Meigs syndrome is a special variant of polyserositis that occurs in women with tumors of the ovarian tissue and uterus. It completely disappears after neoplasia is removed. At the same time, an increase in the volume of the abdomen, an increase in shortness of breath, tachycardia, weakness, fatigue, pallor, weight gain with external signs of cachexia are observed. Diagnosed with a gynecological examination, in the process of ultrasound of the abdominal and pleural cavity, pelvic organs, pericardium. Therapy requires the evacuation of exudate, the correction of disorders of organs and systems, the surgical extirpation of the tumor.
Description of the disease
Meigs Syndrome is a rare paraneoplastic disorder. It is observed in 3% of patients in whom volume formations in the area of reproductive organs are found. The symptom complex with ascites and exudative effusion into the pleural cavity in women with ovarian tumors was described by J. Meigs. A little later, R.W. Light added the interpretation of the syndrome to all tumors of the pelvic organs. The classic combination of ovarian tumor of hydrothorax and ascites is observed in isolated cases, more often patients suffer from abdominal effusion. The average age of patients with this syndrome is 45 years.
The main causes of fluid accumulation in the abdominal cavity in women
The causes of the pathology should be considered in more detail. The development of symptoms is accompanied by a neoplastic lesion of the ovarian tissue and myometrium. Most often, with polyserositis, ovarian fibroma, ovarian cysts, uterine leiomyoma are found. The formation of pleural, peritoneal and pericardial effusion also occurs with ovarian carcinoma without metastasis. Cases of polyserositis with degenerative changes in ovarian tissue without tumor transformation, extensive ovarian edema, hyperstimulation syndrome during IVF are described.
Pathogenesis
So far, the pathogenesis of Meigs syndrome has not been fully studied. There were no specific channels connecting the ovaries and the uterus with the pleural and pericardial cavities. The hypothesis of the occurrence of exudate in tumors of female reproductive organs is somewhat. According to the first, there is an accumulation of exudative effusion in Demon-Meigs-Kass syndrome in the peritoneal cavity as a result of the “anxiety reaction” of the vessels to the growing tumor.
A number of authors do not exclude the pathogenetic role of lymphatic vessels, which provoke perforation of the diaphragmatic septum. There is no confirmation of the idea that venous and lymphatic outflows as a result of mechanical compression of tissues by neoplasia are impaired. Indeed, in some patients, the development of massive polyserositis with neoplasms is observed, the diameter of which is more than five centimeters.
Symptoms of this pathology
Clinical signs of Meigs syndrome with ovarian tumors increase gradually, are nonspecific and, as a rule, are the result of exudate pressure on neighboring organs. The patient periodically arises or constantly has a slight, more often one-sided pain from the lower abdomen. Some women have aching, dull, bursting sensations. With a subsequent increase in the abdomen, the patient suffers from a lack of air, general malaise, weakness, fatigue, sweating, loss of appetite, pallor of the skin, and swelling. A woman gains weight significantly on the background of cachectic syndrome. The amount of urine is getting smaller, and often constipation. In reproductive age, dysfunctional uterine bleeding is often observed.
Complications
If the process progresses and significant volumes of exudative effusion accumulate, the syndrome is complicated by heart and pulmonary insufficiency, metabolic cardiomyopathy, anemia, and increasing ischemia of various organs and tissues. Oxygen starvation of the brain leads to cognitive disorders (memory worsens, inattention is observed), emotional lability, irritability, and a decrease in criticality to one’s state. With irreversible cachectic changes, multiple organ failure is noted, which leads to death.
Diagnosis of Meigs syndrome
The presence of effusion in the cavities is detected during a physical examination. The fluid in the peritoneum is indicated by the dulling of a percussion sound above the chest, the expansion of the borders of the heart on both sides. They note muffling and increased heart rate. The presence of exudate is confirmed by chest x-ray, ultrasound, echocardiography. If peritoneal, pleural, pericardial effusion is found, then an in-depth oncological examination is prescribed to exclude neoplasms of the uterus or ovaries. The most informative methods:
- inspection on the armchair;
- sonography of the pelvic organs;
- analysis of pleural effusion.
To identify the tumor process, diagnostic laparoscopy is performed, an analysis of the tumor marker CA-125.
The main methods of treatment for this disease
When treating Meigs syndrome, symptoms of organ compression should be quickly eliminated, concomitant disorders should be corrected, and neoplasia should be removed surgically. The main stages of therapy are as follows:
- Removal of exudate. In order to quickly unload the body from the accumulated fluid, thoracocentesis and laparocentesis are prescribed. The fluid is evacuated using an active aspiration apparatus through a drainage system. It is important to understand that the pathognomonic sign of the syndrome is its rapid accumulation.
- Correction of multiple organ disorders. In order to improve cardiac activity, diuretics, cardiac glycosides are used. If tachycardia is observed, the use of inhibitors of If-channels of the sinus node is effective, if arrhythmia is present - antiarrhythmic drugs. In case of electrolyte imbalance, salt and oncotic solutions are administered to patients.
- Surgical intervention. How difficult the operation will be depends on the identified gynecological disease, age, and reproductive plans of the woman.
The prognosis for this pathology and the prevention of the disease
Complete resorption of the exudate against the background of restoration of general well-being is usually observed two weeks after removal of the tumor. Some women have small adhesions, as well as pleural and pericardial fusion. Meigs pseudosyndrome complicates the course of oncological processes. The prognosis depends on the form and stage of the disease. Preventive measures include routine examinations by an obstetrician-gynecologist and regular ultrasound screening for timely diagnosis and adequate treatment of tumor lesions of the uterus and ovarian tissue.