Chylous Ascites, Unusual Association with Ductal Pancreatic Adenocarcinoma with Plasmacytoid Morphology: A Case Report and Literature Review

Catalin Bogdan Satala; Tivadar Jr. Bara; Ioan Jung; Vlad Tudorache; Simona Gurzu

doi:10.1055/s-0041-1728651

The Surgery Journal, Inhaltsverzeichnis

CC BY 4.0 · Surg J (N Y) 2021; 07(03): e158-e162
DOI: 10.1055/s-0041-1728651

Review Article

Chylous Ascites, Unusual Association with Ductal Pancreatic Adenocarcinoma with Plasmacytoid Morphology: A Case Report and Literature Review

Catalin Bogdan Satala‡^*

¹Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania

,

Tivadar Jr. Bara

²Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania

,

Ioan Jung‡^*

¹Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania

,

Vlad Tudorache

⁴Department of Gynecology, Clinical County Hospital, Targu-Mures, Romania

,

Simona Gurzu

¹Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania

³Research Center for Oncopathology and Translational Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania

› Institutsangaben

Abstract

Chylous ascites represents a relatively uncommon condition. In this paper, we present a case of chyloperitoneum associated with pancreatic ductal adenocarcinoma (PDAC) and a review of literature regarding chylous ascites. A 76-year-old male patient was admitted in emergency department with acute abdomen. A pancreatic cancer was suspected. Subtotal spleno-pancreatectomy, for a nodular mass infiltrating the mild and distal portion of the pancreas, was necessary. During surgical intervention in the peritoneal cavity, a moderate quantity of whitish and thick consistency fluid with milk-like appearance was observed to be accumulated. After examination of the fluid, chyloperitoneum was diagnosed. The histologic examination showed a PDAC, with multiple emboli in lymph vessels, with tumor cells with plasmacytoid morphology, diagnosed as lymphangiosis carcinomatosa. The patient died at 3 weeks after surgical intervention. In patients with pancreatic cancer and chylous ascites, suspicion of tumor-related blockage of the lymphatic flow should be suspected. Prognosis of PDAC should be evaluated not only based on the number of lymph node metastases, but also considering the number of lymph vessels with tumor emboli and the architecture of tumor cells. This is the first reported case of a PDAC with plasmacytoid morphology of lymphangiosis carcinomatosa.

Keywords

chylous ascites - pancreatic neoplasms - lymph node - plasmacytoid

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Referenzen

References
1 Lizaola B, Bonder A, Trivedi HD, Tapper EB, Cardenas A. Review article: the diagnostic approach and current management of chylous ascites. Aliment Pharmacol Ther 2017; 46 (09) 816-824
2 Tudor A, Botoncea M, Kwizera C, Tudor CB, Nicolescu C, Molnar C. Postoperative lymphorrhagia – a possible complication following cephalic duodenopancreatectomy. Acta Med Marisiensis 2019;
3 Kypson AP, Onaitis MW, Feldman JM, Tyler DS. Carcinoid and chylous ascites: an unusual association. J Gastrointest Surg 2002; 6 (05) 781-783
4 Singh H, Pandit N, Krishnamurthy G, Gupta R, Verma GR, Singh R. Management of chylous ascites following pancreaticobiliary surgery. JGH Open 2019; 3 (05) 425-428
5 Dababneh Y, Mousa OY. Chylous ascites. StatPearls[Internet]. Accessed 2020 at: https://www.ncbi.nlm.nih.gov/books/NBK557406/
6 Badrinath M, Tambe A, Mandru R, Saleem S, Heisig D. Large pancreatic mass with chylous ascites. Proc Bayl Univ Med Cent 2019; 33 (01) 53-54
7 Kovacs Z, Gurzu S, Molnar C. et al. Gastrointestinal carcinoma with plasmacytoid morphology: positivity for c-MET, arylsulfatase, and markers of epithelial-mesenchymal transition, as indicators of aggressivity. J Oncol 2019; 2019: 5836821
8 Steinemann DC, Dindo D, Clavien PA, Nocito A. Atraumatic chylous ascites: systematic review on symptoms and causes. J Am Coll Surg 2011; 212 (05) 899-905.e1 , 4
9 Adler E, Bloyd C, Wlodarczyk S. Chylous ascites. J Gen Intern Med 2020; 35 (05) 1586-1587
10 Ghafoor A, Hashmi JZ, Mateen A, Hashmi QUA. Chylous ascites: a rare initial presentation of pancreatic carcinoma. J Coll Physicians Surg Pak 2020; 30 (09) 989-991
11 Wagayama H, Tanaka T, Shimomura M, Ogura K, Shiraki K. Pancreatic cancer with chylous ascites demonstrated by lymphoscintigraphy: successful treatment with peritoneovenous shunting. Dig Dis Sci 2002; 47 (08) 1836-1838
12 Bhardwaj R, Vaziri H, Gautam A, Ballesteros E, Karimeddini D, Wu GY. Chylous acites: a review of pathogenesis, diagnosis and treatment. J Clin Transl Hepatol 2018; 6 (01) 105-113
13 Simoes PK, Olson SH, Saldia A, Kurtz RC. Epidemiology of pancreatic adenocarcinoma. Linchuang Zhongliuxue Zazhi 2017; 6 (03) 24
14 Morita K, Oshiro H, Mito K. et al. Prognostic significance of the degree of lymphatic vessel invasion in locally advanced, surgically resectable pancreatic head cancer: A single center experience. Medicine (Baltimore) 2018; 97 (49) e13466
15 Japan-Pancreas-Society Classification of pancreatic carcinoma. 4th ed.. Tokyo, Japan: Kanehara & Co. Ltd.; 2017
16 Tuncel D, Basturk O, Bradley KT. et al. Poorly cohesive (signet ring cell) carcinoma of the ampulla of Vater. Int J Surg Pathol 2020; 28 (03) 236-244
17 Gurzu S, Bara T, Sincu M. et al. Solid pseudopapillary neoplasm of pancreas: two case reports. Medicine (Baltimore) 2019; 98 (29) e16455
18 Zhang Z, Lee JG, Gu M. Cytologic features of lipid-rich variant of pancreatic endocrine tumor-report of two cases with literature review. Diagn Cytopathol 2014; 42 (04) 308-313
19 Salomao M, Remotti H, Allendorf JD. et al. Fine-needle aspirations of pancreatic serous cystadenomas: improving diagnostic yield with cell blocks and α-inhibin immunohistochemistry. Cancer Cytopathol 2014; 122 (01) 33-39
20 Canberk S, Elcin BB, Uludokumaci A, Uygun N, Gulsen F. Clear cell variant of solid pseudopapillary neoplasm of pancreas diagnosed by fine needle aspiration: a case report and review of the literature. Cytojournal 2013; 10: 26
21 Stoll LM, Parvataneni R, Johnson MW, Gui D, Dorigo O, Sullivan P. Solid pseudopapillary neoplasm, pancreas type, presenting as a primary ovarian neoplasm. Hum Pathol 2012; 43 (08) 1339-1343
22 Shao YH, Kao CC, Tang SH. et al. Unusual presentation of direct intraperitoneal metastases complicated with massive ascites from plasmacytoid variant of bladder cancer and adenocarcinoma of colon: a case report and literature review. Medicine (Baltimore) 2017; 96 (07) e5816
23 Koga C, Murakami M, Shimizu J. et al. A Case of successful management of postoperative chylous ascites by combination therapy with octreotide and etilefrine. Gan To Kagaku Ryoho 2018; 45 (03) 572-574