Chylous ascites, or chylaskos, is a rare form of ascites characterized by a milky-appearing fluid containing high levels of triglycerides. Its incidence ranges from 1 in 20,000 to 1 in 187,000 admissions at large tertiary referral hospitals. Therapeutic interventions and trauma are well-known causes of chylous ascites. In a cohort of 1,103 patients undergoing abdominal surgery, the incidence of postoperative chylous ascites was reported to be 1.1%. When retroperitoneal, esophageal, gastric, or cytoreductive surgeries were performed, the postoperative incidence was even higher, amounting to 7.4%. Apart from oncologic thoacic and abdominal surgery, chylous ascites can also occur fter abdominal aortic surgery and very rarely after donor nephrectomy. In contrast to the direct injury of lymphatic vessels during surgery, the hyperextension and hyperflexion of the body during a blunt abdominal trauma entail a rupture of lymphatic vessels, thus causing chylous ascites. An additional cause of indirect injury leading to the development of chylous ascites is radiotherapy. Abdominal radiation is thought to induce fibrosis of the lymphatic vessels within the small bowel and the mesentery, causing obstruction and subsequent extravasation of chylous. In patients fter radiation of the whole abdomen for gynecologic maignancies, the incidence was reported to be as high as 3%. The most common clinical presentation of chylous ascites is supposed to be increasing painless abdominal distension. Less frequently, postinterventional and posttraumatic chylous ascites can induce an acute abdomen. Although the clinical features and causes of chylous ascites secondary to surgery or trauma are familiar to most clinicians, little is known about the incidence, etiology, and distribution of different clinical symptoms of atraumatic chylous ascites. The incidental finding of a few milliliters of chylous ascites during a routine inguinal hernia repair in a 28-year-old man finally leading to the diagnosis of non-

https://web2.facs.org/cme/pdfs/Steinemann.pdf

Atraumatic Chylous Ascites: Systematic Review on Symptoms and Causes

We report here a review of the current medical literature on pregnancy associated desmoids, including 10 cases of our own. The pertinent findings are that a large percentage of desmoids in females arise in and around pregnancy. Most occur in the abdominal muscles, particularly the right rectus abdominus, perhaps related to trauma from abdominal stretching and fetal movement. While these tumors may regress spontaneously after delivery most can be surgically resected with low recurrence rates even with R1 resections and this is clearly the treatment of choice. Subsequent pregnancies do not appear to result in recurrence in either FAP or non FAP patients. It is not clear from currently available data whether pregnancy associated desmoids are molecularly distinct from other desmoids.

https://www.mdpi.com/2072-6694/4/1/184/pdf

Desmoid Tumors in Pregnant and Postpartum Women

Desmoid tumors are benign neoplasms that most often arise from muscle aponeurosis and have been associated with both trauma and pregnancy. The etiology of desmoids has not been determined. We present here four almost identical cases with desmoids occurring in the same location, the right rectus abdominus muscle in young post partum females. All were over the age of 30 at the time of diagnosis. Three of them had previously used oral contraceptive agents for an average of 3 years. None had a history of trauma to the area of involvement. Three had early surgical resection and one was treated with tamoxifen and imatinib without response and then had surgical resection. All four patients are disease free at a median follow-up of 2.5 years. The possible etiology of desmoids tumors in this location in postpartum females is discussed.

Desmoid tumors of the right rectus abdominus muscle in postpartum women.

Desmoid tumours are rare mesenchymal tumours, often locally invasive and characteristically associated with a high local recurrence rate after resection. A potential aetiological role for female hormones is indicated. Pregnancy-associated desmoid tumours are almost exclusively located in the abdominal wall. An essential issue is how to counsel women who have had a pregnancy-associated desmoid tumour and subsequently wish to bear a child. A considerably rare case of a patient with a resection of a giant pregnancy-associated, 33 cm in diameter, intra-abdominal desmoid tumour is presented. After a subsequent pregnancy, the patient delivered healthy twins 26 months later. Fifty-four months after treatment, there are no signs of recurrent or second desmoid tumour. Although rarely located in the abdomen, pregnancy-associated desmoid tumours should be included in the differential diagnosis of intra-abdominal tumours detected during or shortly after pregnancy. Based on this case and a few others reported in the literature, subsequent pregnancy does not necessarily seem to be a risk factor for recurrent or new disease.

