Lymphomas and Chylous Ascites: Review of the Literature

Almakdisi, Tony; Massoud, Samuel; Makdisi, George

doi:10.1634/theoncologist.10-8-632

Cited by 85 publications

(92 citation statements)

References 33 publications

(36 reference statements)

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“…The diagnosis is established when the concentration of triglycerides in the ascitic fluid exceeds 200 mg/dl. 6 Chylous ascites may occur due to different mechanisms, including (a) obstruction of the lymph flow caused by external pressure (i.e., compression by a mass) causing leakage from dilated subserosal lymphatics into the peritoneal cavity; (b) exudation of lymph through the walls of dilated retroperitoneal vessels lacking valves, which leak fluid through a fistula into the peritoneal cavity as in congenital lymphangiectasia; or (c) traumatic thoracic duct damage causing direct leakage of chyle through a lymphoidperitoneal fistula. An underlying malignancy is a common cause of chylous ascites in adults.…”

Section: Discussionmentioning

confidence: 99%

Perivascular Epithelioid Cell Tumor of the Retroperitoneum in a Young Woman Resulting in an Abdominal Chyloma

Lans

Ramshorst

Hermans

et al. 2009

Journal of Gastrointestinal Surgery

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Perivascular epithelioid cell tumor (PEComa) is an extremely rare neoplasm which appears to have predominancy for young, frequently Asian, women. The neoplasm is composed chiefly of HMB-45-positive epithelioid cells with clear to granular cytoplasm and usually showing a perivascular distribution. These tumors have been reported in various organs under a variety of designations. Malignant PEComas exist but are very rare. The difficulty in determining optimal therapy, owing to the sparse literature available, led us to present this case. We report a retroperitoneal PEComa discovered during emergency surgery for abdominal pain in a 28-year-old Asian woman. The postoperative period was complicated by chylous ascites that was initially controlled by a wait-and-see policy with total parenteral nutrition. However, the chyle production gradually increased to more than 4 l per day. The development of a bacterial peritonitis resulted in cessation of production of abdominal fluid permitting normal nutrition without chylous leakage. Effective treatment for this rare complication of PEComa is not yet known; therefore, we have chosen to engage in long-term clinical follow-up.

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Section: Discussionmentioning

confidence: 99%

Perivascular Epithelioid Cell Tumor of the Retroperitoneum in a Young Woman Resulting in an Abdominal Chyloma

Lans

Ramshorst

Hermans

et al. 2009

Journal of Gastrointestinal Surgery

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“…1,2 Postoperative chylous ascites is of specific interest in this discussion. Kaas and associates 3 reported a 1.1% incidence after oncologic abdominal resections.…”

Section: Incidencementioning

confidence: 99%

Chylous Ascites After Liver Transplant: Case Report and Review of Literature

Mukerji

Tseng

Karachristos

et al. 2013

Exp Clin Transplant

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Case: A 62-year-old man with cirrhosis, hepatitis C, and hepatocellular carcinoma, underwent a liver transplant. On day 11 after surgery, a chylous leak from a partial wound dehiscence was noted. The leak did not respond to 2 weeks of uninterrupted, fat-free clear liquid diet and 12-hour total parenteral nutrition at night. The same treatment was continued for another 6 weeks with fatty meal challenge every weekend, which he failed. He was then given a fat-free clear liquid diet, 24-hour total parenteral nutrition, and octreotide 100 μg subcutaneously every 8 hours for 14 days. A prompt response was noted. His recovery was excellent at the time of this writing (9 months' follow-up). Discussion: Eleven major cases have been reported with 9 cases being managed conservatively. Four were given a diet plus total parenteral nutrition without octreotide producing a cure in 3 to 36 days. Two cases (including ours) were given the diet and total parenteral nutrition, which failed; octreotide was then added, and these cases were cured in 2 to 4 weeks. Therefore, diet with total parenteral nutrition failed in 33.3% of the cases (2/6). In 3 cases, octreotide was used from the outset. They were all cured in ≤ 2 weeks. One case was operated on for peritonitis; chylous ascites was found and a leak was ligated. One patient with congenital lymphatic disorder underwent peritoneovenous shunting. Octreotide was not used in any of the cases of chylous ascites that were treated surgically. Conclusions:If exploratory surgery is done for any other reason, it is best to identify a chylous leak and ligate it. Otherwise, we recommend octreotide combined with a fat-free, clear liquid diet, and supplementation with medium chain triglycerides and total parenteral nutrition from the outset.

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“…Cirrhosis, malignancies and infectious agents are frequent etiologies, whereas congenital, inflammatory, post-operative and traumatic causes have been described [1]. The incidence of chylous ascites is between 1 in 50,000 and 1 in 187,000 hospital admissions.…”

Section: Fatal Chylous Ascites Pericarditis and Extensive Venous Thrmentioning

confidence: 99%

“…The prognosis is dismal. The majority of patients die within a few months, regardless of chemotherapy [1].…”

Section: Fatal Chylous Ascites Pericarditis and Extensive Venous Thrmentioning

confidence: 99%

Fatal chylous ascites, pericarditis and extensive venous thrombosis, due to an aggressive T cell non-Hodgkin lymphoma

Ioannidou-Papagiannaki

Diamantidis

Livanis

et al. 2008

Ann Hematol

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Lymphomas and Chylous Ascites: Review of the Literature

Abstract: Learning ObjectivesAfter completing this course, the reader will be able to:1. Describe how common medical diseases can cause chylous ascites.

Cited by 85 publications

References 33 publications

Perivascular Epithelioid Cell Tumor of the Retroperitoneum in a Young Woman Resulting in an Abdominal Chyloma

Perivascular Epithelioid Cell Tumor of the Retroperitoneum in a Young Woman Resulting in an Abdominal Chyloma

Chylous Ascites After Liver Transplant: Case Report and Review of Literature

Fatal chylous ascites, pericarditis and extensive venous thrombosis, due to an aggressive T cell non-Hodgkin lymphoma

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