Meigs’ Syndrome - Symptoms, Diagnosis, Treatment and Prognosis
Most symptoms of Meigs’ syndrome are associated with ascites and pleural effusion, but when the condition occurs after menopause, associated symptoms can be seen.
Common symptoms of Meigs’ syndrome include -
- Fatigue
- Dyspnea, which occurs initially on exertion
- Weight gain
- Swollen abdomen
- Non-productive cough
- Irregular menstruation
Diagnosis of Meigs’ syndrome is done by carrying out a chest examination, which is likely to detect dullness due to the effusion. Decreased breath sounds and decreased tactile vocal fremitus (which measures transmitted sounds) are also observed on examination.
The effusion is usually right-sided but can sometimes be present bilaterally. The reasons for this unilateral presentation are not very clear. Abdominal or pelvic examination would reveal a tumor which may sometimes be hidden by the ascites. Fullness in the flanks and dullness are caused by the presence of ascites.
The most significant differential diagnosis includes malignant ovarian tumor, which is more prevalent in comparison to Meigs’ syndrome and which generates ascites with high protein content. But pleural effusion tends to be less common in the case of the malignancy. Other differential diagnoses include cancers of the colon and the lung, tuberculosis, nephrotic syndrome, congestive heart failure and cirrhosis.
Diagnostic tests for Meigs’ syndrome include urine tests (for protein), routine blood tests (including total blood count, LFTs and plasma proteins), and blood tests for tumor market CA-125, which is slightly elevated in Meigs’ syndrome and more elevated in ovarian cancer. In some cases of ovarian malignancy, however, normal levels are reported.
Other diagnostic tests include abdominal ultrasound, CT scan or MRI to detect ascites and tumor or to confirm the diagnosis.
Aspiration of pleural and ascitic fluid is done to relieve the symptoms and also to perform cytological tests on the fluid to distinguish between Meigs’ syndrome and malignancy. In the case of the latter, the protein content is usually very high.
It would be appropriate to carry out an ECG if congestive heart failure is suspected. If the ECG is abnormal, an echocardiogram is advised.
Treatment and Prognosis
Management of Meigs’ syndrome primarily involves aspiration of the pleural effusion and ascites, followed by the surgical removal of the tumor. In girls before menarche, a wedge section is preferred, while in women of reproductive age, a unilateral salpingo-oophorectomy (removal of the ovary and fallopian tube) is usually performed. In menopausal women, however, a total abdominal hysterectomy with bilateral salpingo-oophorectomy (removal of the uterus with both ovaries and fallopian tubes) is carried out.
Postoperative resolution of the fluid is characteristic of the disease. As there is no malignancy in Meigs’ syndrome, the prognosis is excellent. Fertility too would be eventually restored if fertile ovarian tissue is present.
