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GYNAECOLOGY AND OBSTETRICS Table of Contents   
Year : 2005  |  Volume : 15  |  Issue : 3  |  Page : 377-379
Psudomeigs syndrome : An unusual presentation of yolk sac tumour


Department of Radiodiagnosis, Gandhi Medical College, Bhopal, India

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Keywords: Meigs syndrome, pseudo Meigs syndrome, Yolk sac tumor

How to cite this article:
Malik R, Pandya V K, Awasthi P. Psudomeigs syndrome : An unusual presentation of yolk sac tumour. Indian J Radiol Imaging 2005;15:377-9

How to cite this URL:
Malik R, Pandya V K, Awasthi P. Psudomeigs syndrome : An unusual presentation of yolk sac tumour. Indian J Radiol Imaging [serial online] 2005 [cited 2020 May 31];15:377-9. Available from: http://www.ijri.org/text.asp?2005/15/3/377/29159

   Introduction Top


The combination of an ovarian fibroma with ascites and hydrothorax usually, right sided is known as Meigs syndrome. The origin of the ascitic fluid is variously ascribed to an exudate from peritoneum resulting from mechanical irritation by hard heavy mobile tumor, to degeneration of fibroma, to changes in the capsular veins of fibroma, and to an active secretion by the tumor. The first seems the most likely explanation and is supported by the fact that other types of mobile tumors, ovarian or uterine, can cause ascites and give rise to what is then called a pseudo Meigs syndrome. It is now accepted that the diaphragm is porous either by the reason of minute foramina or via the lymphatics through which ascitic fluid can track up. This explains the associated hydrothorax.


   Materials and methods Top


A 20years old lady presented with a large pelvic mass noticed 2 months back which was enlarging rapidly. She also had primary amenorrhea & under developed secondary sexual characters. She was referred to the Department of Radiodiagnosis with the presumptive diagnosis of a retroperitoneal tumor.

Patient was subjected to following investigations sequentially-

Chest radiograph PA view- which revealed gross pleural effusion on right side.[Figure - 1]

USG showed a large, solid, hyperechoic mass lesion measuring approximately 15x17cm in size, showing few specks of calcification and a small area of cystic necrosis.[Figure - 2][Figure - 3] The mass was pelvico-abdominal i.e. arising in pelvis & extending into the lower abdomen. There was associated ascites, right sided pleural effusion [Figure - 4] and right sided mild hydronephrosis. The ovaries and the uterus could not be delineated & appeared to be engulfed by the mass.

The lack of encasement of great vessels & ureters by the mass and intact musculature of posterior abdominal wall helped us to rule out a primary retroperitoneal tumor. However the three findings constituting the triad of

Meigs syndrome i.e. ascites, right sided pleural effusion with a pelvic (ovarian) mass helped us to view the pelvic mass as ovarian in origin.

Then the patient was subjected to IVP & barium enema to rule out any possible invasion of rectosigmoid, ureters & urinary bladder.

IVP displayed mild hydronephrosis on right side, laterally displaced right ureter and indentation on superior surface of urinary bladder without any evidence of invasion.

The barium enema also showed evidence of external compression over the sigmoid colon.[Figure - 5]

Taking into account patients age, clinical features, sonographic appearance of mass, associated findings & rapid growth of mass; diagnosis of a malignant ovarian tumor, most probably a germ cell tumor was considered.

Patient underwent surgery which revealed a large friable, predominantly a solid mass with few cystic areas involving both the adnexa and engulfing the uterus, which could not be seen separately. Ovaries also could not be identified separately. Multiple metastatic deposits were seen in omentum and under surface of liver.

On biopsy the tumor was proved to be a yolk sac tumor showing following pathological characteristics-Grossly: size was 10x13x15cm. Outer surface was gray white to brown and lobulated. It was soft & pultaceous in consistency. The capsule was intact & adherent. The cut section showed variegated appearance.

Microscopically - the paraffin sections stained with H & E showed reticular microscopic areas lined by tumor cells & hyperchromatic nuclei. At places pseudo-papillary processes with central vessels (Schiller Duval bodies) were seen. The neoplastic cells were showing the presence of eosinophilic hyaline droplets intra as well as extracellularly.[Figure - 6][Figure - 7][Figure - 8]


   Discussion Top


Yolk sac tumor also known as endodermal sinus tumor, is a rare tumor but the 2nd most common of germ cell origin after dysgerminoma. It is thought to arise from the undifferentiated and multipotent embryonal carcinoma by selective differentiation towards yolk sac and vitelline structures. This is why the tumor is rich in alpha feto protein and alpha one antitrypsin.

It usually occurs in <20 years,and is almost always unilateral. It commonly presents with nonspecific symptoms, an endocrinal disturbance not being a feature of pure yolk sac tumor and pseudoMeigs syndrome is a very rare presentation, which we were fortunate to pick up.

These tumors are highly malignant and their rapid spread in the abdomen and to the distant sites lead invariably to early death. In recent years, however promising results have been obtained with chemotherapy and the prognosis is relatively hopeful in some cases. The progress of tumor and the development of recurrence can be monitored by serial estimation of alpha feto protein levels.[5]

 
   References Top

1.Jaffcoats : Principles of gynaecology 5th Ed. http://www.arnold publishers.com.,2001.  Back to cited text no. 1    
2.Rumack Wilson Charboneau: Diagnostic ultrasound 2nded. MOSBY, 1998  Back to cited text no. 2    
3.Shaws: text book of gynaecology, 13th ed. Reed Elsevier India Private Limited,2004.  Back to cited text no. 3    
4.Mrire H, Cosgrove D, Dewbury K, Farrant P: Abdominal and general ultrasoumd, 2nd ed.Churchill Livingstone,2001.  Back to cited text no. 4    
5.Peter W Callen: ultrasonography in obstetrics and gynecology, 4th ed. W.B.Saunders, 2000.  Back to cited text no. 5    

Top
Correspondence Address:
R Malik
Department of Radiodiagnosis, Gandhi Medical College, Bhopal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.29159

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8]



 

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    Introduction
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