and HE-4 tumor markers often point clinicians toward a malignant tumor and compel radical surgical treatment. This case report reminds us once again that only histology confirms the diagnosis of cancer.

A rare case of Demons-Meigs’ syndrome with a 7.5 kg giant ovarian fibroma associated with severe dyspnea: case report

“…Ascites and hydrothorax in Demons-Meigs syndrome are still a subject of discussion and conjecture. Although numerous pathophysiological hypotheses have been proposed, the vascular (venous and lymphatic) theory seems more compelling because it is unicast 11 . According to Dockerty and Masson, a pelvic tumor’s twisting in 1944 caused a partial occlusion of the venous return, which was the cause of ascites.…”

“…The right has a pleural effusion predominance since this network is more established on the right than on the left. The tumor edema brought on by compression or twisting of the fibroid on its axis is assumed to be the cause of the ascites 11 , 13 , 14 . The right hemithorax had hydrothorax, according to our case study.…”

“…The most common presenting symptoms are dyspnea (due to pleural effusion), fatigue, and weight loss. Usually, in low- and middle-income countries, extreme presentations of late-stage diseases occur due to the fragility of healthcare systems and also due to cultural and economic reasons 11 , 15 . The treatment of choice for Demons-Meigs’ syndrome is exploratory laparotomy, then thoracocentesis if pleural effusion is causing dyspnea.…”