PDF(Pubmed)
Abstract：
BACKGROUND: Chylous ascites is caused by disruption of the lymphatic system, which is characterized by the accumulation of a turbid fluid containing high levels of triglycerides within the abdominal cavity. The two most common causes are cirrhosis and tuberculosis, and colon signer ring cell carcinoma (SRCC) due to the use of immunosuppressants is extremely rare in cirrhotic patients after liver transplantation, making it prone to misdiagnosis and missed diagnosis.
METHODS: A 52-year-old man who underwent liver transplantation and was administered with immunosuppressants for 8 months was admitted with a 3-month history of progressive abdominal distention. Initially, based on lymphoscintigraphy and lymphangiography, lymphatic obstruction was considered, and cystellar chyli decompression with band lysis and external membrane stripping of the lymphatic duct was performed. However, his abdominal distention was persistent without resolution. Abdominal paracentesis revealed allogenic cells in the ascites, and immunohistochemistry analysis revealed adenocarcinoma cells with phenotypic features suggestive of a gastrointestinal origin. Gastrointestinal endoscopy was performed, and biopsy showed atypical signet ring cells in the ileocecal valve. The patient eventually died after a three-month follow-up due to progression of the tumor.
CONCLUSIONS: Colon SRCC, caused by immunosuppressants, is an unusual but un-neglected cause of chylous ascites.
METHODS: A 52-year-old man who underwent liver transplantation and was administered with immunosuppressants for 8 months was admitted with a 3-month history of progressive abdominal distention. Initially, based on lymphoscintigraphy and lymphangiography, lymphatic obstruction was considered, and cystellar chyli decompression with band lysis and external membrane stripping of the lymphatic duct was performed. However, his abdominal distention was persistent without resolution. Abdominal paracentesis revealed allogenic cells in the ascites, and immunohistochemistry analysis revealed adenocarcinoma cells with phenotypic features suggestive of a gastrointestinal origin. Gastrointestinal endoscopy was performed, and biopsy showed atypical signet ring cells in the ileocecal valve. The patient eventually died after a three-month follow-up due to progression of the tumor.
CONCLUSIONS: Colon SRCC, caused by immunosuppressants, is an unusual but un-neglected cause of chylous ascites.
摘要：
背景：乳糜腹水是由淋巴系统破坏引起的，其特征在于在腹腔内积聚含有高水平甘油三酯的混浊流体。两个最常见的原因是肝硬化和肺结核,和结肠标志环细胞癌（SRCC）由于使用免疫抑制剂是极其罕见的肝硬化患者肝移植后，容易误诊和漏诊。
方法：一名52岁的男子接受了肝移植并接受了8个月的免疫抑制剂治疗，他有3个月的进行性腹胀病史。最初，基于淋巴闪烁显像和淋巴管造影,考虑到淋巴阻塞，并进行膀胱乳糜减压，带溶解和淋巴管外膜剥离。然而,他的腹胀持续没有消退。腹腔穿刺术显示腹水中有同种异体细胞，免疫组织化学分析显示腺癌细胞具有提示胃肠道起源的表型特征。进行了胃肠内窥镜检查，活检显示回盲瓣中存在非典型印戒细胞。由于肿瘤进展，患者最终在三个月的随访后死亡。
结论：结肠SRCC，由免疫抑制剂引起的，是乳糜腹水的不寻常但不容忽视的原因。
方法：一名52岁的男子接受了肝移植并接受了8个月的免疫抑制剂治疗，他有3个月的进行性腹胀病史。最初，基于淋巴闪烁显像和淋巴管造影,考虑到淋巴阻塞，并进行膀胱乳糜减压，带溶解和淋巴管外膜剥离。然而,他的腹胀持续没有消退。腹腔穿刺术显示腹水中有同种异体细胞，免疫组织化学分析显示腺癌细胞具有提示胃肠道起源的表型特征。进行了胃肠内窥镜检查，活检显示回盲瓣中存在非典型印戒细胞。由于肿瘤进展，患者最终在三个月的随访后死亡。
结论：结肠SRCC，由免疫抑制剂引起的，是乳糜腹水的不寻常但不容忽视的原因。
