Unusual manifestation of gastric adenocarcinoma presenting with lymphedema, chylothorax, and chylous ascites
Issued Date
2023-01-01
Resource Type
ISSN
18657257
eISSN
18657265
Scopus ID
2-s2.0-85171791291
Journal Title
Clinical Journal of Gastroenterology
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Journal of Gastroenterology (2023)
Suggested Citation
Wongrukmit S., Ngamphaiboon N., Kiranantawat K., Suwanthanma W., Plumworasawat S., Boonsakan P., Pongtippan A., Phanachet P., Warodomwichit D., Shantavasinkul P.C. Unusual manifestation of gastric adenocarcinoma presenting with lymphedema, chylothorax, and chylous ascites. Clinical Journal of Gastroenterology (2023). doi:10.1007/s12328-023-01851-5 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/90242
Title
Unusual manifestation of gastric adenocarcinoma presenting with lymphedema, chylothorax, and chylous ascites
Author's Affiliation
Other Contributor(s)
Abstract
A 62-year-old Thai man with a 2-year history of bilateral lymphedema and an unprovoked left axillary vein thrombosis presented with progressive leg, scrotal, and abdominal swelling, and shortness of breath. He denied any gastrointestinal symptoms. His lymphedema had initially been diagnosed as chronic filariasis due to positive blood tests for anti-filarial antibodies; however, treatment with anti-filarial drugs failed to improve his symptoms. Subsequently, he underwent surgical lymphaticovenular anastomosis with scrotal reduction, which proved to be of limited symptomatic relief. Later investigations revealed bilateral chylothorax and chylous ascites, with the presence of metastatic adenocarcinoma. Histopathological examination of the patient’s skin and scrotum biopsy from his previous surgery revealed invasion of the lymphatics by neoplastic cells with signet ring cell formation. Gastroscopy uncovered a gastric mass, and biopsy confirmed the diagnosis of stage IV gastric adenocarcinoma with signet ring cell. He later received palliative chemotherapy. For the management of chyle leakage, he was prescribed a very low-fat diet and supplemented with parenteral nutrition. Despite treatment, he developed cutaneous metastasis and was transitioned to best supportive care. The patient passed away 14 months after diagnosis.