Chylaskos as a presentation of serous papillary adenocarcinoma of the endometrium: a case report

Abstract

A 77-year-old female was presented to the emergency department with intense anorexia, weight loss despite progressive abdominal distension, and dyspnea. Abdomen imaging studies revealed moderate-volume ascites and a hepatic space-occupying lesion. Diagnostic paracentesis allowed the drainage of a chylous effusion and cytology analysis identified adenocarcinoma cells. Hepatic metastasis of papillary serous adenocarcinoma of the endometrium was confirmed after tomography-guided biopsy. Endometrial carcinoma is the most common malignant gynecological neoplasm in developed countries and is often classified in type I with endometrioid histology (estrogen-dependent) and non endometrioid type II (non-estrogen-dependent). Chylous ascites or chylaskos is a rare presentation on hospital admission. Several etiologies have been described. In adults, solid malignancy is expected to be identified in less than 20% of the cases. Currently only one case of endometrial carcinoma presenting with chylous ascites was described in a systematic review. Keywords: Chylous ascites, endometrial neoplasms Clinical caseA 77-year-old female was admitted in the Internal Medicine ward for investigation after presenting to the emergency department with intense anorexia, weight loss despite progressive abdominal distension and dyspnea. As past medical history, the patient related chronic gastritis, chronic microcytic anemia, arterial hypertension, dyslipidemia and type 2 diabetes mellitus with no vascular events, besides chronic kidney disease (stage 3). She denied any alcohol or smoke habits. On gynecological reports she had one term labor with eutocic delivery, menarche at 12 and menopause at 40 years, with no further complaints or bleeding discharge since then. Laboratory evaluation showed microcytic anemia (hemoglobin 7.4 g/dL, mean corpuscular volume 75.7 fL) with normal white cells and platelet count, mild hypoalbuminemia (31.6 g/L), normal serum total protein (67.7 g/L), normal serum transaminases ( aspartate aminotranferease 17 U/L, alanine aminotranferease 8 U/L) normal gamma glutamyl transpeptidase (30 U/L), alkaline phosphatase (110 U/l) and lactate dehydrogenase (228 U/L) values; high erythrocyte sedimentation rate (71 mm in the first hour) and a high C-reactive protein (64.3 mg/L), not changed baseline renal function (serum creatinine of 1.60 mg/dL with an estimated glomerular filtration rate of 35 mL/min/1.73 m2). Diagnostic paracentesis allowed the drainage of an exudative effusion. The laboratory analysis revealed 574 total cells with lymphocytes predominance (total protein of 51.9 g/L, albumin of 25.8 g/L, with a serum-to-ascites albumin gradient (SAAG) of 0.58 g/dL, lactate dehydrogenase level of 175 IU/L, glucose level of 126 mg/dL and triglyceride level of 382 mg/dL. It wasn´t detected any microorganism from the effusion. These chemistry results were consistent with a chylous effusion. Cytological analysis identified adenocarcinoma cells of unknown origin. Abdominopelvic magnetic resonance imaging revealed several hyp...