We present a case of pseudo-
meigs' syndrome caused by a metastatic ovarian
tumor of
rectal cancer origin, and examine the possible involvement of
vascular endothelial growth factor (
VEGF) in the pathogenesis of refractory fluid retention. A 42-year-old woman with advanced
rectal cancer underwent a laparoscopic anterior resection of the rectum. During systemic
chemotherapy treatment, she complained of severe abdominal distension 16 months following the operation. We failed to improve massive
ascites by
diuretics and repeated abdominocenteses. Without any definite evidence of carcinomatous
peritonitis, we chose to extirpate an enlarged ovarian
tumor on the presumptive diagnosis of pseudo-
meigs' syndrome.
Ascites disappeared promptly after resecting the ovarian
tumors and the subject resumed systemic
chemotherapy. Preoperative high levels of serum
VEGF were normalized promptly after the operation. Levels of
VEGF expression in metastatic ovarian
tumors were as weak as in the primary
tumor upon immunohistochemical staining. In contrast, increased
VEGF expression was evident in epithelial cells of oviducts. For patients with massive and refractory
ascites, we need to keep in mind the disease entity of pseudo-
meigs' syndrome, since surgical intervention possibly improves conditions. Furthermore, the hypersecretion of
VEGF from oviducts may play a role in the pathogenesis of clinical manifestations of pseudo-
meigs' syndrome.