Meigs Syndrome: Recommended Treatment
The definitive treatment for Meigs syndrome in a postmenopausal woman is surgical removal of the benign ovarian tumor, which results in spontaneous resolution of both ascites and pleural effusion within days to weeks postoperatively. 1, 2, 3
Diagnostic Confirmation Before Treatment
Critical: Do not initiate chemotherapy based solely on elevated CA-125 and imaging findings. Cytologic or histologic confirmation of malignancy is imperative before starting chemotherapy, as Meigs syndrome can mimic advanced ovarian malignancy with CA-125 levels exceeding 1,000 IU/mL 1, 4.
Key Diagnostic Steps:
- Perform fine-needle aspiration or paracentesis to evaluate for malignant cells in ascitic or pleural fluid—absence of tumor cells should raise suspicion for Meigs syndrome 2, 4
- Obtain tissue diagnosis through ultrasound-guided biopsy if feasible preoperatively 2
- Recognize the diagnostic triad: benign solid ovarian tumor + ascites + pleural effusion, all of which resolve after tumor removal 1, 5, 3
Surgical Management
Proceed directly to surgical excision as the primary and curative treatment. 2, 3
For Postmenopausal Women:
- Total abdominal hysterectomy with bilateral salpingo-oophorectomy is the standard approach 5, 2, 4
- Complete tumor removal is both diagnostic and therapeutic 1, 3
- Laparoscopic approach may be considered for appropriate candidates 3
Expected Postoperative Course:
- Ascites and pleural effusion resolve spontaneously within 2-7 days postoperatively 1, 2, 3
- CA-125 normalizes within 2-6 months after surgery 5, 2
- No adjuvant therapy required once benign pathology is confirmed 1, 2
Common Pitfalls to Avoid
Do not misdiagnose as ovarian malignancy and initiate neoadjuvant chemotherapy. One case report documented tumor growth despite chemotherapy because the lesion was actually benign Meigs syndrome 1. The tumor's lack of response to chemotherapy should prompt reconsideration of the diagnosis.
Red Flags Suggesting Meigs Syndrome Rather Than Malignancy:
- Tumor unresponsive to chemotherapy in the setting of presumed ovarian cancer 1
- Absence of malignant cells in ascitic or pleural fluid despite massive effusions 2, 4, 3
- Solid ovarian mass (fibroma, fibrothecoma, granulosa cell tumor, or Brenner tumor) rather than complex cystic lesion 5, 2, 4
Referral Considerations
For postmenopausal women presenting with pelvic mass, ascites, pleural effusion, and elevated CA-125, referral to a gynecologic oncologist is appropriate based on ACOG/SGO criteria for suspected malignancy 6. However, maintain clinical suspicion for Meigs syndrome throughout the evaluation 2, 3.
ACOG/SGO Referral Criteria (Postmenopausal):
- Elevated CA-125 6
- Nodular or fixed pelvic mass 6
- Ascites or metastatic disease 6
- Family history of breast or ovarian cancer 6