Case report
Vascular endothelial growth factor levels in pleural and peritoneal fluid in Meigs’ syndrome

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Abstract

We report that we found differences in changes in vascular endothelial growth factor (VEGF) levels in pleural effusion and ascites after removal of ovarian tumor complicated by Meigs’ syndrome. Postoperative VEGF levels decreased in the patient’s pleural fluid but not in the peritoneal fluid. The mechanism of the development of the pleural effusion and ascites in Meigs’ syndrome may differ.

Introduction

Meigs’ syndrome is defined as presence of pleural effusion and ascites associated with an ovarian tumor, and it spontaneously resolves soon after the tumor is removed [1]. Although the pathogenetic mechanism of the pleural effusion and ascites is still unknown, some researchers have turned their attention to the CA-125 levels in the pleural effusion and peritoneal fluid [2], [3]. In recent years there have also been sporadic reports describing an association between vascular endothelial growth factor (VEGF) and the production of the pleural effusion and ascites associated with inflammatory diseases and malignant tumors, however, there have been no reports on associations between VEGF and the development of the pleural effusion and ascites in Meigs’ syndrome [4], [5], [6]. In this article we report the discovery of an intriguing difference between the time course of the CA-125 and VEGF levels in the pleural and peritoneal fluid after the tumor was removed from a patient with Meigs’ syndrome.

Section snippets

Case report

A 60-year-old woman (para 2, gravida 4) came to our department of internal medicine for treatment of a cough. A chest X-ray revealed a large volume of fluid in the right lung pleural cavity (Fig. 1A). Pelvic MR imaging showed a giant cyst in the right ovary measuring 28cm×18cm×18 cm and ascites. Thoracentesis yielded a light red pleural fluid, and PCR testing for tubercle bacilli was negative. Cytological examination of the pleural and peritoneal fluid yielded no evidence of cancer cells.

Discussion

Senger et al. [4] reported that VEGF is secreted by tumor cells and increases vascular permeability, and VEGF was subsequently shown to be closely associated with the production of peritoneal fluid [5]. There have been sporadic reports on VEGF levels in pleural fluid showing that they increase in lung cancer, pulmonary inflammatory disease, and pulmonary metastatic cancer [6], however, there have been no reports on VEGF levels in pleural and peritoneal fluid in Meigs’ syndrome. Serum CA-125

Acknowledgements

We are grateful to Drs. S. Shiraishi and M. Kawamoto of the First Department of Internal Medicine of Osaka City University Medical School. This study was supported by the Terry Fox Foundation.

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