Chylothorax, chylopericardium and lymphoedema – the presenting features of signet‐ring cell carcinoma

Moğulkoç, Nesrin; Önal, Banu; Okyay, N; Günel, Özden; Bayındır, Ülkü

doi:10.1034/j.1399-3003.1999.13f39.x

Cited by 13 publications

(23 citation statements)

References 10 publications

(10 reference statements)

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“…[1819] One case with lymphedema, pleural effusion and gastric adenocarcinoma was also excluded as the pleural fluid characteristics confirming chylothorax were not available. [20] An additional 2883 references were excluded due to reasons such as (1) chylothorax not associated with gastric carcinoma, (2) studies in the pediatric population, (3) chylothorax was a post-operative complication and (4) published in languages other than English.…”

Section: Resultsmentioning

confidence: 99%

Chylothorax in gastric adenocarcinoma: A case report and systematic review of the English literature

Devaraj¹,

Ramachandran²,

Correa³

2014

Lung India

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Background:Chylothorax is a rare complication of gastric adenocarcinoma and data on its identification, prevalence and outcomes are scant.Objectives:To enable identification of gastric carcinoma as a cause of chylothorax.Methods:A case report and a systematic review were conducted of all reported cases of gastric adenocarcinoma with chylothorax as the presenting complaint in the English literature.Results:Chylothorax is a rare presenting complaint of gastric adenocarcinoma. There are only 18 case reports in the world literature, of which six are in English. Chylothorax occurred variably in gastric adenocarcinoma, either as a presenting feature or as a complication of therapy. Here, we analyze the index case and six patients in whom gastric carcinoma presented with chylothorax as the initial symptom. Respiratory features of cough and dyspnea preempted any abdominal complaint. Bilateral chylothorax (66%) with associated chylous ascites (50%) was common. Four of the six patients had skin lymphedema also as a prominent feature. The chylothoraces have been treated by therapeutic pleurocentesis, intercoastal tube drainage and restriction of oral intake. Gastric adenocarcinoma was associated with high mortality (50%) and morbidity.Conclusions:Chylothorax can be the presenting feature of gastric adenocarcinoma. A thorough search for this life-threatening disease should be done before labeling the chylothorax as idiopathic.

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Section: Resultsmentioning

confidence: 99%

Chylothorax in gastric adenocarcinoma: A case report and systematic review of the English literature

Devaraj¹,

Ramachandran²,

Correa³

2014

Lung India

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“…Chylopericardium is an entity defined as the accumulation of chylous fluid in the pericardial space. It is typically the result of chest trauma [7], thoracic surgical procedures [8], mediastinal radiotherapy, mediastinal neoplasms [7,8], signet-ring cell carcinoma of the stomach [10], mediastinal tuberculosis, filariasis, thrombosis of the subclavian vein [7] and vena cava [11], Behcet's syndrome [12], congenital lymphangiomatosis, Gorham-Stout disease (osteolysis secondary to lymphangiomatosis with bone resorption) [13], congenital mediastinal lymphangiectasia and congenital lymphatic anomalies [12]. A recent case report describes a unique case of chylothorax and chylopericardium in end stage renal disease patient on hemodialysis with a left jugular tunneled catheter who developed superior vena cava syndrome [3], thus increasing the etiology of this illness.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis is confirmed by pericardial fluid test, with a triglyceride concentration at least over 500 mg/dL, a cholesterol-triglyceride ratio characteristically less than 1, and an abundance of lymphocytes in the cell count and negative bacterial counts [12,25]. A score of 2 (specificity and sensitivity of 100%) is required for a diagnosis of chylopericardium [9,10,26,27]. Triglyceride concentration in the pericardial fluid is not universally accepted diagnostic criteria and some chylopericardium cases have been established with lesser values [12].…”

