• Shruti GOCHHWAL

Meigs Syndrome: Causes, Symptoms, Diagnosis and Treatment

We live in an age where health facilities abound. However, as our species progresses and evolves so does the complications within our bodies. There are a ton of diseases and disorders about which the common man is blissfully unaware of. Meigs syndrome belongs to this huge category of lesser known and talked about illnesses. The name may sound unfamiliar and you might have no clue as to what this disease may lead to. Let us explore it in greater detail.

Meigs syndrome was discovered and identified by Joe Vincent Meigs in 1937. He was an American obstetrician and gynecologist who identified a series of patients suffering from this syndrome. After carefully studying this case series he came forward with the description of what is called as the meigs syndrome.

What Is Meigs Syndrome?

meigs syndrome

Illustration of women’s reproductive system, Credit: Canva


The three defining characteristics of meigs syndrome are:

  1. Ascites, or the unusually large accumulation of fluid in the stomach region.

  2. Pleural effusion, or the more than usual amount of fluid that gets accumulated in the fluid-filled space called the pleural cavity around the lungs.

  3. Benign tumours that develop in the ovary.

When Meigs discovered his syndrome, he limited the diagnosis to encompass only benign and solid tumours in the ovary along with pleural effusion and ascites. According to him, the removal or elimination of the tumours could cure the person who was afflicted with it.

After reading about this peculiar disorder, you might be intrigued to know, How common is Meigs syndrome? It is normal for anyone to wonder about its occurrence in people. Meigs syndrome is a very rare disorder and occurs mainly in women who are in the post menopausal stage of their lives. It has been reported in only 1-2% of the women.

What Causes Meigs Syndrome?

meigs syndrome causes of ovarian tumor

Stomach of a woman, Credit: Canva


As mentioned earlier, meigs syndrome consists of ascites, pleural effusion, and tumour in the ovary. It is believed that its removal will treat this disorder. It is because in this condition the ascitic fluid is prone to spreading in the pleural space or the pleural cavity through the presence of tiny apertures in a person’s diaphragm. The excessive amounts of fluid or the pleural effusion is observed to be right-sided in almost 70% of the reported cases. It is observed bilateral or on both sides in almost 20% of the reported cases and left-sided in nearly 10% of the reported cases.

This syndrome is characterised by benign tumours that develop in the ovary. According to WHO histological classification of ovarian tumors benign tumours fall into the category of endometrioid tumours.

Many pathologists make ovarian cysts and uterine fibroids responsible for this condition. As of now, no concrete connection to the causes of this illness is known. It may be because this condition is still being researched intensely in medical circles.

What Are the Symptoms of Meigs Syndrome?

fatigue

Fatigued woman, Credit: Canva


The symptoms of this syndrome are the features that are related to pleural effusion and ascites. There can be many menstrual-like symptoms before a woman is nearing her menopause. Women chiefly experiences the following:

  1. Frequent exhaustion

  2. Difficulty in taking breaths or dyspnoea

  3. Pain in the pelvic region or bloating

  4. Constipation

  5. Swollen stomach region along with weight gain or weight loss

  6. Dry or non-productive cough. It is a kind of cough that is characterized by an absence of mucus-like substance called sputum.

  7. Amenorrhoea, that is the irregularity of periods

Meigs Syndrome – Differential Diagnosis

The symptoms of meigs syndrome are similar to the ones experienced in other conditions. Its major differential diagnosis is with ovarian tumours that are malignant. It is because these tumours are very frequently observed in women and have a tendency to produce ascites. The confusion is due to the presence of benign tumour in the ovary in the meigs syndrome. This leads one to the question Can a benign ovarian tumor cause ascites? The answer to this question is yes, meigs syndrome can be caused by the formation of benign ovarian tumour that is linked to abdominal ascites.

Also, pleural effusion is less common in ovarian tumours that are malignant. Summing up, one can say that if a woman is not diagnosed with ovarian cancer the probability of meigs syndrome strengthens.

Other considerations for the differential diagnosis include

  1. Cancers, especially colon cancer

  2. Breast cancer

  3. Tuberculosis

  4. Congestive heart failure, or the inability of the heart to pump blood

  5. Nephrotic syndrome, or damage to the blood vessels present in the kidney

  6. Cirrhosis, or chronic liver damage

Investigation and Treatment of Meigs Syndrome

meigs syndrome treatment

Team of surgeons, Credit: Canva


For investigating this disorder, doctors may check the protein levels in your urine. You will have to undergo blood tests like that of U&E, FBC, LFTs consisting of plasma proteins. Women who are diagnosed with this syndrome harbour elevated levels of cancer antigen 125 in serum and pleural fluid. An ultrasound of the abdominal region will be done that will show the presence of ascites.

Along with this, CT scan of the chest, pelvis, abdomen, and MRI of the pelvis is also done. If the presence of congestive heart failure is suspected the patient will be required to undergo ECG.

For managing this syndrome, the only way that is prescribed is the elimination of the tumour that exists in the ovary. However, before the patient is operated for it aspiration of ascites and pleural effusion becomes necessary. It is to enhance the functioning of the lungs. The operation consists of laparotomy. Laparotomy is the surgery whereby incisions on the wall of the abdominal region are made to make the abdominal cavity accessible.

If this syndrome is detected in women who fall in the reproductive age group, then a unilateral salpingo-oophorectomy is done. In post-menopausal women, complete abdominal hysterectomy along with salpingo-oophorectomy is done.

Generally, it is observed that after the operation, this condition resolves gradually. The cancer antigen 125 levels also come back to normal. The prognosis of meigs syndrome is good because it is characterized mainly by benign tumour in the ovary. If the tumour was malignant then the prognosis would not have been good. After the operation, women who fall in the reproductive age group face no problem with regards to their fertility.

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