Chylothorax—an unusual presentation of lymphoma and literature review
Objective To investigate the diagnostic approach,etiology and management of chylothorax,so as to strength-en its cognition,guide clinical,reduce misdiagnosis.Methods The levels of triglyceride and chylomicron in pleural effu-sion,serum albumin and globulin,serum immunofixation electrophoresis and flow cytology of bone marrow cells were de-tected.Results The pleural fluid is often milky in appearance and is characterized by elevated triglycerides＞110 mg/dL or the presence of chylomicrons.Serum albumin decreased and globulin increased.Immunofixation electrophoresis of Waldenstrom macroglobulinemia showed that IgM and κ were positive bands in the area,and flow cytometry bone marrow cells showed the expression of B cells.Immunofixation electrophoresis of marginal zone B-cell lymphoma showed that IgA and κ monoclonal immunoglobulin bands appeared in the region.Flow cytometry bone marrow cells showed that 0.10％cells(occupying nuclear cells)were κ abnormal plasma cells with restricted expression of light chain;BCMA positive cells accounted for 67.67％of the total plasma cells;6.77％of the cells(occupying nuclear cells)were abnor-mal κ monoclonal mature small B lymphocytes.Conclusion The presence of a chylothorax is a lesser common pleural effusion with a wide differential diagnosis.Lymphoma is a common cause of non traumatic chylothorax.The diagnosis of chylothorax depends on serum biochemical examination,immunofixation electrophoresis,bone marrow puncture,lymph node biopsy and other comprehensive means.Management of a chylothorax requires a multidisciplinary approach emplo-ying medical therapy and treatment of pleural effusion.
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