Meigs syndrome is classically described by the triad of benign ovarian tumour, ascites, and pleural effusion, with imaging typically showing the presence of an ovarian mass with concurrent ascites and pleural effusion.
Description
Meigs syndrome is a rare condition characterised by the triad of ascites, pleural effusion, and benign ovarian tumour, most commonly a fibroma.
Pathogenesis
While the exact pathophysiology of Meigs syndrome is not fully understood, several theories have been proposed. It is generally believed that the presence of the tumour leads to increased venous pressure and lymphatic obstruction, leading to the accumulation of fluid in the abdominal and thoracic cavities.
Subtypes
Meigs syndrome is a relatively uniform condition with no specific subtypes recognised.
Epidemiology, Risk Factors & Associations
- Primarily affects postmenopausal women (70% of cases)
- Ovarian fibroma is the most common tumour associated with Meigs syndrome (approximately 90% of cases)
- Other less common ovarian tumour associations include: Granulosa cell tumours (2-5% of cases), thecoma (rare association), ovarian cystadenomas and cystadenofibromas(benign epithelial tumours with rare association)
Clinical Features
The classic triad of benign ovarian tumour, ascites, and pleural effusion
- Shortness of breath due to pleural effusion
- Abdominal distension from ascites
- Pelvic mass or discomfort
Complications
Meigs syndrome is benign and does not carry a risk of malignant transformation. However, complications can arise from the size and location of the tumour, as well as the extent of fluid accumulation.
Pathological Features
Histopathology
- See ovarian fibromas.
Radiological Features
General Features
- See ovarian fibromas.
- Ovarian mass often appears as a solid, well-circumscribed lesion, which may contain calcifications
- Presence of ascites and pleural effusion is typically seen
Diagnosis
The diagnosis of Meigs syndrome is established based on clinical presentation and imaging findings demonstrating a benign ovarian tumour with concurrent ascites and pleural effusion. The diagnosis is confirmed when the ascites and pleural effusion resolve following resection of the tumour.
Differential Diagnosis
- Ovarian malignancies: these would typically demonstrate features of malignancy, such as irregular borders, solid and cystic components, and increased vascularity on Doppler ultrasound.
- Congestive heart failure: this condition can cause both ascites and pleural effusion but would not have an associated ovarian tumour. Other clinical and imaging findings, such as cardiac enlargement, would be present.
- Liver cirrhosis: this condition can also cause ascites and pleural effusion. However, clinical and imaging findings of chronic liver disease would be present.
Management
The mainstay of treatment for Meigs syndrome is the surgical removal of the ovarian tumour. After resection, the ascites and pleural effusion typically resolve. Long-term follow-up is recommended to monitor for recurrence of the tumour and syndrome.