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Gynecology and Minimally Invasive... 2019We report a case of synchronous primary corpus and ovarian cancer (SPC) with massive ascites due to Pseudo-Meigs syndrome (PMS). A 48-year-old woman presented with...
We report a case of synchronous primary corpus and ovarian cancer (SPC) with massive ascites due to Pseudo-Meigs syndrome (PMS). A 48-year-old woman presented with complaints of abnormal genital bleeding and abdominal discomfort. Massive ascites and tumors in the endometrium and right ovary were detected. Although imaging tests showed no evidence of dissemination, and ascites cytology was negative, we performed a diagnostic laparoscopy to exclude the possibility of microdissemination because pathological findings of the corpus tumor were suggested to be so-called Type-2 endometrial cancer. Laparoscopy clearly confirmed no dissemination in the peritoneum. We ultimately diagnosed this patient with SPC with massive nonmalignant ascites due to PMS and performed an appropriate treatment. This report is the first case of SPC that developed PMS.
PubMed: 31741847
DOI: 10.4103/GMIT.GMIT_18_19 -
Transplantation Proceedings Oct 2020Ascites is the excessive accumulation of fluid in the peritoneal cavity and predominantly caused by liver cirrhosis, cancers, or heart failure. In this study, a...
Ascites is the excessive accumulation of fluid in the peritoneal cavity and predominantly caused by liver cirrhosis, cancers, or heart failure. In this study, a 31-year-old woman with chronic renal failure of unknown etiology treated with hemodialysis and peritoneal dialysis was often hospitalized because of ascites, which appeared 4 years after the second kidney transplantation. The patient was regularly (every 2-3 weeks) treated with paracentesis. Peritoneal fluid tested negative for bacterial (including atypical) and fungal infections and tuberculosis. Doppler ultrasound and liver FibroScan did not show any irregularities. Computed tomography (CT) revealed an enlarged left ovary. A high level of CA 125 was found. The second diagnostic laparoscopy revealed no changes in the ovaries, and there were no tumor cells. Diagnostics were extended, but no deviations were revealed. Suspecting drug etiology, mycophenolic acid was discontinued, bringing no improvement. Diagnostic tests caused suspicion of Meigs' syndrome; therefore, oophorectomy of left ovary was conducted, revealing numerous small cysts filled with serous fluid, without tumor cells in the ovary or peritoneal fluid. Despite the procedure performed, ascites was recurrent. Five month later, ascites spontaneously stopped growing. Paracentesis to decompress ascites was no longer required. There were 9 paracenteses performed from oophorectomy (the latest on May 23, 2019). The need for repetitive paracentesis, significantly reducing the patient's quality of life, required diagnosis for casuistic diseases. The described case is atypical because of the confusing etiology of ascites and its spontaneous cessation. Despite numerous examinations and recession of ascites, the cause of the problem is not entirely clear.
Topics: Adult; Ascites; Female; Humans; Kidney Failure, Chronic; Kidney Transplantation; Meigs Syndrome; Paracentesis; Postoperative Complications; Quality of Life; Renal Dialysis; Tomography, X-Ray Computed; Ultrasonography
PubMed: 32276839
DOI: 10.1016/j.transproceed.2020.01.094 -
Respirology Case Reports Feb 2023Pleural effusion is a common condition related to various diseases such as heart failure, malignancies, and pneumonia. Ovarian hemangioma is a rare type of female...
Pleural effusion is a common condition related to various diseases such as heart failure, malignancies, and pneumonia. Ovarian hemangioma is a rare type of female genital tumour and can rarely cause pleural effusion. In this case, we present a 48-year-old female with repeated episodes of recurrent right-sided pleural effusion over 1 year with no clear aetiology. Abdominal computed tomography revealed a large left ovarian mass. After surgical removal of the mass, the repeated pleural effusion episodes ceased, and histopathology analysis reported a rare ovarian hemangioma. Pseudo Meigs' syndrome is a triad of an ovarian tumour, ascites, and hydrothorax that rarely presents with ovarian hemangioma; both effusions are eradicated after removing the tumour.
