McGonagall syndrome

Introduction to McGonagall syndrome Meg syndrome refers to patients with ovarian fibroids (fibroma) with pleural effusion and ascites, which can be bloody. A group of syndromes in which pleural effusions and ascites can disappear after tumor resection. In 1879, Cullingworth first reported the disease. In 1934, Salmon described the intrinsic pleural effusion with benign pelvic tumors. In 1937, Meigs and Cass elaborated on 7 cases of ovarian fibroids with pleural effusion and ascites and was named Meg syndrome. In 1948, ovarian fibroids, follicular gland cell tumors, ovarian thyroid tumors, granulosa cell tumors and other intrinsic reports were reported. basic knowledge The proportion of patients: 0.001%-0.002% (the incidence rate of women of childbearing age is about 0.001%-0.002%) Susceptible people: women Mode of infection: non-infectious Complications: uterine prolapse

The cause of McGregor syndrome

(1) Causes of the disease

There are many etiological theories about Meg's syndrome. The more consistent view is that the tumor itself is the main source of ascites. Some people think that the ascites is the result of partial embolism of the large vein in the ovarian tumor pedicle. The embolism is related to the weight of the tumor itself. Meigs believes that ovarian fibroids can form cysts and have interstitial edema. Excess water can be mixed into the abdominal cavity. Many scholars have done a lot of experiments to prove that the tumors to be removed are placed. In a dry, closed bottle, after 24 hours, its weight is significantly reduced (can be changed from 3200g to 2050g). Rubin also suggested that the pedicle torsion of fibroids can cause pressure on the lymphatic vessels or blood vessels of the tumor, causing blood or lymphatic stasis, liquid self The tumor leaks into the abdominal cavity, and the mechanism of pleural effusion is more complicated than that of ascites. Because the thoracic cavity is far away from the ovarian tumor, the thoracic cavity and the abdominal cavity are separated by sputum, which obviously cannot be explained by the action of the tumor itself.

(two) pathogenesis

The primary disease of Meg's syndrome is pelvic tumor. There are still differences in understanding the pathogenesis of pleural effusion and ascites. However, there are several reasons for the cause of ascites: hypoproteinemia theory, oppression theory above, vein Compression, inflammation, liver and heart disease, pedicle torsion, tumor surface necrosis and edema theory, experiments have shown that the characteristics of intrinsic pleural effusion and ascites are exactly the same, which means that ascites can enter the chest through certain channels, Meigs will ink Injected into the abdominal cavity, it was found that the ink did migrate to the chest cavity. Recently, it was treated with radioactive colloidal gold. It was found that the radioactive substance can be freely moved from the abdominal cavity to the chest cavity, and can also be quickly moved from the chest cavity to the abdominal cavity. Therefore, currently The theory that the lymphatic system is connected between the chest and abdomen has been basically affirmed.

Further research found that the lymph on the right side of the sputum is richer on the left side; and because the position of the right iliac dome is also higher, the suction effect is relatively strong, so the pleural effusion is more common in the right chest, in addition, it has been reported There are a number of small holes in the sputum, which can make the pleural effusion and ascites move directly through the small hole to the other side.

Megger syndrome prevention

First, prevention:

1, early detection, surgical treatment.

2. Pay attention to follow-up.

Meg syndrome complications Complications, uterine prolapse

In some cases, uterine prolapse can occur.

Symptoms of McGregor Syndrome Common symptoms Abdominal pain Urinary incontinence Breath sounds weakened Abdominal shortness Short legs Limb edema Chest pain Chest tightness Pleural effusion

1. There is no significant difference in the incidence of left and right side of ovarian tumors. According to statistics, 1% to 40% of patients with ovarian fibroma can be complicated with ascites.

2. Pleural effusion can occur on the same side of the ovarian tumor, or on the contralateral side, 62% of which is found in the right thoracic cavity, 11% in the left side, and 24% in the bilateral thoracic cavity, although repeated chest and abdominal puncture Liquid, but the liquid still grows rapidly. After the tumor is removed, the pleural effusion and ascites disappear by itself.

3. Patients with ascites do not necessarily have pleural effusion at the same time. Some cases have only ascites without pleural effusion, or have had pleural effusion, but then disappear.

4. Pleural effusion, ascites is mostly leakage, there are a few can be exudate relative density (specific gravity) in the range of 0.010 ~ 1.017, there is no relationship between the amount of fluid and tumor size, but with pleural effusion, ascites tumor They are all larger, generally more than 10cm in diameter, pleural effusion, and the amount of ascites varies. It can cause symptoms and signs of compression for a long time. When the tumor is bleeding, the ascites can be bloody.

5. May have abdominal pain, bloating, cough, chest tightness, chest pain, shortness of breath, not lying, lower extremity edema, urinary incontinence, weight loss, vaginal bleeding can also occur.

6. Physical examination of the lungs percussion is a real sound, the breath sounds weakened, the ascites sign is positive, the patient likes the right lateral position, and the double-combination can touch the ovarian mass with the texture as hard as the stone, medium size, generally greater than 10cm The surface of the mass is smooth, the activity is good, and there is no tenderness.

7. Often can be complicated by solid tumors of the ovary, such as ovarian fibroma, leiomyoma, follicular tumor, ovarian fibroepithelial neoplasia.

Examination of Meg's syndrome

1. The biochemical examination of ascites is mostly leakage, color or yellowish, the specific gravity is 1.010~1.017, the cell number is often less than 400×106/L, and the protein content is often less than 0.3g/L.

2. There are no abnormalities in blood and ascites tumor markers.

3. Ascites through ascites cytology, cell chromosome examination, AgNOR detection, flow cytometry and imaging analysis are all suggestive of benign ascites.

4. Ascites biochemical identification such as specific gravity, ascites protein, lactate dehydrogenase (LDH) and ascites-serum LDH ratio (ASLR), adenosine deaminase (ADA), ferritin (FA) and ascites-serum ferritin Ratio, both suggest benign ascites.

5. Ascites immunological tests such as CA125, -microglobulin, etc. to identify ascites properties.

6. Abdominal B-ultrasound can be seen on the side of the attachment with a medium or enhanced echo zone, the quality is more uniform, medium size, no clear cyst wall, pelvic or abdominal cavity, there is a liquid dark area.

7. X-ray examination of fibroids can also be seen in the calcification zone, pleural effusion also has X-ray signs.

8. Laparoscopy.

9. Histopathological examination.

Diagnosis and diagnosis of Megger syndrome

According to the symptoms and signs, gynecological examination found that the ovarian tumor texture is hard, combined with pleural and abdominal effusion (not necessarily concurrent with pleural and abdominal effusion) should consider the syndrome, such as surgery confirmed that the ovarian tumor is a fibroid, then can be diagnosed.

Differential diagnosis

1. Cancerous pleural effusion, ascites is mostly bloody exudate, there are primary lesions and cachexia.

2. Typical history of cirrhosis and ascites, spider mites, abnormal liver function, no pelvic masses, etc.

3. Tuberculous ascites is exudative, with a history of tuberculosis, or other parts of the body tuberculosis and tuberculosis toxins.

4. Congestive heart failure is leakage, no other symptoms and signs of heart disease, no pelvic mass.

5. Nephrotic syndrome.

6. Advanced schistosomiasis.

7. Hypoproteinemia.

8. Severe ovarian edema.

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