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Wagenpfeil J, Hoß K, Henkel A, Kütting D, Luetkens JA, Feldmann G, Brossart P, Attenberger UI, Pieper CC. Interventional treatment of refractory non-traumatic chylous effusions in patients with lymphoproliferative disorders. Clin Exp Med 2024; 24:63. [PMID: 38554229 PMCID: PMC10981590 DOI: 10.1007/s10238-024-01312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/28/2024] [Indexed: 04/01/2024]
Abstract
To report results of interventional treatment of refractory non-traumatic abdomino-thoracic chylous effusions in patients with lymphoproliferative disorders. 17 patients (10 male; mean age 66.7 years) with lymphoproliferative disorders suffered from non-traumatic chylous effusions (chylothorax n = 11, chylous ascites n = 3, combined abdomino-thoracic effusion n = 3) refractory to chemotherapy and conservative therapy. All underwent x-ray lymphangiography with iodized-oil to evaluate for and at the same time treat lymphatic abnormalities (leakage, chylo-lymphatic reflux with/without obstruction of central drainage). In patients with identifiable active leakage additional lymph-vessel embolization was performed. Resolution of effusions was deemed as clinical success. Lymphangiography showed reflux in 8/17 (47%), leakage in 2/17 (11.8%), combined leakage and reflux in 3/17 (17.6%), lymphatic obstruction in 2/17 (11.8%) and normal findings in 2/17 cases (11.8%). 12/17 patients (70.6%) were treated by lymphangiography alone; 5/17 (29.4%) with leakage received additional embolization (all technically successful). Effusions resolved in 15/17 cases (88.2%); 10/12 (83.3%) resolved after lymphangiography alone and in 5/5 patients (100%) after embolization. Time-to-resolution of leakage was significantly shorter after embolization (within one day in all cases) than lymphangiography (median 9 [range 4-30] days; p = 0.001). There was no recurrence of symptoms or post-interventional complications during follow-up (median 445 [40-1555] days). Interventional-radiological treatment of refractory, non-traumatic lymphoma-induced chylous effusions is safe and effective. Lymphangiography identifies lymphatic abnormalities in the majority of patients and leads to resolution of effusions in > 80% of cases. Active leakage is found in only a third of patients and can be managed by additional embolization.
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Affiliation(s)
- Julia Wagenpfeil
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany.
| | - Katharina Hoß
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Andreas Henkel
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Daniel Kütting
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Julian Alexander Luetkens
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Georg Feldmann
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
- Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany
| | - Ulrike Irmgard Attenberger
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
| | - Claus Christian Pieper
- Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany
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Tavares M, Ramalheira S, Chacim S, Henrique R, Oliveira Â, Mariz JM. Successful treatment of refractory chylous ascites due to follicular lymphoma with very low-dose radiotherapy. Rep Pract Oncol Radiother 2019; 24:344-346. [PMID: 31194016 DOI: 10.1016/j.rpor.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/16/2019] [Accepted: 05/11/2019] [Indexed: 12/29/2022] Open
Abstract
Chylous ascites is an extremely rare complication of lymphoma. Here, we discuss the case of a patient presenting with refractory chylous ascites due to a massive retroperitoneal follicular lymphoma, staged as IVB. The patient was unresponsive to chemoimmunotherapy, which prompted us to consider alternative treatment strategies. Low-dose radiotherapy was initiated and resulted in a marked decrease of the lymphadenopathy and complete regression of the peritoneal fluid. Low-dose radiotherapy represents a well-tolerated, highly effective treatment and should remain an important modality in cases of follicular lymphoma-associated chylous ascites.