PubMed: 36721846
DOI: 10.1002/rcr2.1087 -
International Journal of Women's Health 2024Meigs' syndrome is a rare gynecological disease characterized by the triad of benign ovarian tumor, ascites, and pleural effusion. Ovarian malignancies should be highly...
PURPOSE
Meigs' syndrome is a rare gynecological disease characterized by the triad of benign ovarian tumor, ascites, and pleural effusion. Ovarian malignancies should be highly suspected in a postmenopausal woman with a pelvic mass, ascites, hydrothorax, and an elevated carbohydrate antigen 125 (CA125) level. It can be challenging to make a preoperative diagnosis of Meigs' syndrome. In this report, we present a case of Meigs' syndrome caused by an ovarian fibrothecoma and review the relevant literature to raise awareness and avoid misdiagnosis.
CASE PRESENTATION
An 82-year-old woman with a 2-week history of abdominal distension was admitted to the Department of Gynecology. Ultrasound and thoracoabdominal computed tomography scans showed a left-sided hypoechoic mass in the pelvic cavity with bilateral pleural effusion and massive ascites. The CA125 concentration was 1040 U/mL (normal, 0-35 U/mL). With a working diagnosis of ovarian malignancy, the patient underwent ultrasound-guided fine-needle puncture of the pelvic mass and paracentesis to drain the ascites. The fine-needle puncture and paracentesis fluid analysis results revealed that the ascites did not contain any tumor cells, and the pelvic mass was identified as a spindle cell tumor. Immunohistochemistry confirmed that it was a sex-cord stromal tumor. Total abdominal hysterectomy and bilateral adnexectomy were performed under general anesthesia. The pathology results confirmed the mass to have been an ovarian fibrothecoma. At the 2-month postoperative follow-up, the ascites and hydrothorax had resolved and not recurred, and the CA125 level was normal.
CONCLUSION
Despite the high suspicion of ovarian carcinoma in postmenopausal women presenting with pelvic mass, ascites, pleural effusion, and elevated CA125, Meigs' syndrome should be considered.
PubMed: 38544782
DOI: 10.2147/IJWH.S450833 -
Cureus Jan 2023Pseudo-Meigs' syndrome is caused by uterine fibroids, which is often treated using gonadotropin-releasing hormone (GnRH) agonists. Here we report a case of pseudo-Meigs'...
Pseudo-Meigs' syndrome is caused by uterine fibroids, which is often treated using gonadotropin-releasing hormone (GnRH) agonists. Here we report a case of pseudo-Meigs' syndrome that developed with massive pleural effusion after the initiation of GnRH agonist therapy for uterine fibroids. A 48-year-old woman presented with dyspnea. Her medical history included uterine fibroids and GnRH agonist therapy. Contrast-enhanced computed tomography revealed a massive pleural effusion, uterine fibroids, and ascites. A total laparoscopic hysterectomy was performed. The pathologic findings were consistent with those of uterine fibroids. The pleural effusion and ascites resolved completely. The patient was diagnosed with pseudo-Meigs' syndrome due to uterine fibroids.
PubMed: 36779091
DOI: 10.7759/cureus.33520 -
Case Reports in Obstetrics and... 2021Ovarian tumors can get extremely giant to occupy the whole abdominal cavity. We report a case of 36 kg solid ovarian tumor, which was the largest ovarian solid tumor...
