Demons-Meigs Syndrome: A Case Report at the Fatick Regional Hospital

Demons-Meigs syndrome combines a benign tumor of the ovary with thoracic and abdominal effusion, it is a rare disease whose pathophysiological me-chanism is not yet well understood. This rare syndrome often gives rise to fear of ovarian neoplasia due to the existence of ascites and the significant elevation of CA 125. In this observation, we report the case of Demons-Meigs syndrome diagnosed in a 36-year-old young woman who presented with pleural and peritoneal effusion syndrome with an ovarian mass and a CA 125 level = 406.6 IU/ml. Laparotomy performed revealed very abundant ascites, the uterus and tubes were healthy, no suspicious peritoneal lesions, the left ovary is healthy, a right ovarian mass of 300 × 150 mm. A right annexectomy was performed. The operative suites were simple with drying of the effusions. The control CA 125 returned to normal after 6 months of follow-up. A pathological anatomy result is a fibrothecoma. Demons-Meigs syndrome has a good prognosis; treatment is based on removal of the ovarian tumor.


Introduction
Demons-Meigs syndrome is defined as the presence of ascites with hydrothorax in association with a benign ovarian [1]. This syndrome was first described in Mali in 1887 by Albert Demons-Meigs et al. [2], in 1937 they discovered identical cases and made relevant studies [2] [3]. It is very rare and its physiopathology remains obscure. The following criteria are to be met for the diagnosis of Meigs syndrome: 1) Presence of the benign tumor of the ovary-Fibroma, thecoma, granulosa cell tumor or Brenner tumor; 2) Ascites; 3) Pleural effusion; 4) A resolution of ascites and pleural effusion after removal of the tumor [2] [3] [4] [5] [6]. The most frequently reported tumors are fibroids and thecomas [7] [8]. Before the pathological examination of the surgical specimen, this rare syndrome often gives rise to fear of ovarian neoplasia due to the existence of ascites and the significant elevation of CA 125 [9]. In our context of Regional Hospital Center, we reporta clinical case of Demons-Meigs syndrome, which we took care of and followed for more than 6 months.

Patient and Observation
This is Mrs. MC.N, 36 years old 4gestes, 4pares, received for abdomino-pelvic pain, an abdominal mass evolving for 3 months, where the patient thought she was pregnant, when the menstruation appeared that ultrasound was performed objectifying an ascites and an ovarian mass. The medical-surgical history was unremarkable. Clinical examination found an abdomen increased in size ( Figure 1) with a rounded mass extending from the right iliac fossa up to the umbilicus, mobile with a smooth outline. There is also a syndrome of thoracic effusion (pleurisy) and abdominal (ascites) of great abundance. On vaginal examination: clean vulva, cervix without particularity, normal vaginal wall.
On rectal examination: free anal margin with normotonic sphincter, blister rectal containing stools of normal appearance. The ascites exploratory puncture

Discussion
Demons-Meigs syndrome is a rare anatomo-clinical entity that is seen in 0.25% of ovarian tumors; and which most often affects women in the pre-and post-menopausal period, between 40 and 50 years old [10]. A significant increase in CA 125 associated, peritoneal and pleural effusion and the presence of an ovarian tumor are more suspicious of ovarian neoplasia [7]. It groups together in its typical form the Funck-Brentano conditions [11] [19].
The age of our patient is 36 years old. This age is lower than most cases described in the literature, Boufettal et al. [20] in Tunisia, Mssrouri et al. In Morocco [21] and Mwansa et al. [17] in Congo who described cases occurring in patients aged 65 and 66, respectively, but is similar to that which was described in our country Senegal by Cissé et al. [22] who is 25 years old. A genetic predisposition could explain the appearance of the syndrome in young women in the Senegalese population. The course of our patient is marked by spontaneous drying after removal of the ovarian tumor. This spontaneous resorption is one of the criteria for this pathology although cases of recurrence have been described after a very long remission of 30 years [23]; which could lead to a bilateral adnexectomy in peri-menopausal patients.

Conclusion
Although rare, Demons-Meigs syndrome should be known to surgeons because it can mimic advanced ovarian neoplasia. The existence of ascites and/or pleural effusion does not necessarily mean malignancy in the presence of an ovarian tumor. Preoperative recognition of this syndrome is possible. It makes it possible to avoid carrying out heavy surgical procedures in the treatment of ovarian cancer and unnecessary in this benign pathology which has a good prognosis.

Conflicts of Interest
The authors declare no conflict of interest.