Chylothorax and lymphedema as the initial manifestations of gastric carcinoma: A case report and review of the literature

Wu,Jie; Lv,Liang; Zhou,Kunyan; Huo,Jirong

doi:10.3892/ol.2016.4285

Chylothorax and lymphedema as the initial manifestations of gastric carcinoma: A case report and review of the literature

Authors:
- Jie Wu
- Liang Lv
- Kunyan Zhou
- Jirong Huo
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Affiliations: Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China, Department of Gastroduodenal Surgery, Hunan Cancer Hospital of Xiangya Medical School, Central South University, Changsha, Hunan 410013, P.R. China
Published online on: February 29, 2016 https://doi.org/10.3892/ol.2016.4285
Pages: 2835-2838

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Abstract

Chylothorax is the accumulation of lymph fluid in the pleura. Gastric carcinoma with chylothorax and lymphedema as the initial manifestations has rarely been reported, with only 14 cases reported to date. The mechanisms of gastric carcinoma generating chylothorax have not yet been determined. The current study reports the case of a 63‑year‑old woman presenting with chylothorax and lower extremity lymphedema, and reviews the existing literature. A chest radiograph performed on the present patient revealed large pleural effusion and chylothorax was diagnosed. Upper gastrointestinal endoscopy identified an irregular apophysis lesion and a biopsy confirmed poorly differentiated gastric adenocarcinoma. The patient was discharged at her request, and subsequently succumbed to the disease 4.5 months later. Based on the findings of the present study, as well as those of the literature, we proposed a novel form of gastric carcinoma infiltrating the body. Chylothorax and lymphedema may be a consequence of gastric carcinoma cells infiltrating the lymphatic circulatory system; therefore, the differential diagnosis of chylothorax and lymphedema of unknown cause should consider gastric carcinoma, regardless of gastrointestinal symptoms.

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1	Romero S: Nontraumatic chylothorax: Curr Opin Pulm Med. 6:287–291. 2000.
2	Schild HH, Strassburg CP, Welz A and Kalff J: Treatment options in patients with chylothorax. Dtsch Arztebl Int. 110:819–826. 2013.PubMed/NCBI
3	Segal R, Waron M, Reif R and Zecler E: Chylous ascites and chylothorax as presenting manifestations of stomach carcinoma. Isr J Med Sci. 22:897–899. 1986.PubMed/NCBI
4	Bautz JB, Delaney MD, Mostaghim R and Lodato RF: Chylothorax as presenting manifestation of adenocarcinoma with probable gastric primary. Chest. 99:1044–1045. 1991. View Article : Google Scholar : PubMed/NCBI
5	Shibata K, Kitagawa S, Fujimura M and Matsuda T: Chylothorax associated with inflammatory carcinoma. Intern Med. 37:538–541. 1998. View Article : Google Scholar : PubMed/NCBI
6	Mogulkoc N, Onal B, Okyay N, Günel O and Bayindir U: Chylothorax, chylopericardium and lymphoedema-the presenting features of signet-ring cell carcinoma. Eur Respir J. 13:1489–1491. 1999. View Article : Google Scholar : PubMed/NCBI
7	Majoor CJ, Aliredjo RP, Dekhuijzen PN, Bulten J and van der Heijden HF: A rare cause of chylothorax and lymph edema. J Thorac Oncol. 2:247–248. 2007. View Article : Google Scholar : PubMed/NCBI
8	Lanznaster G, Adami M, Crivellaro C, Kluge R, Egarter-Vigl E and Wiedermann CJ: Gastric signet-ring cell carcinoma: Unilateral lower extremity lymphoedema as the presenting feature. ScientificWorldJournal. 7:1189–1192. 2007. View Article : Google Scholar : PubMed/NCBI
9	Kayacan O, Karnak D, Can Ayşe B, Sak Dizbay S and Beder S: Gastric signet-ring cell adenocarcinoma presenting with left arm deep-vein thrombosis and bilateral chylothorax. Clin Appl Thromb Hemost. 14:476–480. 2008. View Article : Google Scholar : PubMed/NCBI
10	Devaraj U, Ramachandran P, Correa M and Dsouza GA: Chylothorax in gastric adenocarcinoma: A case report and systematic review of the English literature. Lung India. 31:47–52. 2014. View Article : Google Scholar : PubMed/NCBI
11	Yamada M, Kudoh S, Hirata K and Yoshikawa J: Bilateral chylothorax as initial manifestation of gastric cancer. Nihon Kokyuki Gakkai Zasshi. 39:343–346. 2001.(In Japanese). PubMed/NCBI
12	Watanabe K, Yamauchi K, Kobayashi K and Takeda H: A case of gastric cancer initially presented by bilateral chylothorax. Nihon Kokyuki Gakkai Zasshi. 42:415–418. 2004.(In Japanese). PubMed/NCBI
13	Miyazaki S, Noda H, Morita T, Joman M, Okada M, Moriyama Y, Suzuki K and Takeuchi T: A case of gastric cancer detected incidentally following to chylothorax, followed by change in the appearance of pleural effusion with cancer progression. Nihon Shokakibyo Gakkai Zasshi. 104:1359–1364. 2007.PubMed/NCBI
14	Miwa M, Kasamatsu N, Shibata M, et al: A case of gastric cancer with bilateral chylothorax. Nihon Kokyuki Gakkai Zasshi,. 47:1115–1119. 2009.(In Japanese).
15	Yoshizawa K, Sasaki Y, Abe Y, Kanno N, Mizumoto N, Yagi M, Yaoita T, Iwano D, Nagino K, Sato T, et al: Chylothorax in a patient with advanced gastric cancer and mediastinal lymph node metastasis causing thoracic duct obstruction. Nihon Shokakibyo Gakkai Zasshi. 110:1943–1949. 2013.(In Japanese). PubMed/NCBI
16	Martín-Joven A, Ballesteros Fernández A, Cervero M, Marco J and Solís J: Chylothorax as presenting form of a gastric adenocarcinoma. Rev Esp Enferm Dig. 88:880–881. 1996.(In Spanish). PubMed/NCBI
17	Skandalakis JE, Skandalakis LJ and Skandalakis PN: Anatomy of the lymphatics. Surg Oncol Clin N Am. 16:1–16. 2007. View Article : Google Scholar : PubMed/NCBI
18	Schulman A, Fataar S, Dollrymple R and Tidbury I: The lymphographic anatomy of chylothorax. Br J Radiol. 51:420–427. 1978. View Article : Google Scholar : PubMed/NCBI
19	Murdaca G, Cagnati P, Gulli R, Spanò F, Puppo F, Campisi C and Boccardo F: Current views on diagnostic approach and treatment of lymphedema. Am J Med. 125:134–140. 2012. View Article : Google Scholar : PubMed/NCBI