Case ReportAscites, pleural effusion, and CA 125 elevation in an SLE patient, either a Tjalma syndrome or, due to the migrated Filshie clips, a pseudo-Meigs syndrome
Introduction
Pleural effusion, ascites, normal or risen CA 125, and a solid ovarian tumor are considered the signature of a malignancy until proven otherwise. In 1892 already, Tait was the first to notice that these features were not always associated with cancer [1]. The syndrome, however, bears the name of Joe Vincent Meigs (1892–1963), a Harvard Medical School professor of gynecology [2]. There are two types: true-Meigs syndrome and pseudo-Meigs syndrome. The first concerns benign ovarian tumors like fibroma, thecoma, granulosa cell tumor, or Brenner tumor [3] and the second involves other benign ovarian or gynecological tumors [4].
Systemic lupus erythematosus (SLE) is an inflammatory connective tissue disorder of unknown etiology in which tissues and cells are damaged by autoantibodies and immune complexes. We present a case of migrated Filshie clips in a patient with SLE, accompanied by ascites, pleural effusion and elevated CA 125 and discuss the different explanations for the development of this combination.
Section snippets
Case report
This concerns a 38-year-old nulligravida. She is a nonsmoker who presented herself with shortness of breath. Her complex medical history included an anti-phospholipid syndrome with a cerebrovascular accident, mild systemic lupus erythematosus with secondary Sjögren, and autoimmune thrombocytopenia. In the past, she had a cesarean for premature labor and a laparoscopic sterilization with Filshie clips. On clinical examination, she had a tender abdomen and reduced breathing sounds. At vaginal
Discussion
In 1954, Meigs syndrome was defined as a solid ovarian mass (primary fibroma, thecoma, or granulosa cell tumor or Brenner tumor) in combination with ascites, and pleural effusion on the condition that excision of this tumor cured the patient [3], [5]. When the same findings were associated with tumors other than the originally described types, the term pseudo-Meigs was used. Pseudo-Meigs syndromes have been described with struma ovarii, yolk sac tumor, ovarian carcinoma, leiomyoma,
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Cited by (35)
Incomplete pseudo-Meigs’ syndrome caused by endometrial ovarian cyst: A case report
2021, Respiratory Medicine Case ReportsCitation Excerpt :Cases that satisfy all 4 criteria are defined as true MS, but PMS if associated with tumors other than outlined in (1), but satisfying the other criteria [2]. Furthermore, those who present with symptoms of systemic lupus erythematosus and high CA-125 in pleural effusion and ascites are called pseudo-pseudo Meigs' syndrome (PPMS), also known as Tjalma syndrome [4]. Since this case was negative for antinuclear antibody and PPMS was excluded, the patient was diagnosed as incomplete PMS derived from an endometriotic cyst.
The multidisciplinary approach to ovarian tumours in children and adolescents
2019, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Ascites, either as an exudate or as a transudate, can be a presenting sign of ovarian pathology and is present in approximately a third of patients [2,26]. Ascites is not limited to malignant tumours but can be associated with benign tumours such as fibromas [10,27]. Many speculative theories exist regarding the production of ascites in the presence of ovarian tumours.
Obstetric and gynecologic causes of pleural effusions
2019, Disease-a-MonthCitation Excerpt :This right-sided predilection is attributed to transmigration of fluid into the pleural space from the abdomen.15 Proposed mechanisms for development of ascites include pressure on the lymphatics causing escape of fluid, peritoneal irritation or inflammation by the tumor, and transudation of interstitial edema or leakage of intratumoral fluid due to torsion, injury, or necrosis.18,20 Krenke et al reported that an exudative pattern has been most commonly cited; however, a transudative pattern may also be seen.15,19
Pleuro-pericarditis developed under a leflunomide therapy
2015, Revue de Pneumologie CliniqueWhat is your call?: Severe edema and elevated CA 125 in a 56-year-old woman
2012, CMAJ. Canadian Medical Association JournalCitation Excerpt :The patient's elevated level of CA 125 and the ovarian mass detected one year earlier were suggestive of cancer. However, it is important to recognize that an elevated level of CA 125 in conjunction with ascites and pleural effusion can occur in patients with active systemic lupus erythematosus in the absence of malignant disease.2,3 The increased synthesis of CA 125 has been attributed to activated peritoneal mesothelial cells.