Li Y, Tai Y, Wu H. Colon signet-ring cell carcinoma with chylous ascites caused by immunosuppressants following liver transplantation: A case report. World J Gastrointest Surg 2024; 16(7): 2343-2350 [PMID: 39087099 DOI: 10.4240/wjgs.v16.i7.2343]
Corresponding Author of This Article
Hao Wu, PhD, Doctor, Professor, Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. hxxhwh@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2343-2350 Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2343
Colon signet-ring cell carcinoma with chylous ascites caused by immunosuppressants following liver transplantation: A case report
Ying Li, Yang Tai, Hao Wu
Ying Li, Yang Tai, Hao Wu, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Co-first authors: Ying Li and Yang Tai.
Author contributions: Li Y and Tai Y acquired the clinical data and produced the initial draft; Wu H reviewed and edited the manuscript. All authors have read and approved the final manuscript. Li Y and Tai Y contributed equally to this work as co-first authors.
Supported byNational Natural Science Foundation of China, No. 82270649.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao Wu, PhD, Doctor, Professor, Department of Gastroenterology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. hxxhwh@163.com
Received: April 6, 2024 Revised: May 23, 2024 Accepted: June 12, 2024 Published online: July 27, 2024 Processing time: 106 Days and 21.1 Hours
Abstract
BACKGROUND
Chylous ascites is caused by disruption of the lymphatic system, which is characterized by the accumulation of a turbid fluid containing high levels of triglycerides within the abdominal cavity. The two most common causes are cirrhosis and tuberculosis, and colon signer ring cell carcinoma (SRCC) due to the use of immunosuppressants is extremely rare in cirrhotic patients after liver transplantation, making it prone to misdiagnosis and missed diagnosis.
CASE SUMMARY
A 52-year-old man who underwent liver transplantation and was administered with immunosuppressants for 8 months was admitted with a 3-month history of progressive abdominal distention. Initially, based on lymphoscintigraphy and lymphangiography, lymphatic obstruction was considered, and cystellar chyli decompression with band lysis and external membrane stripping of the lymphatic duct was performed. However, his abdominal distention was persistent without resolution. Abdominal paracentesis revealed allogenic cells in the ascites, and immunohistochemistry analysis revealed adenocarcinoma cells with phenotypic features suggestive of a gastrointestinal origin. Gastrointestinal endoscopy was performed, and biopsy showed atypical signet ring cells in the ileocecal valve. The patient eventually died after a three-month follow-up due to progression of the tumor.
CONCLUSION
Colon SRCC, caused by immunosuppressants, is an unusual but un-neglected cause of chylous ascites.
Core Tip: Chylous ascites can be caused by various etiologies, among which cirrhosis, malignancy and tuberculosis are the most common. However, colon signer ring cell carcinoma secondary to use of immunosuppressants is rare in cirrhotic patients after liver transplantation, and these patients are easily prone to misdiagnosis and missed diagnosis. We report a case of chylous ascites caused by colon signer ring cell carcinoma due to the use of immunosuppressants after liver transplantation. Clinical alerts should be raised to determine whether the etiology of chylous ascites is related to carcinoma in patients who have been administered immunosuppressants after liver transplantation.
