Elsevier

Gynecologic Oncology

Volume 97, Issue 1, April 2005, Pages 288-291
Gynecologic Oncology

Case Report
Ascites, 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

https://doi.org/10.1016/j.ygyno.2004.12.022Get rights and content

Abstract

Background

The combination ascites, pleural effusion, and elevated CA 125 are usually associated with a malignancy.

Case

A 38-year-old SLE patient consulted her physician for shortness of breath. On clinical examination, she had a tender abdomen and reduced breathing sounds. X-ray and computed tomography of the chest showed pleural effusion. An adjustment of her SLE maintenance therapy was performed. Vaginal ultrasound and computed tomography of the abdomen revealed massive ascites and an intracavitair myoma of 2 cm, but no obvious mass in the pelvis. CA 125 was 887 U/ml. A laparoscopy was performed showing ascites and 2 Filshie clips embedded in the peritoneum of the vesicouterine pouch, but no sign of malignancy. Both clips were removed. The cytology of the aspirated ascites showed sings of acute inflammation. Within 10 weeks, the pleural effusion was resolved and the CA 125 normalized.

Conclusion

The combination of ascites, pleural effusion, CA 125 elevation, and no tumor in an SLE patient is 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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