title: VEGF hypersecretion as a plausible mechanism for pseudo-meigs' syndrome in advanced colorectal cancer.
abstract: 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.
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Okuchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mori
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kawamura
authors.forename: Shigemi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Takafumi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000328:Adult; D001201:Ascites / Q000209:etiology*; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008539:Meigs Syndrome / Q000209:etiology; D010051:Ovarian Neoplasms / Q000150:complications / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D010996:Pleural Effusion / Q000209:etiology*; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*
chemical_list: D042461:Vascular Endothelial Growth Factor A