Meigs syndrome is defined as the presence of ascites and pleural effusion in association with a benign, usually solid ovarian tumor, most commonly an ovarian fibroma.
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Epidemiology
Most presentations occur in post-menopausal women with a peak incidence at ~70 years old. It is extremely rare in women under 30 years old.
Pathology
The pathophysiology of ascites in Meigs syndrome is speculative. It was initially suggested that irritation of the peritoneal surfaces by a hard, solid ovarian tumor could stimulate peritoneal fluid production. The pathophysiology of the pleural effusion is also speculative with some suggesting ascitic fluid being transferred via trans-diaphragmatic lymphatic channels into the pleural space.
Etiology
Less than 1% of ovarian tumors present with this syndrome 8 with primary tumors being:
ovarian fibroma: 80-90%
Brenner tumor: rare
Location
The pleural fluid tends to be right-sided in a majority (~60-70%) of cases.
Treatment and prognosis
The condition is benign and the ascites and pleural effusion resolve after resection of the primary pelvic tumor.
History and etymology
Named after Joe Vincent Meigs (1892-1963), an American obstetrician and gynecologist 4.
Differential diagnosis
General considerations include:
malignant ascites and pleural effusion in the presence of an aggressive ovarian tumor
pseudo-Meigs syndrome: benign reversible pleural effusion in the presence of a primary tumor other than solid ovarian tumors, e.g. broad ligament leiomyoma
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