Nigi Akina, Kumasa Toshikazu, Iwamoto Keisuke, Nishiki Junichiro, Nakamura Haruka, Itani Hidetoshi, Kondou Shigeto
Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, Ise, Japan.
Department of Hematology and Medical Oncology, Japanese Red Cross Ise Hospital, Ise, Japan.
Case Rep Oncol. 2025 Apr 18;18(1):694-701. doi: 10.1159/000545958. eCollection 2025 Jan-Dec.
Chylothorax is a rare manifestation of malignant pleural effusion, with gastric cancer accounting for only a small percentage of cases. Signet ring cell carcinoma (SRCC) is an aggressive tumor subtype that frequently invades the lymphatic system, leading to early dissemination.
A 66-year-old woman presented with bilateral chylothorax that was initially suspected to be a lymphoma. After a transient resolution, the pleural effusion returned on the left side, with a shift from chylous to non-chylous fluid and an increase in carcinoembryonic antigen levels. Despite endoscopic findings resembling early stage gastric cancer, cytology confirmed SRCC. Despite treatment with capecitabine plus oxaliplatin and nivolumab, the disease progressed, resulting in bilateral effusion recurrence and death within 4 months. Genetic analysis revealed CLDN18.2 positivity.
This case is unique because it demonstrates a rare progression from bilateral to unilateral pleural effusion, accompanied by a transition in pleural fluid characteristics, which has not been previously reported. The observations suggest dynamic changes in lymphatic obstruction and tumor infiltration. Early molecular profiling, which includes CLDN18.2 testing, may provide new opportunities for targeted therapy in aggressive gastric cancer cases.
乳糜胸是恶性胸腔积液的一种罕见表现，胃癌导致的乳糜胸病例仅占一小部分。印戒细胞癌（SRCC）是一种侵袭性肿瘤亚型，常侵犯淋巴系统，导致早期播散。
一名66岁女性出现双侧乳糜胸，最初怀疑为淋巴瘤。经过短暂缓解后，左侧胸腔积液复发，从乳糜液转变为非乳糜液，癌胚抗原水平升高。尽管内镜检查结果类似早期胃癌，但细胞学检查确诊为SRCC。尽管接受了卡培他滨加奥沙利铂和纳武单抗治疗，疾病仍进展，导致双侧胸腔积液复发，并在4个月内死亡。基因分析显示CLDN18.2呈阳性。
该病例独特之处在于，它展示了一种罕见的从双侧胸腔积液进展为单侧胸腔积液的过程，同时伴有胸腔积液特征的转变，此前未见报道。这些观察结果提示淋巴管阻塞和肿瘤浸润存在动态变化。早期分子分析，包括CLDN18.2检测，可能为侵袭性胃癌病例的靶向治疗提供新机会。
