Streit Arthur, Guerrera Francesco, Kouki Matthieu, Siat Joelle, Lyberis Paraskevas, Filosso Pier Luigi, Renaud Stéphane
1 Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France.
2 Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
Tumori. 2018 Dec;104(6):NP46-NP49. doi: 10.1177/0300891618791956. Epub 2018 Aug 29.
Pseudochylothorax is a rare cause of pleural effusion. Sometimes confounded with chylothorax, firm diagnosis relies on analysis of the pleural liquid: exudative liquid (protein >30 g/L, lactate dehydrogenase >200 UI/L) with a high level of cholesterol (usually >200 mg/dL), low level of triglyceride (usually <110 mg/dL), cholesterol total/triglyceride ratio >1, absence of chylomicron, and in some cases the presence of cholesterol crystals. Pseudochylothorax is secondary to tuberculosis and rheumatoid arthritis in nearly 90% of cases. Its oncologic etiologies are mainly represented by malignant hematologic disorders.
We report the first case of pseudochylothorax whose cause was the pleural metastasis of an extrathoracic solid tumor in a 61-year-old man with a medical history of oropharynx carcinoma.
Computed tomography scan disclosed a left partitioned effusion of high abundance, responsible for a passive atelectasis of the left lower lobe and multiple bilateral pulmonary nodules. A drainage tube was inserted to allow the evacuation of serous liquid; biochemical examination revealed an exudative effusion with pseudochylothorax criteria. Because the daily chest drainage output remained greater than 1 L per day, videothoracoscopy pleural biopsies and talc pleurodesis were performed. Histopathologic examination of the pleural biopsies found a pleural localization of oropharynx carcinoma.
Because its occurrence is probably underestimated, when pseudochylothorax is diagnosed, oncologic causes should be considered.
假性乳糜胸是胸腔积液的一种罕见病因。有时会与乳糜胸混淆，明确诊断依赖于对胸腔积液的分析：渗出液（蛋白质>30 g/L，乳酸脱氢酶>200 UI/L），胆固醇水平高（通常>200 mg/dL），甘油三酯水平低（通常<110 mg/dL），胆固醇总量/甘油三酯比值>1，无乳糜微粒，且在某些情况下存在胆固醇结晶。在近90%的病例中，假性乳糜胸继发于结核病和类风湿关节炎。其肿瘤学病因主要由恶性血液系统疾病引起。
我们报告了首例假性乳糜胸病例，病因是一名有口咽癌病史的61岁男性发生了胸外实体瘤的胸膜转移。
计算机断层扫描显示左胸腔大量分隔性积液，导致左肺下叶被动性肺不张和双侧多发肺结节。插入引流管以排出浆液性液体；生化检查显示渗出性积液符合假性乳糜胸标准。由于每日胸腔引流量仍大于1 L/天，遂进行了电视胸腔镜胸膜活检和滑石粉胸膜固定术。胸膜活检的组织病理学检查发现口咽癌的胸膜定位。
由于其发生率可能被低估，在诊断假性乳糜胸时，应考虑肿瘤学病因。
