A case of chylous ascites

Gastrointestinal Carcinoid Tumor and Chylous Ascites, a Rare Association with a Poor Prognosis. A Case Report

Gastrointestinal carcinoid is a rare tumor. The association of this tumor with chylous ascites is uncommon. A review of the English-language literature carried out in 2002 identified only 15 cases. We report a case of chylous ascites, gastrointestinal carcinoid tumor and elevated blood levels of CA-125 in a patient who did not respond to chemotherapy.

Serum and ascites chromogranin-A in patients with metastatic neuroendocrine tumors

OBJECTIVES

Ascites secondary to neuroendocrine tumor metastases may arise from a variety of mechanisms. Our aim was to measure serum and ascitic chromogranin-A (CgA) to help determine whether ascites resulted from intraperitoneal/retroperitoneal disease burden or from other carcinoid complications such as congestive heart failure or portal hypertension.

METHODS

Patients with metastatic neuroendocrine tumors and ascites were identified. Chromogranin-A was obtained and measured from both serum and ascites. The causes of carcinoid ascites was categorized into 2 groups: high intraperitoneal or retroperitoneal disease burden (ie, peritoneal metastases and/or lymphatic obstruction; n = 12, group 1) or other organ-specific carcinoid complications such as CHF or portal hypertension (n = 12, group 2).

RESULTS

An ascites CgA/serum CgA ratio greater than 1 was more likely to be found in group 1 (P = 0.01). This ratio produced 100% sensitivity and 75% specificity for ascites secondary to peritoneal metastases and/or lymphatic obstruction.

CONCLUSIONS

An ascites CgA/serum CgA ratio greater than 1 produces excellent accuracy in predicting peritoneal metastases and/or retroperitoneal disease as the cause of ascites in the setting of metastatic carcinoid. This test may play a role in the earlier identification of those patients who may be well served by aggressive management.

Carcinoid and chylous ascites: an unusual association

Chylous ascites caused by carcinoid tumors is extremely rare. While carcinoid tumors usually have an indolent course, their association with chylous ascites is a harbinger of a poor outcome.

Chylous Ascites Revisited - old Disease, new Management

Extravasation of chyle from the intestinal lymphatics into the peritoneal cavity results in chylous ascites, identified by its characteristic milky appearance. Chylous ascites is rare, but it has been suggested that its incidence may be increasing in the adult population. Successful management depends on identifying the underlying cause of the lymphatic disruption. The spectrum of causative pathologies seen in adult and paediatric practices are vastly different: congenital lymphatic problems predominate in the latter, while occult malignancy often causes adult chylous ascites. This review looks at the various aetiologies, diagnosis and the recent advances in the management of this condition. gynaecological malignancies, while in the paediatric population, both sexes are affected equally. It has been suggested that the incidence of chylous ascites may be increasing in line with higher incidence of malignant disease and complications of HIV infection. The reason for this may simply reflect increased reporting of the disorder, or it may be due to increasing diagnostic capability.

The majority of early reports of chylous ascites describe anecdotal cases, and there are very few series describing the causes and management of the condition. This again reflects the rarity of chylous ascites.

There is a need for a review of this rare cause of ascites to highlight changing aetiology and new therapeutic options.