/pdf/a-giant-pregnancy-associated-intra-abdominal-desmoid-tumour-33cxevigmh.pdf

A giant pregnancy-associated intra-abdominal desmoid tumour: not necessarily a contraindication for subsequent pregnancy

Desmoid tumors are benign neoplasms that most often arise from muscle aponeurosis and have been associated with both trauma and pregnancy. The etiology of desmoids has not been determined. We report the case of anterior abdominal wall desmoid tumor in a female patient with previous history of cesarean section. Preoperative ultrasound and computed tomography demonstrated a large mass mimicking a large hematoma or an intraabdominal mass. The tumor was removed by wide excision with safe margins. The abdominal wall defect was reconstructed with polypropylene mesh. Subsequent histology revealed a desmoid tumor. Desmoid tumors in females are often associated with pregnancy or occur post-partum. The reasons behind this association are unclear. The most common sites are in the abdominal muscles.

/pdf/huge-desmoid-tumor-of-the-anterior-abdominal-wall-mimicking-28c4qnzcja.pdf

Huge desmoid tumor of the anterior abdominal wall mimicking an intraabdominal mass in a postpartum woman: a case report

Mesenteric fibromatosis is a rare benign nonmetastatic neoplasm that appears as a sporadic lesion or occurs in patients with familial polyposis, while chylous ascites associated with aggressive mesenteric fibromatosis during pregnancy has never been reported thus far. Here we present the case of a 28-year old pregnant woman, in whom an aggressive mesenteric fibromatosis with chylous ascites was detected, involving the jejunum, superior mesenteric artery (SMA) and superior mesenteric vein (SMV) and pancreas. One year after a successful surgical excision, the patient had no signs of recurrence. The authors report the case for its rarity and emphasize on combining clinicopathological, radiological and immunohistochemistry analysis for management of the disease.

/pdf/a-rare-case-of-pregnancy-complicated-by-mesenteric-mass-what-4oztotok9d.pdf

A rare case of pregnancy complicated by mesenteric mass: What does chylous ascites tell us?

To explore the feasibility of [68Ga]Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) in patients with non-keratinizing nasopharyngeal carcinoma (NPC) and to evaluate whether [68Ga]Ga-DOTATATE PET/CT could be used for non-invasive determination of somatostatin receptor 2 (SSTR2) expression in NPC. This prospective study included patients with NPC who underwent [68Ga]Ga-DOTATATE PET/CT between February and May 2021. The [68Ga]Ga-DOTATATE and [18F]FDG uptakes in primary and metastatic NPC lesions were calculated and compared, and the [68Ga]Ga-DOTATATE uptake between SSTR2 score groups was analysed. A total of 36 participants (25 patients, initial staging; 11 patients, recurrence detection) were included; 33 patients also underwent [18F]FDG PET/CT for staging/restaging as a part of their routine diagnostic workup. [68Ga]Ga-DOTATATE PET/CT showed an intense tracer uptake in primary and metastatic NPC lesions. The radiotracer uptake was higher with [68Ga]Ga-DOTATATE than with [18F]FDG PET in primary NPC lesions (SUVmax: 12.03 vs. 10.07, P = 0.048; tumour-to-brain ratio: 36.16 vs. 0.86, P < 0.001) and regional lymph node metastases (median SUVmax: 9.11 vs. 6.12, P < 0.001) and comparable in bone and visceral metastases. Importantly, most NPC lesions showed intense SSTR2 expression (85.7%), which was strongly correlated with the [68Ga]Ga-DOTATATE uptake. The SUVmax of SSTR2-negative lesions was significantly lower than that of SSTR2-positive lesions (SUVmax: 4.95 vs. 12.61, P = 0.013). [68Ga]Ga-DOTATATE PET/CT is a promising imaging modality for detecting primary and metastatic NPC, with favourable image contrast and comparable diagnostic efficacy when compared to [18F]FDG PET/CT. An intense SSTR2 expression was observed in most NPCs, and this expression was significantly correlated with the [68Ga]Ga-DOTATATE uptake.

Somatostatin receptor imaging with [68Ga]Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) in patients with nasopharyngeal carcinoma.

Yanzhen Zhuang

Papers

A rare case of pregnancy complicated by mesenteric mass: What does chylous ascites tell us?

Somatostatin receptor imaging with [68Ga]Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) in patients with nasopharyngeal carcinoma.