Colon signet-ring cell carcinoma with chylous ascites caused by immunosuppressants following liver transplantation: A case report

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.

Keywords: Colonic signer ring cell carcinoma; Immunosuppressant; Chylous ascites; Cirrhosis; Liver transplantation; Case report

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.