So-Called “Meigs' Syndrome” Associated with Benign and Malignant Ovarian Tumors

Fibroma of the ovary associated with ascites and hydrothorax was reported by Cullingworth in 1879, Demons in 1887, and Tait in 1892 (1, 2). Demons and Tait were the first to report that removal of the ovarian lesion would result in a cure. This clinical syndrome was definitely established in 1937, when Meigs and Cass reported a series of 7 cases of ovarian fibroma with ascites and hydrothorax in which the effusions disappeared following the removal of the tumor (3). Prior to this the association of ascites and hydrothorax with clinical evidence of a pelvic tumor had generally been considered evidence of an inoperable malignant lesion. Although it is now generally recognized that Meigs' syndrome appears with benign tumors of the ovary, especially fibroma, its association with malignant ovarian neoplasms is less well known. Removal of the malignant ovarian tumor in such cases is also followed by disappearance of the effusions.

Schenck and Eis (4), in 1939, reported a case of papillary cystadenocarcinoma of the left ovary in which the ascites and hydrothorax disappeared after removal of the tumor, though they indicated that the malignant nature of the lesion was not in itself the cause of the fluid accumulations. Townsend (5) presented a case of bilateral multilocular papillary cystadenocarcinoma of the ovaries associated with ascites and pleural effusion in which the effusions disappeared and the patient recovered following operation. Dick, Spire and Worboys (6) described Meigs' syndrome associated with a Krukenberg tumor. Cases of Meigs' syndrome associated with malignant ovarian tumors have also been reported by Beresford (1) in 1950, by Nelson and Dennison (7) in 1951, by Conway-Hughes (8) in 1951, and by Deacon (9) in 1954.

The syndrome as originally described by Meigs was limited to fibroma of the ovary. Recently he redefined this syndrome and included thecomas, granulosa-cell tumors, and Brenner tumors. These, according to Meigs, are the tumors with which this syndrome is most commonly associated. He did not include malignant ovarian tumors, though he did state that there is no question but that a malignant process may be responsible. His review of the literature (2) in 1954 showed 14 cases of malignant ovarian disease which resembled this syndrome. Most of these tumors were papillary cystadenocarcinomas, with one Krukenberg tumor, a fibrosarcoma of the ovary, and an adenocarcinoma of the round ligament. The same review disclosed 69 cases of the syndrome due to fibroma. Thirty-four other benign ovarian tumors, including thecomas, granulosa-cell tumors, Brenner tumors, teratoma, and various types of ovarian cyst, were reported in patients who had a clinical course similar to that seen with Meigs' syndrome. It is of interest to note that, although Meigs' syndrome is generally well known, it is a relatively uncommon occurrence either with a benign or malignant tumor.