Management of Meigs Syndrome
Definitive Treatment
Surgical resection of the benign ovarian tumor is the definitive and curative treatment for Meigs syndrome, resulting in complete resolution of pleural effusion and ascites. 1, 2, 3
Preoperative Diagnostic Confirmation
Before proceeding to surgery, confirm the diagnosis through:
- Imaging with CT or MRI to identify the ovarian mass, quantify ascites, and characterize pleural effusion (unilateral or bilateral, typically right-sided) 1, 2
- Serum CA-125 measurement, which is typically elevated but does not indicate malignancy in this context 1, 4
- Thoracentesis and/or paracentesis to exclude malignant cells and infectious etiologies; cytology should be negative for malignancy 2, 3
- Exclude monoclonal gammopathy with serum and urine protein electrophoresis with immunofixation, as polyclonal hypergammaglobulinemia can coexist 5
The key diagnostic pitfall is misdiagnosing Meigs syndrome as disseminated malignancy due to the combination of pelvic mass, elevated CA-125, and effusions. 1, 3
Preoperative Stabilization
Address life-threatening complications before definitive surgery:
- For severe dyspnea from massive pleural effusion: Perform therapeutic thoracentesis or tube thoracostomy for drainage 2, 6
- For tense ascites causing respiratory compromise: Perform paracentesis to relieve symptoms 6
- For severe anemia (if hemolytic anemia is present from tumor torsion): Administer blood transfusions and consider glucocorticoid therapy to stabilize hemoglobin levels before surgery 3
These temporizing measures improve the patient's condition for surgery but do not resolve the underlying syndrome. 3, 6
Surgical Approach
Laparoscopic excision of the ovarian mass is the preferred surgical approach when feasible, offering shorter hospitalization, lower morbidity, and faster recovery compared to laparotomy. 3
- For postmenopausal women or those with completed childbearing, perform total abdominal hysterectomy with bilateral salpingo-oophorectomy 4
- For younger women desiring fertility preservation, unilateral oophorectomy may be considered if the contralateral ovary appears normal 1
- Intraoperative frozen section should be obtained to confirm benign histology 3
The laparoscopic approach is safe even for large tumors (>10 cm) when performed by experienced gynecologic surgeons. 3
Postoperative Course
Complete resolution of pleural effusion and ascites occurs within 7-14 days after tumor removal, confirming the diagnosis of Meigs syndrome. 1, 2, 4
- CA-125 levels normalize within 2 months postoperatively 4
- No additional treatment (chemotherapy, radiation, or chronic drainage) is required after successful tumor resection 1, 2
Critical Pitfalls to Avoid
- Do not delay surgery for prolonged medical management: Repeated thoracentesis or paracentesis without addressing the ovarian tumor will not resolve the syndrome 2, 6
- Do not assume malignancy based on imaging and CA-125 alone: Histopathologic confirmation is essential, as Meigs syndrome mimics ovarian cancer but has an excellent prognosis with surgery 1, 3
- Consider Meigs syndrome in postmenopausal women with unexplained pericardial effusion: Rare cases present with pericardial effusion preceding pleural effusion 2