Meigs syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Demons Meigs syndrome; Meigs-Cass syndrome; Meigs-Salmon syndrome

Overview

Meigs syndrome (also known as "Demons Meigs syndrome") is defined as the triad of ascites, pleural effusion, and benign ovarian tumor (fibroma, Brenner tumour and occasionally granulosa cell tumour). Meigs syndrome was first discovered by Otto von Spiegelberg, a German gynecologist, in 1866.

Historical Perspective

• Meigs syndrome was first discovered by Otto von Spiegelberg, a German gynecologist, in 1866.
• Meigs syndrome is named after Joe Vincent Meigs, an American gynecologist who defined Meigs syndrome as the presence of ascites, hydrothorax, association with benign ovarian tumor.
• In 1900, the first therapeutical surgical approach was developed by Albert Jean Octave Demons to treat Meigs syndrome.

Classification

• There is no classification system established for Meigs syndrome.
• Other variants of Meigs syndrome include pseudo-meigs syndrome, and atypical Meigs' syndrome.

Pathophysiology

• The pathogenesis of Meigs syndrome is characterized by a transudative process.
• The transudative process consists in the formation of peritoneal and pleural effusion to the filtration of interstitial fluid in the peritoneum through the tumor capsule, and the diffusion to the pleural space.
• There are no genes associated with the development of Meigs syndrome.
• On gross pathology, marked ovarian enlargement, watery cut surface,and no necrosis are characteristic findings of Meigs syndrome.
• On microscopic histopathological analysis, variable stromal luteinization, marked edema of stroma surrounding follicles, and stroma around vessels are characteristic findings of Meigs syndrome.

Causes

• Meigs syndrome may be caused by either ovarian fibroma, Brenner tumor, or granulosa cell tumor.
• In general, Meigs syndrome may be caused by any benign ovarian tumor.

Differentiating Meigs syndrome from other Diseases

• Meigs syndrome must be differentiated from other diseases that cause bloating, fatigue, and shortness of breath such as:

• Ovarian cancer
• Cirrhosis
• Colon cancer
• Tuberculosis
• Milroy's disease

Epidemiology and Demographics

Prevalence

• The prevalence of Meigs syndrome is unknown.
• The prevalence of benign ovarian tumors is approximately 2-10%, and only 1-2% develop Meigs syndrome.

Age

• Meigs syndrome is more commonly observed among postmenopausal women.
• The median age at diagnosis is approximately 50 years.

Gender

• Meigs syndrome affects exclusively females.

Race

• There is no racial predilection for Meigs syndrome.
• Meigs syndrome usually affects females with higher socioeconomic status.

Risk Factors

• Common risk factors in the development of Meigs syndrome are enlarged adnexal mass ( >5cm) , co-existing pleural effusion, and family history of any form of cancer.

Natural History, Complications and Prognosis

• The majority of patients with Meigs syndrome are asymptomatic.
• Early clinical features include bloating, fatigue, and shortness of breath.
• If left untreated, the majority of patients with Meigs syndrome may progress to develop respiratory failure, ovarian torsion, and hypoproteinaemia.
• Common complications of Meigs syndrome include portal vein obstruction, inferior vena cava obstruction, and thoracic duct obstruction.
• Prognosis is generally good, and the 5 survival rate of patients with Meigs syndrome is approximately 100%.

Diagnosis

Diagnostic Criteria

• The diagnosis of Meigs syndrome is made when at least [number] of the following [number] diagnostic criteria are met:

• [criterion 1]
• [criterion 2]
• [criterion 3]
• [criterion 4]

Symptoms

• Meigs syndrome is usually asymptomatic.
• Symptoms of Meigs syndrome may include the following:

• [symptom 1]
• [symptom 2]
• [symptom 3]
• [symptom 4]
• [symptom 5]
• [symptom 6]

Physical Examination

• Patients with Meigs syndrome usually appear [general appearance].
• Physical examination may be remarkable for:

• [finding 1]
• [finding 2]
• [finding 3]
• [finding 4]
• [finding 5]
• [finding 6]

Laboratory Findings

• There are no specific laboratory findings associated with Meigs syndrome.

• A [positive/negative] [test name] is diagnostic of Meigs syndrome.
• An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of Meigs syndrome.
• Other laboratory findings consistent with the diagnosis of Meigs syndrome include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

• There are no [imaging study] findings associated with Meigs syndrome.

• [Imaging study 1] is the imaging modality of choice for Meigs syndrome.
• On [imaging study 1], Meigs syndrome is characterized by [finding 1], [finding 2], and [finding 3].
• [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

• Meigs syndrome may also be diagnosed using [diagnostic study name].
• Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

• There is no treatment for Meigs syndrome; the mainstay of therapy is supportive care.

• The mainstay of therapy for Meigs syndrome is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for Meigs syndrome.
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of Meigs syndrome.
• [Surgical procedure] can only be performed for patients with [disease stage] Meigs syndrome.

Prevention

• There are no primary preventive measures available for Meigs syndrome.

• Effective measures for the primary prevention of Meigs syndrome include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with Meigs syndrome are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].