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Metastatic colon cancer
1%
2/183
Metastatic lung cancer
2%
4/183
Metastatic ovarian cancer
8%
15/183
Meigs syndrome
87%
159/183
Nephrotic syndrome
1/183
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The patient likely suffers from Meigs Syndrome, given the triad of ovarian tumor, ascites, and hydrothorax. Meigs syndrome is characterized by pleural effusion, ascites, and a benign ovarian tumor. The benign tumor is usually a fibroma, which is composed of spindle-shaped fibroblasts on histology. The findings of pleural effusion and ascites in combination with an ovarian mass can mimic a disseminated malignancy, but, unlike metastatic cancer, symptoms resolve with removal of the tumor. Porcel and Light note that Meigs syndrome should be on the differential diagnosis for pleural effusions. Iyer et al. note that the management of Meigs syndrome is surgical removal of the ovarian mass. Postoperatively, Meigs syndrome is characterized by rapid resolution of the pleural effusion and ascites. Illustration A shows a MRI of an ovarian fibroma, which appears as a large, heterogenous mass arising from the left ovary. Illustration B shows the gross pathology of an ovarian fibroma (the white part on the left of the image). Illustration C shows the histology of an ovarian fibroma (bundles of spindle-shaped fibroblasts). Incorrect Answers: Answers 1-3 & 5: Ascites would not be expected to resolve upon removal of an ovarian mass.
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