Morán-Mendoza A, Alvarado-Luna G, Calderillo-Ruiz G, Serrano-Olvera A, López-Graniel C M, Gallardo-Rincón D
Sub-direction of Internal Medicine, National Institute of Cancerology, Mexico City, Mexico.
Int J Gynecol Cancer. 2006 Jan-Feb;16 Suppl 1:315-8. doi: 10.1111/j.1525-1438.2006.00228.x.
Meigs' syndrome is the association of ovarian fibroma, pleural effusion, and ascites. Meigs' syndrome with marked elevation of CA125 is an unusual clinical condition reported in 27 cases in the literature. The patient was a 46-year-old woman with right pleural effusion, ascites, ovarian tumor, and CA125 level of 1808 U/mL. Tomography revealed ascites and bilobate pelvic tumor of approximately 25 cm. The diagnosis of advanced epithelial ovarian cancer was considered, and the patient was treated with chemotherapy. Three chemotherapy schemes were applied due to the total lack of response in tumor volume; however, CA125 decreased to 90 U/mL. Thus, surgery was performed with resection of 25 cm of the left ovarian tumor, with intact capsule and without implants; the result of histopathologic analysis was fibroma. Postoperative CA125 was 11 U/mL. Patients with elevated CA125 and ascites cytology positive for malignancy must be cautiously treated due to the possibility of false positives, even if the probability is low. Therefore, minimally invasive surgery for biopsy collection must be considered. Although the association between ovarian tumor, pleural effusion, ascites, and marked elevation of CA125 is highly indicative of epithelial ovarian cancer, Meigs' syndrome must be considered in the differential diagnosis.
梅格斯综合征是指卵巢纤维瘤、胸腔积液和腹水同时存在。伴有CA125显著升高的梅格斯综合征是一种罕见的临床情况，文献中报道了27例。该患者为46岁女性，有右侧胸腔积液、腹水、卵巢肿瘤，CA125水平为1808 U/mL。断层扫描显示有腹水和一个约25 cm的双侧盆腔肿瘤。考虑诊断为晚期上皮性卵巢癌，患者接受了化疗。由于肿瘤体积完全没有反应，应用了三种化疗方案；然而，CA125降至90 U/mL。因此，进行了手术，切除了25 cm的左侧卵巢肿瘤，包膜完整且无种植转移；组织病理学分析结果为纤维瘤。术后CA125为11 U/mL。CA125升高且腹水细胞学检查恶性阳性的患者，即使假阳性概率较低，也必须谨慎治疗，因为存在假阳性的可能性。因此，必须考虑采用微创手术获取活检组织。虽然卵巢肿瘤、胸腔积液、腹水和CA125显著升高之间的关联高度提示上皮性卵巢癌，但在鉴别诊断中必须考虑梅格斯综合征。
