Adnexal mass, Ascites, Bilateral pleural effusion, Cancer antigen 125, Case report, Diagnostic thoracentesis, Meigs syndrome, Reproductive age-group women
Citation Information :
Raghu S, Ratnam DB, Kumar PV, Nikhita AD, Chagalamarri S, Thanuja Sri V, Natarajan U, Shanmuganandavadivel K. Meigs Syndrome Presenting as Bilateral Pleural Effusion in the Reproductive Age-group: A Rare Case Report. Indian J Chest Dis Allied Sci 2023; 65 (2):114-118.
Introduction: Meigs syndrome constitutes about 1% of ovarian tumors with a characteristic triad of benign ovarian tumors, ascites, and pleural effusion that usually resolves after resection of the tumor. It commonly presents as a right-sided pleural effusion in postmenopausal women, but it may rarely present as a bilateral (B/L) pleural effusion.
Case presentation: A 35-year-old female presented with progressive dyspnea, chest pain, and dry cough for 2 months. The patient had a similar history in the past for which she was treated with antituberculosis drugs for 2 months on the basis of pleural fluid analysis. There is no resolution of pleural effusion even after 2 months of treatment. Examination revealed bilateral pleural effusion. Ultrasonography (USG) diagnostic thoracentesis revealed B/L exudative pleural effusion with low adenosine deaminase (ADA). On further evaluation, an USG abdomen reported ascites and soft tissue lesion on the right adnexa. Contrast-enhanced computerized tomography (CECT) abdomen confirmed well defined soft tissue lesion of right ovarian origin with elevated serum cancer antigen 125 (CA125) (273 µ/mL). The patient underwent a right salpingo-oophorectomy, and the sample was sent for histopathological examination (HPE). Histopathological examination is suggestive of right cellular ovarian fibroma with positive desmin and Wilms tumor gene 1 (WT1) immunohistochemistry (IHC) markers. The patient showed clinical improvement after the resection of the tumor. Postoperative follow-up after 2 weeks showed complete resolution of effusion on chest radiograph and USG.
Conclusion: Although the incidence of Meigs syndrome is rare in the reproductive age-group female, it should be considered as one of the differentials in persistent and recurrent pleural effusion. Meigs syndrome usually (85%) presents as unilateral (U/L) and mostly right-sided effusion. In rare instances it can present as B/L pleural effusion due to transduction of ascitic fluid. An elevated serum CA125 test does not always indicate malignancy.
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