Meigs' syndrome is a special variant of polyserositis that occurs in women with tumors of the ovarian tissue and uterus. It disappears completely after the neoplasia is removed. At the same time, there is 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. Diagnosed at a gynecological examination, in the process of ultrasound of the abdominal and pleural cavities, pelvic organs, pericardium. Therapy requires evacuation of exudate, correction of disorders of organs and systems, surgical extirpation of the tumor.
Description of the disease
Meigs syndrome is a rare paraneoplastic disorder. It is observed in 3% of patients who have volumetric formations in the area of the reproductive organs. 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 expanded the interpretation of the syndrome to all neoplasms of the pelvic organs. The classic combination of an 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 old.
The main causes of fluid accumulation in the abdominal cavity in women
The causes of pathology should be considered in more detail. The development of symptoms is accompanied by neoplastic lesions of the ovarian tissue and myometrium. Most often, with polyserositis, ovarian fibroma, ovarian cysts, and 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, and hyperstimulation syndrome during IVF have been described.
Pathogenesis
So far, the pathogenesis of Meigs' syndrome has not been fully studied. No specific channels connecting the ovaries and uterus with the pleural and pericardial cavities have been identified. There are several hypotheses for the occurrence of exudate in tumors of the female reproductive organs. According to the first, there is an accumulation of exudative effusion in the Demon-Meigs-Kass syndrome in the peritoneal cavity as a result of an “alarm reaction” of the vessels to a growing tumor.
A number of authors do not exclude the pathogenetic role of lymphatic vessels that provoke perforation of the diaphragmatic septum. There is no support for the idea that venous and lymphatic outflows are impaired as a result ofmechanical compression of tissues by neoplasia. After all, some patients develop massive polyserositis with neoplasms whose diameter is more than five centimeters.
Symptoms of this pathology
Clinical signs of Meigs syndrome in ovarian tumors increase gradually, are non-specific and, as a rule, are the result of effusion pressure on neighboring organs. The patient periodically has or constantly has a slight, often unilateral pain in the lower abdomen. In some women, the sensations are aching, dull, bursting. With a subsequent increase in the abdomen, the patient suffers from lack of air, general malaise, weakness, fatigue, sweating, loss of appetite, pale skin, swelling. A woman is gaining weight a lot against the background of cachectic syndrome. The amount of urine becomes less, constipation is not uncommon. In reproductive age, dysfunctional uterine bleeding is often observed.
Complications
If the process progresses and significant amounts of exudative effusion accumulate, the syndrome is complicated by heart and lung failure, metabolic cardiomyopathy, anemia, and increasing ischemia of various organs and tissues. Oxygen starvation of the brain leads to the fact that cognitive disorders occur (memory deteriorates, 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 tofatalities.
Diagnosis of Meigs syndrome
The presence of effusion in the cavities is detected during a physical examination. Fluid in the peritoneum is indicated by dullness of percussion sound above the chest, expansion in both directions of the borders of the heart. Muffled and increased heart sounds are noted. The presence of exudate is confirmed by chest x-ray, ultrasound, echocardiography. If a peritoneal, pleural, pericardial effusion is detected, then an in-depth oncological examination is prescribed to exclude neoplasms of the uterus or ovaries. Most informative methods:
- examination on the chair;
- pelvic sonography;
- pleural effusion analysis.
To detect the tumor process, a diagnostic laparoscopy is performed, an analysis for the CA-125 tumor marker.
The main methods of therapy for this disease
When treating Meigs' syndrome, the symptoms of organ compression should be quickly corrected, comorbid disorders corrected, and neoplasia surgically removed. The main stages of therapy are as follows:
- Exudate removal. In order to quickly unload the body from the accumulated fluid, thoracocentesis, laparocentesis are prescribed. The liquid is evacuated using an active aspiration apparatus through the 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 toimprove cardiac activity, use diuretics, cardiac glycosides. 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, patients are given saline and oncotic solutions.
- Surgical intervention. How difficult the operation will be depends on the identified gynecological disease, age, reproductive plans of the woman.
Prognosis for this pathology and prevention of the disease
Complete resorption of exudate against the background of restoration of general well-being is usually observed two weeks after tumor removal. Some women have small adhesions, as well as pleural and pericardial adhesions. Meigs pseudosyndrome complicates the course of oncological processes. The prognosis depends on the form and stage of the disease. Preventive measures include scheduled examinations by an obstetrician-gynecologist and regular ultrasound screening for timely diagnosis and adequate treatment of tumor lesions of the uterus and ovarian tissue.
