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Lock 1941
Lock 1941
Lock 1941
MEIGS’ SYNDROME
FIBROMA OF THE OVARY WITH ASCITES AND HYDROTHORAX
FRANK R. LOCK, B.A., M.D., AND
CONRAD G. COLLINS, MS., M.D., F.A.C.S., NEW ORLEANS, LA.
(From the Department of Gynecology, Tulane University and Charity Hospital)
F IBROMA
to the attention
of the ovary associated
of the medical
with ascites and hydrothorax
profession by Meigs
was first called
and Cassl in 1937. At that
time they were able to collect 7 cases. In 1939, Meigsa brought the literature up
to date with an additional 8 eases. Bomze and Kirshbauma have added two cases
since the appearance of Meigs last publication. The importance of accurate diag-
nosis of this benign neoplasm is obvious when it is noted that of the 17 cases in
the literature 15 patients were treated by surgical removal of the tumor and survived.
One of the remaining 2 patients was not given the benefit of a laparotomy, and
died as a result of the syndrome. The other reported by Bomze and Kirshbaum
presented numerous complicating factors and died two days following laparotomy.
These authors considered 3 possible mechanisms as the cause of death. First, the
presence of a large ovarian tumor interfering with the progress of gestation and
causing abortion, combined with the effects of toxemia and exploratory laparotomy.
Second, acute glomerulonephritis which was observed on microscopic examination
of necropsy material, and third, death as a result of an untreated Meigs’ syndrome.
518 AMERICAN JOURNAL OF OBSTETRICS AXD GYNECOLOGY
Clinically, the condition may closely simulate advanced pelvic malignancy with
peritoneal, and pleural or pulmonary metastases. Caehexia is not uncommon. The
patient usually has known of the presence of an abdominal mass for a long time
prior to consulting a physician. The ascitic fluid may be so marked that the
patient is incapacitated, and the abdominal mass obscured hy the distended
abdomen. Attention is called to the co-existing hydrothorax by dyspnea which
may have been present for months. Sufficient fluid is usually present to gi\-e
ample physical findings. The diagnosis of Me&s syndrome is relatively simple
if the condition is considered.
The rarity of this condition has prompted us to report a case which has re-
cently come under our observation, and in which the diagnosis was made pre-
operatively.
V. V., aged 31 years, colored, was admitted to the Charity Hospital March 31,
1940, complaining that her stomach was swollen. Two weeks prior to admission,
she began to have generalized cramping pains in her abdomen, which became
progressively worse during an interval of approximately six hours. The pains
subsided somewhat, and she noticed that her abdomen had become greatly dis-
tended. She had no nausea or vomiting. She ate dinner as usual, but the inges-
tion of food caused a recurrence of the pains. There was little or no increase in
the size of the patient’s abdomen from the acute onset until admission to the
hospital. She had more or less constant cramping pains of varying intensity
during the two-week interval. Her bowt>l function haul been unchange~l, and no
nausea or vomiting occurred at any time.
She had noticed a lumpy mass in the lower abdomen for a year. She had
dyspnea on climbing steps for the year prior to admission, which had become
progressively more severe and was noticeable on slight exertion during the past
month. Occasional palpitation was present, associated with the periods of dyspnea.
She was not confined to bed during the two weeks of her illness, but. experi-
enced discomfort on walking. She had uo swelling of her feet, ankles, or hands.
The patient had a slight product.ivc cough for one month. There were no
hemoptysis, night sweats or chest pain.
Menstrual and Xurital History.-The patient reached menarche at. l:! years of
age. Her periods occurred at a twenty-eight-day interval, lasting five to six days
throughout her menstrual life. There was no dysmenorrhea. Her last menstrual
period began Feh. 17, 1940. The present menstrual period began afar& 12, 1940.
One pregnancy occurred terminating in a normal full-term delivery when the
patient was 13 years of age.
Hiisfory.-The past and family hist.ory revealed nothing of signiiieanc3r.
Physiwl Emminntion.-She was a slightly undernourished colored female with
a tense protuberant abdomen. Flatness and impaired breath sounds were noted
over the right base posterior and lateral to the level of the seventh rib. No rales
were noted. Tactile fremites were absent. No abnormalities were noted on ex-
amination of the left hemithorax. The heart was within normal limits on per-
cussion and no anscultatory abnormalities were noted. Her blood pressure was
101/78.
Marked symmetrical enlargement of the patient’s abdomen was present. The
skin was tense. No enlarged veins were noted. A tympanitic percussion note was
present in superior portion of abdomen. IMluess to flatness was noted in de-
pendent port,ions of the abdomen. Bhifting dullness and fluid vvaves were demon-
strable. When the patient was in the supine position, a ballotable mass was
present in the lower abdomen that extended up to the umbilicus. The mass was
very hard and nodular on palpation. The mass shifted from one side of the
abdomen to the other as the patient was turned from side to side. The liver and
spleen were not palpable. No sacral edema was present.
Genital examination revealed a multiparous introitus with 3 slight cystocele
and rectocele. Bartholin’s glands were not palpable. No exudate could be ex-
pressed from Skene’s glands. The cervix was normal in size and color. A healed
laceration was present on the right side. The external OS was slightly dilated;
the cervix was a little softer than normal in consistency. The uterus was en-
larged to the size of an eight weeks’ pregnancy with a single fibroid palpable
LOCK AND COLLINS: MEIGS’ SYNDROME 519
(1) Meigs, J. V., and Cass, J. W.: AM. J. OBST. & GYNEC. 33: 249, 1937. (2)
Mei’gs, J. V. : Ann. Surg. 110: 731, 1939. (3) Bomze, E. J., and Ekshbaum, J. D.:
-1lnr.J. OBST.& G~x~c.40: 281,194O.