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Unilateral upper extremity edema. A case report

J Freischlag1, H I Machleder

  • 1Department of Surgery, UCLA Center for the Health Sciences.

The Journal of Cardiovascular Surgery
|June 1, 1993
PubMed
Summary
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A rare case of adenocarcinoma presenting with severe edema due to thoracic duct compression is detailed. Despite treatment, the patient succumbed to respiratory arrest, highlighting the poor prognosis of this unusual presentation.

Area of Science:

  • Oncology
  • Gastroenterology
  • Thoracic Surgery

Background:

  • Adenocarcinoma can present with unusual symptoms, including significant edema.
  • Early diagnosis and identification of the primary tumor are crucial for effective treatment.

Observation:

  • A 28-year-old male presented with a 5-month history of left arm, face, and supraclavicular edema.
  • Imaging revealed left subclavian vein compression and a questionable neck mass.
  • Exploration identified a fibrotic thoracic duct and a scalene lymph node.

Findings:

  • Pathological examination confirmed adenocarcinoma in both the thoracic duct and lymph node.
  • Tumor markers including keratin and carcinoembryonic antigen were positive.
  • The primary gastrointestinal source of the adenocarcinoma remained unknown.

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Implications:

  • This case underscores the importance of thorough investigation for unknown primary tumors, even with rare presentations.
  • The poor prognosis associated with such advanced, undiagnosed adenocarcinoma necessitates further research into diagnostic and therapeutic strategies.
  • Understanding the metastatic pathways of gastrointestinal adenocarcinomas is vital for improving patient outcomes.