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Shiraiwa Y, Taniguchi Y, Hyoudou M, Shiba A, Aga M, Miyazaki K, Hamakawa Y, Misumi Y, Agemi Y, Shimokawa T, Hasegawa C, Hayashi H, Okamoto H. A case of pulmonary tumor thrombotic microangiopathy following lymphedema on the lower extremities. Respir Med Case Rep 2022; 37:101631. [PMID: 35342709 PMCID: PMC8941268 DOI: 10.1016/j.rmcr.2022.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/19/2022] [Accepted: 03/07/2022] [Indexed: 11/06/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare manifestation of malignancy. The antemortem diagnosis is difficult, since patients present with rapidly progressive symptoms. We recently observed a case of PTTM following lymphedema of the lower extremities. We did not reach a diagnosis, even after performing BAL and TBLB. The patient manifested pulmonary hypertension and died on the 9th day of admission. Autopsy revealed a tumor embolism in the pulmonary arterioles accompanied by fibrocellular epithelial cell proliferation, but the primary organ was not identified. To our knowledge, this is the first reported case of PTTM with lymphedema.
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Nagano N, Suzuki M, Tamura K, Kobayashi S, Kojima Y, Naka G, Iikura M, Izumi S, Takeda Y, Sugiyama H. Refractory Chylothorax and Lymphedema Caused by Advanced Gastric Cancer. Intern Med 2019; 58:3143-3148. [PMID: 31292374 PMCID: PMC6875443 DOI: 10.2169/internalmedicine.2351-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Chylothorax is the accumulation of lipid pleural effusion. Few reports have described chylothorax caused by gastric cancer. A 45-year-old woman presented with progressive lymphedema and bilateral chylothorax. Although repetitive thoracentesis was performed to relieve her dyspnea, swelling of her axillary lymph nodes became significant. Positron emission tomography/computed tomography demonstrated the accumulation of 18F-fluorodeoxyglucose in these nodes, and a lymph node biopsy showed signet ring cell carcinoma. The primary site was a 0-IIc type lesion in the gastric body that was only detected by upper gastrointestinal endoscopy. The patient was diagnosed with advanced gastric cancer 3.5 months after presentation for chylothorax.
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Affiliation(s)
- Naoko Nagano
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Kentaro Tamura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Sakurako Kobayashi
- Department of Gastroenterology, National Center for Global Health and Medicine, Japan
| | - Yasushi Kojima
- Department of Gastroenterology, National Center for Global Health and Medicine, Japan
| | - Go Naka
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yuichiro Takeda
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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Nguyen S, Ouvrier D, Massalou D, Viau P, Chevallier A, Patouraux S, Passeron T, Lacour JP, Montaudié H. [Lymphedema of the lower limbs: Initial manifestation of gastric linitis plastica]. Ann Dermatol Venereol 2017. [PMID: 28647380 DOI: 10.1016/j.annder.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Primary lymphedemas are constitutional abnormalities of the lymphatic system. Secondary lymphedemas occur after damage to the lymphatic system, mainly after cancer treatments or tumour mass compression. There are many other causes, including filariasis, which is nonetheless very rare in France. PATIENTS AND METHODS A 52-year-old man presented with a two-month history of increased size of the left leg. He was asymptomatic and in good general condition. Clinical examination revealed non-pitting lymphedema and ipsilateral hydrocele without loco-regional compressive lymph node. Initial extensive explorations were unremarkable. Lymphoscintigraphy revealed low tracer fixation in the left leg. The symptoms continued to worsen, with exacerbation and bilateralization of the lymphedema. Two months later, axillary lymph nodes appeared corresponding to metastasis from a signet-ring cell carcinoma. Despite two lines of chemotherapy, the patient died 8 months later due to multiple metastatic disease. DISCUSSION Our case is remarkable because the lymphedema was not related to extrinsic compression and was the first symptom of gastric cancer. In the absence of compression, endo-lymphatic micro-metastases could constitute the causative process. Acquired lymphedema of the lower limbs must be recognized as a potential early symptom of gastric carcinoma and should therefore prompt further investigations.
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Affiliation(s)
- S Nguyen
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - D Ouvrier
- Service d'oncologie digestive, CHU de Nice, Archet 2, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - D Massalou
- Chirurgie générale d'urgence, Pasteur 2, université de Nice, CHU de Nice, 30, voie Romaine, 06000 Nice, France; UMRT24, IFSTTAR, laboratoire de biomécanique appliquée, Aix-Marseille université, boulevard Pierre-Dramard, 13005 Marseille, France
| | - P Viau
- Service de médecine nucléaire, Archet 1, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - A Chevallier
- Laboratoire central d'anatomie et cytologie pathologiques, Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - S Patouraux
- Laboratoire central d'anatomie et cytologie pathologiques, Pasteur 1, CHU de Nice, 30, voie Romaine, 06001 Nice, France
| | - T Passeron
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - J-P Lacour
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - H Montaudié
- Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France.
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Coussa-Koniski MLM, Maalouf PA, Raad NE, Bejjani NA. Scrotal wall metastasis from a primary lung adenocarcinoma. Respir Med Case Rep 2015; 15:77-9. [PMID: 26236609 PMCID: PMC4501526 DOI: 10.1016/j.rmcr.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This a case of a 77 years old male heavy smoker, known to have Combined Pulmonary Fibrosis and Emphysema complicated by a primary invasive adenocarcinoma of the lung with bone metastasis, who presented with a two weeks history of right inguino-scrotal pain and swelling. Imaging studies revealed a right paratesticular formation that appeared to involve the epididymis and the scrotal wall. A biopsy of the mass showed morphological and Immunophenotypic features in favor of metastasis of an adenocarcinoma of the lung. Based on our literature review, there are only few published cases about scrotal wall metastasis of a lung primary.
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Affiliation(s)
| | - Pia A. Maalouf
- Lebanese American University, School of Medicine, Lebanon
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Abstract
ZusammenfassungEin 51-jähriger Mann stellt sich wegen eines rasch progredienten Bein- und Genitallymphödems vor. Die komplexe physikalische Entstauung bleibt ohne Erfolg. Nach ergebnisloser Bildgebung wird in der endoskopischen Exploration ein metastasierendes Siegelring-Karzinom der Kardia als Ursache nachgewiesen.
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Le cancer gastrique, une cause exceptionnelle de lymphœdème des membres inférieurs. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Dermatology offers many clinical examples of abnormalities in the production, absorption and transport of lymph. Lymphatic thromboses also occur. Many diseases are not named in accordance with their underlying pathogenesis. Malignant lymphedema must be recognized immediately. The differential diagnosis of regional lymphedema is also part of dermatology. Stemmer sign is a clue to chronic lymphedema. Lymphoedema is first divided into primary and secondary forms, depending on the cause, and then subdivided into stages depending on severity. Complications of chronic lymphedema include recurrent erysipelas, superficial lymphangiectases, verrucous lymphedema (papillomatosis lymphostatica) and angiosarcoma, which is often multifocal. Established diagnostic approaches are available to correctly diagnose lymphatic disease. The treatment of chronic lymphedema centers around reducing the edema which then influences all of the other problems. The physical therapeutic approach to reducing blockage is the best way to achieve these goals.
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Affiliation(s)
- W C Marsch
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin Luther-Universität Halle-Wittenberg, Halle (Saale)
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