Clinical laboratory features of Meigs’ syndrome: a retrospective study from 2009 to 2018

doi:10.1007/s11684-019-0732-6

Front. Med.

2021, Vol. 15

Issue (1) : 116-124 https://doi.org/10.1007/s11684-019-0732-6

RESEARCH ARTICLE

Clinical laboratory features of Meigs’ syndrome: a retrospective study from 2009 to 2018

Wenwen Shang, Lei Wu, Rui Xu, Xian Chen, Shasha Yao, Peijun Huang, Fang Wang(

)

Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; National Key Clinical Department of Laboratory Medicine, Nanjing 210029, China

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Abstract

Meigs’ syndrome (MS), a rare complication of benign ovarian tumors, is easily misdiagnosed as ovarian cancer (OC). We retrospectively reviewed the clinical laboratory data of patients diagnosed with MS from 2009 to 2018. Serum carbohydrate antigen 125 and HE4 levels were higher in the MS group than in the ovarian thecoma-fibroma (OTF) and healthy control groups (all P <0.05). However, the serum HE4 levels were lower in the MS group than in the OC group (P <0.001). A routine blood test showed that the absolute counts and percentages of lymphocytes were significantly lower in the MS group than in the OTF and control groups (all P <0.05). However, these variables were higher in the MS group than in the OC group (both P <0.05). The neutrophil-to-lymphocyte ratio (NLR) was also significantly lower, whereas the lymphocyte-to-monocyte ratio was higher in the MS group than in the OC group (both P <0.05). The NLR, platelet-to-lymphocyte ratio, and systemic immune index were significantly higher in the MS group than in the OTF and control groups (all P <0.05). The hypoxia-inducible factor-1 mRNA levels were also significantly higher, whereas the glucose transporter 1, lactate dehydrogenase, and enolase 1 mRNA levels were lower in peripheral CD4⁺ T cells obtained preoperatively in a patient with MS than those in patients with OTF, patients with OC, and controls (all P <0.05). The expression of these four glucose metabolism genes was preferentially restored to normal levels after the tumor resection of MS (P <0.001). These clinical laboratory features can be useful in improving the preoperative diagnostic accuracy of MS.

Keywords Meigs’ syndrome ovarian thecoma-fibroma NLR (neutrophil to lymphocyte ratio) CD4⁺ T cells glucose metabolism

Corresponding Author(s): Fang Wang

Just Accepted Date: 27 April 2020 Online First Date: 13 July 2020 Issue Date: 11 February 2021

Cite this article:

Wenwen Shang,Lei Wu,Rui Xu, et al. Clinical laboratory features of Meigs’ syndrome: a retrospective study from 2009 to 2018[J]. Front. Med., 2021, 15(1): 116-124.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-019-0732-6
https://academic.hep.com.cn/fmd/EN/Y2021/V15/I1/116

Tab.1 Sequence of primers for four glucose metabolism genes

Fig.1 Clinical imaging and pathological findings, and serum CA125 and HE4 levels in patients with MS. (A, B) CT scan and MRI examination show a lesion with a diameter of>10.0 cm × 10.0 cm, accompanied by massive ascites (>1000 mL). The left arrow indicates ascites, and the right arrow represents the tumor. (C) The pathological type is fibroma, as shown by hematoxylin and eosin staining (200×). (D) Serum CA125 levels in the MS group (n = 9) compared with those in the OC (n = 34), OTF (n = 70), and control groups (n = 42). (E) Serum HE4 levels in the MS group (n = 6) compared with those in the OC (n = 31), OTF (n = 10), and control groups (n = 42). (F, G) Correlations of serum CA125 and HE4 levels with the amount of ascites. Data are shown as median±IQR. *P<0.05 and ***P<0.001.

Tab.2 Clinical characteristics of patients with MS

Fig.2 Features of peripheral blood cells in the MS group. (A–D, H) Absolute counts of white blood cells (WBC), lymphocytes, monocytes, neutrophils, and platelets in the MS group (n = 9) compared with the OC group (n = 40), OTF group (n = 81), and control group (n = 42). (E, F, G) Percentages of lymphocytes (LYM%), monocytes (MONO%), and neutrophils (NEUT%) in the MS group (n = 9) compared with the OC group (n = 40), OTF group (n = 81), and control group (n = 42). Data are shown as median±IQR. *P<0.05, **P<0.01, ***P<0.001.

Fig.3 Levels of systemic inflammatory indicators in the MS group. (A–D) The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and systemic immune index (SII= NLR × platelets) in the MS group (n = 9) compared with the OC group (n = 40), OTF group (n = 81), and control group (n = 42). Data are shown as median±IQR. *P<0.05, **P<0.01, ***P<0.001.

Fig.4 Gene expression of glucose metabolism genes in peripheral CD4⁺ T cells in a patient with MS. (A–D) Preoperative and postoperative gene expression levels of HIF1a, GLUT1, LDHa, and ENO1 in peripheral CD4⁺ T cells in a patient with MS and a patient with OTF, patients with OC (n = 9) before the operation, and controls (n = 10). Data are shown as mean±SEM of the three independent experiments. *P<0.05, **P<0.01, and *** P<0.001.

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