Ovarian tumors can get extremely giant to occupy the whole abdominal cavity. We report a case of 36 kg solid ovarian tumor, which was the largest ovarian solid tumor that have been ever reported. A 54-year-old woman presented to our hospital with a chief complaint of markedly distended abdominal wall. Preoperative imaging examinations revealed that most of the tumor was uniform and its density was like that of subcutaneous fat. Pleural effusion was detected in the right thoracic region. We organized a multidisciplinary team and successfully resected the right adnexa. The patient had an uneventful postoperative course, and she was discharged on the 7 postoperative day and diagnosed with a fibroma of the ovary with Meigs syndrome. A comprehensive literature search revealed 48 cases of extremely giant ovarian tumor in these 20 years. Six out of 48 cases are solid. Twelve out of 48 cases are malignant or borderline malignant, and patients' age and tumor size/weight were not related to the frequency of malignancy/borderline malignancy. As many as 4 out of 48 patients died before their first hospital visit or early after surgery. Clinicians should consider a considerable high mortality and frequency of severe surgical complications when planning the treatment strategy for extremely giant ovarian tumors.
PubMed: 34434586
DOI: 10.1155/2021/1076855 -
The American Journal of Medicine Nov 2019
Topics: Biomarkers; CA-125 Antigen; Diagnosis, Differential; Diagnostic Imaging; Female; Humans; Hysterectomy; Meigs Syndrome; Middle Aged; Salpingo-oophorectomy
PubMed: 31153867
DOI: 10.1016/j.amjmed.2019.05.014 -
The Journal of Clinical Endocrinology... Jan 2022Obesity is an established risk factor for severe COVID-19 outcomes. The mechanistic underpinnings of this association are not well-understood. (Observational Study)
Observational Study
BACKGROUND
Obesity is an established risk factor for severe COVID-19 outcomes. The mechanistic underpinnings of this association are not well-understood.
OBJECTIVE
To evaluate the mediating role of systemic inflammation in obesity-associated COVID-19 outcomes.
METHODS
This hospital-based, observational study included 3828 SARS-CoV-2-infected patients who were hospitalized February to May 2020 at Massachusetts General Hospital (MGH) or Columbia University Irving Medical Center/New York Presbyterian Hospital (CUIMC/NYP). We use mediation analysis to evaluate whether peak inflammatory biomarkers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], D-dimer, ferritin, white blood cell count and interleukin-6) are in the causal pathway between obesity (BMI ≥ 30) and mechanical ventilation or death within 28 days of presentation to care.
RESULTS
In the MGH cohort (n = 1202), obesity was associated with greater likelihood of ventilation or death (OR = 1.73; 95% CI = [1.25, 2.41]; P = 0.001) and higher peak CRP (P < 0.001) compared with nonobese patients. The estimated proportion of the association between obesity and ventilation or death mediated by CRP was 0.49 (P < 0.001). Evidence of mediation was more pronounced in patients < 65 years (proportion mediated = 0.52 [P < 0.001] vs 0.44 [P = 0.180]). Findings were more moderate but consistent for peak ESR. Mediation by other inflammatory markers was not supported. Results were replicated in CUIMC/NYP cohort (n = 2626).
CONCLUSION
Findings support systemic inflammatory pathways in obesity-associated severe COVID-19 disease, particularly in patients < 65 years, captured by CRP and ESR. Contextualized in clinical trial findings, these results reveal therapeutic opportunity to target systemic inflammatory pathways and monitor interventions in high-risk subgroups and particularly obese patients.
