Chylothorax in non-Hodgkin's lymphoma managed by mediastinal radiotherapy

Chylothorax in a Patient with Hodgkin's Lymphoma: A Case Report and Review of the Literature

Background

Chylothorax is defined as chyle entering the pleural space. The most common causes of chylothorax are lymphoma followed by bronchogenic carcinoma and trauma.

Case report

We report a case of chylothorax in a patient with Hodgkin's lymphoma. A 28-year old man was admitted to the hospital with exertional dyspnea and dry cough. A chest X-ray showed the large opacity on the left side suggesting to the presence of pleural effusion.

Methods

The effusion was drained, and biochemical tests of the pleural fluid revealed high contents of triglycerides and, hence, confirmed the diagnosis of chylothorax. Cytology of the pleural fluid showed no evidence of Hodgkin's cells. Computer tomography scans of the chest and abdomen exhibited the presence of a soft tissue mass located in the left mediastinum. Mediastinal mass biopsy led to diagnosis of Hodgkin's lymphoma of the nodular sclerosis subtype. The patient received the standard treatment with two cycles of chemotherapy with prednisolone, doxorubicin, cyclophosphamide, vincristine, bleomycin, procarbazine, and etoposide (BEACOPP), followed by an additional two cycles of therapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).

Results

After one cycle of chemotherapy, chylothorax initially decreased. Unfortunately, during the following courses of chemotherapy, the pleural effusion reoccurred and repeated pleural taps were necessary. According to the treatment protocol, radiation of the mediastinal bulk was performed after chemotherapy. Now, nearly one year after completion of radiotherapy, the chylothorax has significantly regressed and no further thoracocenteses were necessary.

Conclusion

The case reveals an example of left-sided chylothorax as the first manifestation of Hodgkin's lymphoma in a young patient. In this case, radiotherapy was shown to be an effective treatment option for lymphoma-associated chylothorax unresponsive to chemotherapy.

Spontaneous Resolution of Chylothorax-Associated Lymphoma Treated with External Beam Radiotherapy: A Case Report and Comprehensive Review of the Literature

Chylothorax is a rare complication of advanced lymphoma. We present the case of an 80-year-old man diagnosed with B cell lymphoma presenting with a right chylothorax secondary to a large retroperitoneal mass. His disease was not responsive to initial treatment with chemotherapy. Fractionated radiotherapy to a dose of 2,000 cGy in five fractions was delivered to the retroperitoneal mass, and the chylothorax improved significantly within days of initiation of treatment.

Spontaneous recovery of chylothorax caused by lymphoma

Chylothorax is a rare complication with both traumatic and non-traumatic causes. The most common non-traumatic cause is malignancy, especially lymphoma. Lymph discharges into the pleural space, causing nutritional, metabolic, immunologic and respiratory complications. We evaluated the case of a patient suffering from a low-grade lymphoma who developed chylothorax that did not respond to chemotherapy and conservative treatment. This patient recovered spontaneously.