Department of Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan.
Jpn J Clin Oncol. 2010 May;40(5):476-81. doi: 10.1093/jjco/hyq014. Epub 2010 Feb 23.
We present a case of pseudo-meigs' syndrome caused by a metastatic ovarian tumor of rectal cancer origin, and examine the possible involvement of vascular endothelial growth factor (VEGF) in the pathogenesis of refractory fluid retention. A 42-year-old woman with advanced rectal cancer underwent a laparoscopic anterior resection of the rectum. During systemic chemotherapy treatment, she complained of severe abdominal distension 16 months following the operation. We failed to improve massive ascites by diuretics and repeated abdominocenteses. Without any definite evidence of carcinomatous peritonitis, we chose to extirpate an enlarged ovarian tumor on the presumptive diagnosis of pseudo-meigs' syndrome. Ascites disappeared promptly after resecting the ovarian tumors and the subject resumed systemic chemotherapy. Preoperative high levels of serum VEGF were normalized promptly after the operation. Levels of VEGF expression in metastatic ovarian tumors were as weak as in the primary tumor upon immunohistochemical staining. In contrast, increased VEGF expression was evident in epithelial cells of oviducts. For patients with massive and refractory ascites, we need to keep in mind the disease entity of pseudo-meigs' syndrome, since surgical intervention possibly improves conditions. Furthermore, the hypersecretion of VEGF from oviducts may play a role in the pathogenesis of clinical manifestations of pseudo-meigs' syndrome.
我们报告一例由直肠癌转移性卵巢肿瘤引起的假性梅格斯综合征，并探讨血管内皮生长因子（VEGF）在难治性液体潴留发病机制中的可能作用。一位 42 岁的女性患有晚期直肠癌，接受了腹腔镜直肠前切除术。术后 16 个月，她在全身化疗期间抱怨严重的腹胀。我们用利尿剂和反复腹腔穿刺未能改善大量腹水。由于没有明确的癌性腹膜炎证据，我们选择切除增大的卵巢肿瘤，假定诊断为假性梅格斯综合征。切除卵巢肿瘤后腹水迅速消失，患者恢复全身化疗。术前血清 VEGF 水平高，术后迅速正常化。免疫组织化学染色显示，转移性卵巢肿瘤中的 VEGF 表达水平与原发性肿瘤一样弱，但输卵管上皮细胞中的 VEGF 表达增加。对于大量难治性腹水的患者，我们需要记住假性梅格斯综合征的疾病实体，因为手术干预可能会改善病情。此外，输卵管中 VEGF 的过度分泌可能在假性梅格斯综合征临床表现的发病机制中起作用。
