Nguyen S, Ouvrier D, Massalou D, Viau P, Chevallier A, Patouraux S, Passeron T, Lacour J-P, Montaudié H
Service de dermatologie, hôpital Archet 2, CHU de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France.
Service d'oncologie digestive, CHU de Nice, Archet 2, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France.
Ann Dermatol Venereol. 2017 Aug-Sep;144(8-9):530-535. doi: 10.1016/j.annder.2017.03.008. Epub 2017 Jun 21.
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.
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.
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.
原发性淋巴水肿是淋巴系统的先天性异常。继发性淋巴水肿发生在淋巴系统受损后，主要是在癌症治疗或肿瘤肿块压迫之后。还有许多其他原因，包括丝虫病，不过在法国这种情况非常罕见。
一名52岁男性，左腿肿大两个月。他无症状，一般状况良好。临床检查发现非凹陷性淋巴水肿和同侧鞘膜积液，无局部压迫性淋巴结。最初的广泛检查无异常。淋巴闪烁造影显示左腿放射性示踪剂摄取低。症状持续恶化，淋巴水肿加重并发展为双侧性。两个月后，出现腋窝淋巴结，提示印戒细胞癌转移。尽管进行了两线化疗，患者8个月后因多发转移疾病死亡。
我们的病例很特殊，因为淋巴水肿与外部压迫无关，而是胃癌的首发症状。在没有压迫的情况下，淋巴管内微转移可能是致病过程。下肢后天性淋巴水肿必须被视为胃癌潜在的早期症状，因此应促使进一步检查。