Topics: Adult; Aged; Aged, 80 and over; Aging; Blood Sedimentation; C-Reactive Protein; COVID-19; Female; Ferritins; Fibrin Fibrinogen Degradation Products; Humans; Interleukin-6; Leukocyte Count; Male; Middle Aged; Obesity; Risk Factors; Systemic Inflammatory Response Syndrome; Treatment Outcome; United States
PubMed: 34473294
DOI: 10.1210/clinem/dgab629 -
American Journal of Respiratory and... Nov 2022A common gene polymorphism, rs35705950-T, is associated with idiopathic pulmonary fibrosis (IPF), but its role in severe acute respiratory syndrome coronavirus 2... (Meta-Analysis)
Meta-Analysis
A common gene polymorphism, rs35705950-T, is associated with idiopathic pulmonary fibrosis (IPF), but its role in severe acute respiratory syndrome coronavirus 2 infection and disease severity is unclear. To assess whether rs35705950-T confers differential risk for clinical outcomes associated with coronavirus disease (COVID-19) infection among participants in the Million Veteran Program (MVP). The rs35705950-T allele was directly genotyped among MVP participants; clinical events and comorbidities were extracted from the electronic health records. Associations between the incidence or severity of COVID-19 and rs35705950-T were analyzed within each ancestry group in the MVP followed by transancestry meta-analysis. Replication and joint meta-analysis were conducted using summary statistics from the COVID-19 Host Genetics Initiative (HGI). Sensitivity analyses with adjustment for additional covariates (body mass index, Charlson comorbidity index, smoking, asbestosis, rheumatoid arthritis with interstitial lung disease, and IPF) and associations with post-COVID-19 pneumonia were performed in MVP subjects. The rs35705950-T allele was associated with fewer COVID-19 hospitalizations in transancestry meta-analyses within the MVP (N = 4,325; N = 507,640; OR = 0.89 [0.82-0.97]; = 6.86 × 10) and joint meta-analyses with the HGI (N = 13,320; N = 1,508,841; OR, 0.90 [0.86-0.95]; = 8.99 × 10). The rs35705950-T allele was not associated with reduced COVID-19 positivity in transancestry meta-analysis within the MVP (N = 19,168/N = 492,854; OR, 0.98 [0.95-1.01]; = 0.06) but was nominally significant ( < 0.05) in the joint meta-analysis with the HGI (N = 44,820; N = 1,775,827; OR, 0.97 [0.95-1.00]; = 0.03). Associations were not observed with severe outcomes or mortality. Among individuals of European ancestry in the MVP, rs35705950-T was associated with fewer post-COVID-19 pneumonia events (OR, 0.82 [0.72-0.93]; = 0.001). The variant rs35705950-T may confer protection in COVID-19 hospitalizations.
Topics: Humans; COVID-19; Mucin-5B; Polymorphism, Genetic; Idiopathic Pulmonary Fibrosis; Genotype; Hospitalization; Genetic Predisposition to Disease
PubMed: 35771531
DOI: 10.1164/rccm.202109-2166OC -
Przeglad Menopauzalny = Menopause Review Jun 2021Abdominal-pelvic mass, ascites and pleural effusion are suggestive of malignant metastatic ovarian cancer. This triad is also present in a rare benign condition called...
INTRODUCTION
Abdominal-pelvic mass, ascites and pleural effusion are suggestive of malignant metastatic ovarian cancer. This triad is also present in a rare benign condition called Meigs syndrome. Rarely this condition is associated with an increased CA 125 level.
CASE REPORT
A 62-year-old woman with a history of abdominal pain underwent an ultrasound (US) examination and a chest X-ray. The imaging revealed the presence of a large pelvic mass and ascites with a monolateral pleural effusion and a high level of the tumor marker CA 125. The patient underwent a total abdominal hysterectomy, salpingoophorectomy, removal of the pelvic mass, pelvic lymphadenectomy and peritoneal biopsies. The histology showed an ovarian fibrothecoma.
DISCUSSION
The US analysis according to international ovarian tumor analysis simple rules revealed "inconclusive results"; the logistic regression model LR2 and Adnex suggested a high risk of malignancy. The presence of ascites and the size of the lesion associated with a high level of CA 125 affected the correct assessment of the risk of malignancy, exposing the patient to overtreatment.
CONCLUSIONS
Meigs syndrome is characterized by the resolution of symptoms after surgical removal of the pelvic mass. However, it mimics the clinical picture of a malignant metastatic ovarian cancer. Clinicians have to exclude ovarian cancer and recognize the syndrome to reduce inappropriate procedures.
PubMed: 34321989
DOI: 10.5114/pm.2021.106100