Chylous Ascites as a Serious Complication of the Neuroendocrine Tumor of Ileum – Case Report

Česká verzia

Authors: V. M. Matějka ¹; O. Fiala ¹; R. Tupý ²; L. Holubec ¹; J. Fínek ¹
Authors place of work: Onkologické a radioterapeutické oddělení, FN Plzeň ¹; Klinika zobrazovacích metod LF UK a FN Plzeň ²
Published in the journal: Klin Onkol 2013; 26(5): 358-361
Category: Kazuistika

Summary

Background:
Chylous ascites is a rare complication of the gastrointestinal neuroendocrine tumor. There are two mechanisms of its origin: mechanical obstruction by the tumor mass and fibrosis of the surrounding tissue due to overproduction of serotonin. Its presence restricts treatment options.

Case:
We report a case of 66‑year old man suffering from recurrent diarrhoea and ascites. We found elevated tumor marker Chromogranin A and elevation of hydroxyindoleacetic acid (5- HIAA) in the urine. A subsequent whole‑ body scintigraphy scan by octreoscan confirmed multinodal process with increased somatostatin receptors activity in the wall of the ileum, rectosigmoideum, lymph nodes of the retroperitoneum and mesenterium and left supraclavicular area. We performed biopsy from the lymph node of supraclavicular area, and there was metastasis of the neuroendocrine tumor. Start of cytostatic therapy was repeatedly complicated by recurrent massive chylous ascites. The patient underwent only one series of palliative chemotherapy. Another procedure was again complicated by chylous ascites that caused hospitalization at the internal department, and the patient died four months after diagnosis.

Conclusion:
Chylous ascites is a very rare complication of gastrointestinal neuroendocrine tumor. It is not only a marker of poor prognosis, but also a complication that makes systemic treatment very difficult.

Key words:
case report – neuroendocrine tumors – chylous ascites – malignant carcinoid syndrome

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
25. 5. 2013

Accepted:
27. 6. 2013

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