Section: Discussionmentioning

confidence: 99%

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

Aranalde¹,

Lorenzin²,

Cánaves³

et al. 2019

AJIM

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The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and Effler in 1954. Even when most patients are asymptomatic, constrictive pericarditis or cardiac tamponade may be referred. Cardiac tamponade, the most serious complication, represents an entity characterized by fluid accumulation in the pericardial cavity. Claudius Galen from Pergamum (131-201 D. C.) described pericardial effusions in gladiators with stab injuries of the chest and Richard Lowe (1669) described its physiology. It took two hundred years for the term "cardiac tamponade" was coined by german surgeon Edmund Rose. Cardiac tamponade can be presented from asymptomatic setting to life-threatening conditions. By the former reason, the early recognition of this entity has crucial importance. Idiopathic chylopericardium occurs in all age groups and affects both sexes equally. Although several mechanisms have been proposed in order to explain the development of chylopericardium, the underlying pathophysiology remains unclear. Damaged lymphatic vessels with abnormal communication of the thoracic duct to the pericardial lymphatics and elevated pressure in the thoracic duct can justify the presence of chyle into the pericardial sac. Diagnosis is confirmed by pericardiocentesis which must reveal at least two of the classical five criteria. Chylopericardium may be managed through conservative or surgical treatment. The conservative treatment consist a medium chain triglyceride diet or total parenteral nutrition but has a high degree of recurrence, for which reason the safest option is thoracic duct ligation with a pericardial window. The present study reports a case of chylopericardium wherein the leak was diagnosed by lymphoscintigraphy that was successfully treated by a low-fat diet, rich in medium-chain triglycerides and octreotide infusion.

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“…Şiloperikardiyum ile şilotoraks birlikte bulunabilmektedir (4,8,9,16,17). Şiloperikardiyum ile şilotoraksın birlikte bulunduğu bir olguda ilginç bir şekilde 1.5 cm'lik mezenterik lenfanjiektazi ve familial hipobetalipoproteinemi saptanmıştır (17).…”

Section: Discussionunclassified

Adli Otopsi İle Saptanan Şiloperikardiyum

2018

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Bu sunumda adli otopside şiloperikardiyum saptanan 72 yaşındaki kadın olguyu medikolegal boyutuyla sunarak tartışmayı ve kısa literatür incelemesi yapmayı amaçladık. Basit bir tıbbi müdahale ile giderilebilecek nitelikte yaralanmaya maruz kaldığı darp olayından 5 gün sonra gastrointestinal sistem şikayetleri nedeniyle bir hastaneye başvurmuştur. İnsizyonel herni ve kolon divertikül perforasyonu cerrahi tedavisi sonrası hemodinamisi stabil olarak klinikte takip ve tedavileri devam ederken, hastaneye yatışının ikinci gününde ölmüştür. Otopsisinde iç muayenede, perikardın gergin ve boşluğunun beyaz renkli şilöz sıvı ile dolu olduğu görüldü. Batında cerrahi sütüre yara, ekimoz, membran ve noktasal kanama alanları ile adhesiv alanlar izlendi. Makroskobik olarak yoğun peritonit bulgusu izlenmedi. Histopatolojik incelemede; akciğerlerde ödem, kalpte myosit sitoplazmalarında genişleme, ince ve kalın bağırsaklarda serozal yüzde yoğun nötrofil lökosit infiltrasyonu, sütür materyali yanısıra nonspesifik bulgular saptandı. Kimyasal analizlerde herhangi bir toksik madde saptanmadı. Perikard boşluğundan alınan sıvının biyokimyasal analizinde; 461 mg/dL trigliserid ve 114 mg/dL kolesterol saptandı. Kişinin ölüm nedeni ‘‘insizyonel herni....

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Chylothorax, chylopericardium and lymphoedema – the presenting features of signet‐ring cell carcinoma

Abstract: This report describes a patient with chylous pleural and pericardial effusions in conjunction with severe lymphoedema resembling elephantiasis. The chylous effusions and generalized lymphoedema were associated with a signet‐ring cell carcinoma.

Cited by 13 publications

References 10 publications

Chylothorax in gastric adenocarcinoma: A case report and systematic review of the English literature

Chylothorax in gastric adenocarcinoma: A case report and systematic review of the English literature

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

Adli Otopsi İle Saptanan Şiloperikardiyum

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