[Recurrence of Demons-Meigs' syndrome. A case report]

[Pseudo-Meigs syndrome secondary to ovarian serous cystadenoma]

Le pseudo-syndrome de Demons Meigs, associe une tumeur ovarienne, bénigne (tous types histologiques inclus) ou maligne (ovarienne primitive ou métastase ovarienne d'un autre primitif) ou une tumeur pelvienne (non nécessairement ovarienne, utérine par exemple), à une ascite et à une pleurésie (non métastatiques en cas de tumeur maligne), ces épanchements disparaissent après résection de la tumeur. Une patiente de trente-sept ans a été admise dans notre service pour une dyspnée et un point de côté gauche. Les examens radiologiques ont objectivé une pleurésie gauche de moyenne abondance, une ascite de faible abondance et une masse pelvienne. L'exploration chirurgicale a révélé une tumeur ovarienne, après ablation, la pleurésie s'était résolue spontanément. C'est dire l'intérêt, en pneumologie, de penser à ce syndrome chez une femme qui se présente pour une pleurésie dont le bilan étiologique demeure négatif, et de prescrire un examen simple qui est l'échographie abdomino-pelvienne permettant une orientation diagnostique.

Bilateral Ovarian Fibrothecoma Associated with Ascites, Bilateral Pleural Effusion, and Marked Elevated Serum CA-125

Background. The risk of ovarian cancer is increased in the association of ovarian tumor, ascites, and hydrothorax with the significant elevated tumor marker CA-125. However, this association can be observed in a rare clinical and benign pathological entity, that is Demons-Meigs' syndrome. Objective. To describe a rare case of Demons-Meigs' syndrome observed in our department. Methods. A black African woman of 35 years old, seventh gravida and fourth parous, underwent a total abdominal hysterectomy with bilateral salpingoophorectomy for large bilateral ovarian masses associated with significant ascites, bilateral pleural effusion, and particular highly elevated tumor marker CA-125 (1835 UI/mL) in a pronounced general alteration condition. Results. The postoperative course was uneventful characterized by a complete remission of hydrothorax and ascites with normal level of CA-125 three months after tumor excision. Histology of both masses revealed a bilateral ovarian fibrothecoma, a benign tumor of the ovary, thus confirming the diagnosis of Demons-Meigs' syndrome. Conclusion. The Demons-Meigs syndrome, although it strongly mimics the clinical picture of malignant metastatic ovarian cancer, remains a disease with benign prognosis after surgical tumor resection. This is a rare condition that must be known and recognized by practitioners to avoid unnecessary practices.

Meigs' syndrome with elevated serum cancer antigen 125 levels in a case of ovarian sclerosing stromal tumor

OBJECTIVE

Meigs' syndrome presenting as an ovarian tumor with elevated serum cancer antigen 125 (CA 125) levels is unusual. Only 37 cases have been reported, including three cases of ovarian sclerosing stromal tumor (SCT). Many reports have suggested that the presence of ascites is the major factor inducing mesothelial expression of CA 125.

CASE REPORT

An 18-year-old woman presented with massive ascites, elevated serum CA 125 levels, and radiographic evidence of ovarian tumor. The histological and immunohistochemical examinations revealed a benign SCT.

CONCLUSION

SCT is a benign ovarian tumor and complete excision is curative. We also review all 37 cases and discuss possible mechanisms of Meigs' syndrome and elevated serum CA 125 level.

[Demons-Meigs syndrome: information on a new case and review of the literature]

Demons-Meigs syndrome is a benign tumor of the ovary. It is very rare and its physiopathology remains obscure. We report a case of Demons-Meigs syndrome in a woman aged 51 years. It was discovered following a right pleural effusion syndrome with ascites and an abdominopelvic mass. Rate of serum CA 125 was 412IU/mL. Surgical exploration revealed ascites of one litre with no suspicious peritoneal lesion and an ovarian fibrothecoma of 70 mm. There were no post-operative complications and three months later, the level of CA 125 was negative with a total drainage of effusions.

[An atypical Demons-Meigs syndrome]

Meigs'syndrome is defined as a hydrothorax with ascites and benign ovarian tumor, both of which resolve on removal of the tumor. Pseudo-Meigs'syndrome or atypical Meigs'syndrome occurs when a pelvic mass other than an ovarian fibroma is present with hydrothorax and ascites. Both these syndromes should be nevertheless considered in women who present hydrothorax and ascites. This case concerns a 50-year-old woman who presented a pseudo-Meigs'syndrome (Hydrothorax and uterine leiomyoma). The distinction between these two syndrome is useless, because tumour removal is the only treatment.

[Demons-Meigs syndrome: apropos of 1 case]

A 33-year-old patient presented with ascites and a right abdominal mass. Ultrasound and scannography showed it was probably a solid ovarian tumor measuring 175 mm x 115 mm. Serum Ca 125 was 752 UI/mL and ACE was normal. Surgical exploration revealed 3.2 liters ascites without any suspect peritoneal implant and a bulky ovarian fibrothecoma. The patient recovered quickly and serum Ca 125 was 43 UI/mL one month post-operatively. In this case report of Meigs' syndrome serum CA 125 level was particularly high. Preoperative diagnostic difficulties are discussed.