The Indian Journal of Chest Diseases and Allied Sciences

Register      Login

VOLUME 65 , ISSUE 2 ( April-June, 2023 ) > List of Articles


Meigs Syndrome Presenting as Bilateral Pleural Effusion in the Reproductive Age-group: A Rare Case Report

S. Raghu, Dollu Balamani Ratnam, Penumuchu Venkata Kalyan Kumar, Avanigadda Dimple Nikhita, Siddavali Chagalamarri, Vushakoyala Thanuja Sri, Uthara Natarajan, Kalaivani Shanmuganandavadivel

Keywords : 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.

DOI: 10.5005/jp-journals-11007-0071

License: CC BY-NC 4.0

Published Online: 01-11-2023

Copyright Statement:  Copyright © 2023; The Author(s).


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.

PDF Share
  1. Riker D, Goba D. Ovarian mass, pleural effusion, and ascites: revisiting Meigs syndrome. J Bronchology Interv Pulmonol. 2013;20(1): 48–51. DOI: 10.1097/LBR.0b013e31827ccb35.
  2. Saha S, Robertson M. Meigs’ and pseudo-Meigs’ syndrome. Australas J Ultrasound Med 2012;15:29–31. DOI: 10.1002/j.2205-0140.2012.tb00140.x.
  3. Shiau CS, Chang MY, Hsieh CC, et al. Meigs’ syndrome in a young woman with a normal serum CA-125 level. Chang Gung Med J. 2005;28(8):587–591. PMID: 16265850.
  4. Scully RE. Ovarian tumors: A review. Am J Pathol 1977;8(3)7:686–720. PMID: 194486.
  5. Young RH, Scully RE. Ovarian sex cord-stromal tumors. Problems in differential diagnosis. Pathol Annu 1988;23(Pt 1):237–296. PMID: 2838794.
  6. Chan CY, Chan SM, Liauw L. A large abdominal mass in a young girl. Br J Radiol 2000;73(872):913–914. DOI: 10.1259/bjr.73.872.11026873.
  7. Meigs JV. Fibroma of the ovary with ascites and hydrothorax: Meigs’ syndrome. Am J Obstet Gynecol 1954;67(5):962–985. DOI: 10.1016/0002-9378(54)90258-6.
  8. Krenke R, Maskey–Warzechowska M, Korczynski P, et al. Pleural effusion in Meigs’ syndrome: Transudate or exudate? Systematic review of the literature. Medicine (Baltimore) 2015;94(49):e2114. DOI: 10.1097/MD.0000000000002114.
  9. Peparini N, Chirletti P. Ovarian malignancies with cytologically negative pleural and peritoneal eff usions: Demons’ or Meigs’ pseudosyndromes? Int J Surg Pathol 2009;17:396–397. DOI: 10.1177/1066896909336441.
  10. Benjelloun H, Zerraa M, Zaghba N, et al. Demons Meigs syndrome: About three cases. 2020;6(4):5. DOI: 10.36347/sasjm.2020.v06i04.005.
  11. Tanaka M, Yamanoi K, Kitamura S, et al. A 36 kg giant ovarian fibroma with Meigs syndrome: A case report and literature review of extremely giant ovarian tumor. Case Rep Obstet Gynecol 2021;2021:1076855. DOI: 10.1155/2021/1076855.
  12. Benjapibal M, Sangkarat S, Laiwejpithaya S, et al. Meigs’ syndrome with elevated serum CA125: Case report and review of the literature. Case Rep Oncol 2009;2(1):61–66. DOI: 10.1159/000210441.
  13. Navarro–Esteva J, Laseca–Modrago M, Arencibia–Sánchez O. Two patients with Meigs’ syndrome and elevated serum CA-125: A case report. Cureus 2020;12(6):e8927. DOI: 10.7759/cureus.8927.
  14. Khanduja D, Kajal NC. A case report on Meigs’ syndrome and elevated serum CA-125: A rare case report. J Pulmonol Respir Res 2021;5:031–033. DOI: 10.29328/journal.jprr.1001021.
  15. Hung–Wen Chen, Nan–Jie Huang, Shun–Tim Chen, et al. Meigs’ syndrome: A case report Taiwan. J Fam Med 2011;21:141–148. Available from: documentId=e104d3534ba04084aee8d561eb42f78a.
  16. Monteith C, Kalisse T, Farrell RA, et al. A pelvic mass masquerading as high stage malignancy: An interesting presentation of psuedo-Meigs syndrome. Obstet Gynecol Cases Rev 2020;7:187. DOI: 10.23937/2377-9004/1410187.
  17. Slaoui A, Lazhar H, Amail N, et al. Meigs syndrome: About an uncommon case report. Clin J Obstet Gynecol 2023;6:010–013. DOI: 10.29328/journal.cjog.1001120.
  18. Upreti D, Rohita DK, Yadav SK, et al. Ovarian fibroma: Typical presentation with Meigs's syndrome. F1000Res 2022;11:815. DOI: 10.12688/f1000research.122368.1.
  19. Stabile G, Romano GZF, Laganà AS, et al. Pelvic mass, ascites, hydrothorax: a malignant or benign condition? Meigs syndrome with high levels of CA125 Menopause Rev 2021;20(2):103–107. DOI: 10.5114/pm.2021.106100.
  20. Tsai WC, Chang FW, Chang JL, et al. Meigs’ syndrome in an elderly woman with short of breath. 2015;35(3):125–127. DOI: 10.4103/1011-4564.158688.
  21. Handler CE, Fray RE, Snashall PD. Atypical Meigs’ syndrome. Thorax 1982;37(5):396–397. DOI: 10.1136/thx.37.5.396.
  22. Colectivo de autores. Manual Merck, 10th ed., ediciçndel Centenario. Madrid, Harcourt. 1999. Sectiòn 6 Neumologia, Capìtula 80 Enfermedades de la pleura. Versiòn HTML.
  23. Terada S, Suzuki N, Uchide K, et al. Uterine leiomyoma associated with ascites and hydrothorax. Gynecol Obstet Invest 1992;33:54–58. DOI: 10.1159/000294848.
  24. Murayma Y, Kamoi Y, Yamamoto H, et al. Meigs’ syndrome mimicking heart failure with preserved ejection fraction: A case report. BMC Cardiovascular Disorders 2020;20:436. DOI: 10.1186/s12872-020-01718-4.
  25. Kabawat SE, Bast RC Jr, Bhan AK, et al. Tissue distribution of a coelomic-epithelium-related antigen recognized by the monoclonal antibody OC125. Int J Gynecol Pathol 1983;2(3):275–285. DOI: 10.1097/00004347-198303000-00005.
  26. Kudlacek S, Schieder K, Kölbl H, et al. Use of CA125 monoclonal antibody to monitor patients with ovarian cancer. Gynecol Oncol 1989;35(3):323–329. DOI: 10.1016/0090-8258(89)90072-3.
  27. O'Connell GJ, Ryan E, Murphy KJ, et al. Predictive value of CA125 for ovarian carcinoma in patients presenting with pelvic masses. Obstet Gynecol 1987;70:930–993. PMID: 3479735.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.