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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‡   *
1   Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania
,
Tivadar Jr. Bara
2   Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania
,
Ioan Jung‡   *
1   Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania
,
Vlad Tudorache
4   Department of Gynecology, Clinical County Hospital, Targu-Mures, Romania
,
Simona Gurzu
1   Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania
3   Research Center for Oncopathology and Translational Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania
› Author Affiliations
Funding Romanian National Authority for Scientific Research CNCS – UEFISCDI funded this study, under project number 20 PCCF/2018, code: PN-III-P4-ID-PCCF-2016–0006.
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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

Authors' Contributions

C.B.S. drafted the paper and performed study design. T.B. performed the surgical intervention and follow-up of clinical data. I.J. participated at the interpretation of histological slides and diagnosis interpretation. V.T. contributed to the literature review. S.G. participated at the histological diagnosis and paper design and conferred the final agreement for publication.


* Authors contributed equally to the paper.




Publication History

Received: 06 July 2020

Accepted: 17 February 2021

Article published online:
19 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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