Ovarian mass, pleural effusion, and ascites: revisiting Meigs syndrome

The triad of pleural effusion, ascites, and benign ovarian fibroma is rare. Often, the ovarian mass is accompanied by elevated cancer antigen-125, both in serum and in pleural and peritoneal fluid. When benign ovarian fibroma is associated with ascites and/or pleural effusion it is termed Meigs syndrome. Meigs syndrome, however, is a diagnosis of exclusion only after ovarian carcinoma is ruled out. The presentation of symptoms and radiographic findings mimics that of metastatic ovarian cancer, creating a significant clinical challenge. We report a case of a patient with recurrent pleural effusions and an ovarian mass, with the outside hospital pleural fluid cytology report describing ovarian cancer. Although initially suspected to have metastatic ovarian cancer, subsequent workup of the patient's pleural and peritoneal fluid revealed no carcinoma. Surgical biopsy of the ovarian mass showed the presence of a benign tumor (fibroma). Postovarian mass resection, the patient showed resolution of pleural and peritoneal effusions. We describe our case in detail and review the literature on Meigs syndrome.