Refractory Chylothorax and Lymphedema Caused by Advanced Gastric Cancer

Published on Nov 1, 2019in Internal Medicine1.005
· DOI :10.2169/INTERNALMEDICINE.2351-18
Naoko Nagano3
Estimated H-index: 3
Manabu Suzuki5
Estimated H-index: 5
+ 7 AuthorsHaruhito Sugiyama19
Estimated H-index: 19
: Chylothorax is the accumulation of lipid pleural effusion. Few reports have described chylothorax caused by gastric cancer. A 45-year-old woman presented with progressive lymphedema and bilateral chylothorax. Although repetitive thoracentesis was performed to relieve her dyspnea, swelling of her axillary lymph nodes became significant. Positron emission tomography/computed tomography demonstrated the accumulation of 18F-fluorodeoxyglucose in these nodes, and a lymph node biopsy showed signet ring cell carcinoma. The primary site was a 0-IIc type lesion in the gastric body that was only detected by upper gastrointestinal endoscopy. The patient was diagnosed with advanced gastric cancer 3.5 months after presentation for chylothorax.
#1Jaffer A. Ajani (University of Texas MD Anderson Cancer Center)H-Index: 123
#2M AbramovH-Index: 1
Last. Gerardo RosatiH-Index: 20
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Abstract The effect of histology-based treatment regimen on diffuse gastric adenocarcinoma has not been evaluated in clinical trials. This international phase III trial evaluated the efficacy and safety of S-1 (a contemporary oral fluoropyrimidine)/cisplatin versus 5-fluorouracil (5-FU)/cisplatin in chemotherapy-naive patients with diffuse-type adenocarcinoma involving the gastroesophageal junction or stomach. Eligibility criteria included untreated, measurable, advanced diffuse adenocarcinoma c...
15 CitationsSource
#1Jie Wu (CSU: Central South University)H-Index: 1
#2Liang Lv (CSU: Central South University)H-Index: 9
Last. Jirong Huo (CSU: Central South University)H-Index: 9
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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...
4 CitationsSource
#1Yasuhide YamadaH-Index: 61
#2Katsuhiko Higuchi (Kitasato University)H-Index: 18
Last. Ichinosuke Hyodo (University of Tsukuba)H-Index: 42
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Background: We evaluated the efficacy and safety of S-1 plus oxaliplatin (SOX) as an alternative to cisplatin plus S-1 (CS) in first-line chemotherapy for advanced gastric cancer (AGC). Patients and methods: In this randomized, open-label, multicenter phase III study, patients were randomly assigned to receive SOX (80–120 mg/day S-1 for 2 weeks with 100 mg/m 2 oxaliplatin on day 1, every 3 weeks) or CS (S-1 for 3 weeks with 60 mg/m 2 cisplatin on day 8, every 5 weeks). The primary end points wer...
219 CitationsSource
#1Uma Devaraj (St. John's Medical College)H-Index: 6
#2Priya Ramachandran (St. John's Medical College)H-Index: 4
Last. George D'Souza (St. John's Medical College)H-Index: 14
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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...
5 CitationsSource
#1Kazuya YoshizawaH-Index: 5
#2Yu SasakiH-Index: 9
Last. Yoshiyuki UenoH-Index: 62
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: We report the case of a 61-year-old female with advanced gastric cancer and mediastinal lymph node metastasis who developed chylothorax. The patient presented with cough, dyspnea and pain in the left lower limb, back, and hips. Her lower limb symptoms were attributed to cellulitis. Computed tomography revealed right-sided pleural effusion, multiple lymph node swelling, and thickening of the gastric wall. Following pleural aspiration, the effusion was identified to be chyle. Cytopathologically,...
4 Citations
Lymphedema is a chronic, progressive, and often debilitating condition. Primary lymphedema is a lymphatic malformation developing during the later stage of lymphangiogenesis. Secondary lymphedema is the result of obstruction or disruption of the lymphatic system, which can occur as a consequence of tumors, surgery, trauma, infection, inflammation, and radiation therapy. In this review, we report an update upon the diagnostic approach and the medical and surgical therapy for both primary and seco...
69 CitationsSource
The patient, a 77 year-old woman, visited our hospital with chief complaints of coughing and dyspnea. Chest radiography revealed bilateral pleural effusion especially on the right side, and she was admitted to our hospital to undergo a more thorough examination. The pleural effusion was identified as chyle. In cytodiagonosis, a number of adenocarcinoma cells in clumps were detected. After admission, her general condition worsened, and she died. Her condition was diagnosed as advanced gastric car...
4 Citations
#1Oya Kayacan (Ankara University)H-Index: 12
#2Demet Karnak (Ankara University)H-Index: 14
Last. Sumru Beder (Ankara University)H-Index: 11
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A 28-year-old housewife, a life-long nonsmoker, presented with 3 weeks of pleuritic chest pain along with swollen right leg, left arm, and left breast. Six months previously she had left subclavian vein thrombosis. On admission, bilateral supraclavicular lymphedema on right leg and left arm and breast was observed and bilateral pleural fluid, chylous exudates, was detected. Abdomen computed tomography revealed abundant ascites and right ovarian enlargement. Whole body bone scintigraphy showed bo...
7 CitationsSource
: We report a case of gastric cancer that was detected due to chylothorax. A 64-year-old man visited our hospital with chief complaints of anterior chest pain and right lower leg swelling. Chest X-ray showed bilateral pleural effusion. Biochemical tests of the pleural fluid detected chyle and cytological examination of the left pleural revealed poorly differentiated adenocarcinoma cells. An upper gastrointestinal examination revealed a type 4 gastric cancer that was diagnosed as the primary lesi...
3 Citations
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