Ascites, pleuravocht en een benigne ovariumtumor

Background

Classical Meigs’ syndrome consists of the triad of an ovarian fibroma, ascites and pleural effusion. A characteristic of the syndrome is that the excess fluid is resorbed after surgical resection of the tumour.

Case description

A 49-year-old woman was admitted to accident and emergency department in a neglected, cachectic and hypothermic condition. A CT scan revealed an ovarian tumour, ascites and a right-sided pleural effusion. The level of the tumour marker CA-125 was also greatly elevated. Our initial working diagnosis was, therefore, ‘high-grade ovarian carcinoma’, but on repeated testing no malignant cells were found in the aspirated fluid. We suspected Meigs’ syndrome. We first ensured that her general and nutritional condition improved; then she underwent a bilateral adnexectomy. A fibrothecoma was found in each ovary. The ascites and pleural effusion resolved following surgery and the patient recovered well.

Conclusion

The clinical picture of Meigs’ syndrome can resemble that of high-grade ovarian carcinoma. This syndrome should be included in the differential diagnosis in patients with an ovarian tumour, ascites and, possibly, pleural effusion.