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Affiliation(s)
- Márcio Tavares
- Department of Onco Hematology, Portuguese Oncology Institute of Porto, Portugal
| | - Sofia Ramalheira
- Department of Onco Hematology, Portuguese Oncology Institute of Porto, Portugal
| | - Sérgio Chacim
- Department of Onco Hematology, Portuguese Oncology Institute of Porto, Portugal
| | - Rui Henrique
- Department of Pathology, Portuguese Oncology Institute of Porto, Portugal
| | - Ângelo Oliveira
- Department of Radiation Therapy, Portuguese Oncology Institute of Porto, Portugal
| | - José Mário Mariz
- Department of Onco Hematology, Portuguese Oncology Institute of Porto, Portugal
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Pospiskova J, Smolej L, Belada D, Simkovic M, Motyckova M, Sykorova A, Stepankova P, Zak P. Experiences in the treatment of refractory chylothorax associated with lymphoproliferative disorders. Orphanet J Rare Dis 2019; 14:9. [PMID: 30626415 PMCID: PMC6327395 DOI: 10.1186/s13023-018-0991-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/28/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chylothorax is a rare condition which can be associated with malignant lymphoproliferative disorders (LPDs). We retrospectively analyzed the results of the conservative treatment of 10 patients with persistent non-traumatic malignant chylothorax. RESULTS Conservative treatment lead to a decline of chylothorax after mean of 66 days and consisted of the treatment of the underlying disease and of simultaneous long-term supportive care (drainage of the thoracic cavity, dietary measures and nutrition management). In most cases (80%), chylothorax disappeared only after a successful therapeutic response of the underlying disease. Low-dose radiotherapy had very good effects in two patients. CONCLUSION Conservative treatment of malignant chylothorax can be considered a suitable method. Based on our results, successful treatment of the lymphoproliferative disorder seems to be a very important factor for the disappearance of chylothorax.
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Affiliation(s)
- Jana Pospiskova
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic
| | - Lukas Smolej
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic
| | - David Belada
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic
| | - Martin Simkovic
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic
| | - Monika Motyckova
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic
| | - Alice Sykorova
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic
| | - Pavla Stepankova
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic
| | - Pavel Zak
- 4th Department of Internal Medicine - Hematology, University Hospital, Sokolska Street 581, 5005, Hradec Kralove, Czech Republic. .,Faculty of Medicine in Hradec Králové, Charles University Prague, Hradec Kralove, Czech Republic.
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Laba JM, Nguyen TK, Boldt RG, Louie AV. Spontaneous Resolution of Chylothorax-Associated Lymphoma Treated with External Beam Radiotherapy: A Case Report and Comprehensive Review of the Literature. Cureus 2016; 8:e761. [PMID: 27733965 PMCID: PMC5045324 DOI: 10.7759/cureus.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Joanna M Laba
- Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON
| | - Timothy K Nguyen
- Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Ontario, CA
| | | | - Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Ontario, CA
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Acar T, Harman M, Guneyli S, Gemici K, Efe D, Guler I, Yildiz M. Cross-sectional Imaging Features of Primary Retroperitoneal Tumors and Their Subsequent Treatment. J Clin Imaging Sci 2015; 5:24. [PMID: 25973288 PMCID: PMC4421890 DOI: 10.4103/2156-7514.156135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023] Open
Abstract
Basically malignant tumors in the retroperitoneal region arise from a heterogeneous group of tissues: mesodermal, neurogenic, germ cell, and lymphoid. Although rare, benign tumors and cystic masses can be also encountered in retroperitoneal space. Developments in computed tomography (CT) and magnetic resonance imaging (MRI) have contributed to both diagnosis and staging of the retroperitoneal tumors. High spatial resolution and superiority in calcification make CT indispensable; on the other hand, MRI has a better soft-tissue contrast resolution which is essential for the assessment of vascular invasion and tissue characterization. The aim of this article is to review the CT and MRI features of retroperitoneal tumors and their subsequent management.
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Affiliation(s)
- Turker Acar
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Serkan Guneyli
- Department of Radiology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Kazim Gemici
- Department of General Surgery, Mevlana University School of Medicine, Konya, Turkey
| | - Duran Efe
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
| | - Ibrahim Guler
- Department of Radiology, Konya Education and Research Hospital, Konya, Turkey
| | - Melda Yildiz
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
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