一例以子宫肌瘤为首发表现的滤泡性淋巴瘤致乳糜性腹水的病例报道及文献回顾

A Case Report of Chylous Ascites Caused by Follicular Lymphoma Presenting with Uterine Fibroids as the Initial Manifestation and Literature Review

摘要: 背景：子宫平滑肌瘤为女性常见良性肿瘤，但伴发乳糜性腹水(chylous ascites, CA)极为罕见。病例：女，52岁，因下腹痛1年入院，既往子宫肌瘤5年史。术中发现约1000 mL乳白色腹水及肠系膜增厚，腹水甘油三酯9.62 mmol/L，李凡他实验阳性，确诊为乳糜性腹水。病理示子宫平滑肌瘤伴系膜淋巴细胞浸润。进一步的胃肠镜活检确诊为胃十二指肠滤泡性淋巴瘤。患者接受奥妥珠单抗联合糖皮质激素治疗10个疗程，随访未见腹水复发。结论：子宫平滑肌瘤合并乳糜性腹水罕见，若无肝硬化或术后病史，应警惕潜在淋巴系统疾病导致的乳糜性腹水。多学科联合诊治及针对原发病的治疗有助改善预后。

Abstract: Background: Uterine leiomyoma is a common benign tumor in women, but chylous ascites (CA) is an extremely rare manifestation. Case: A 52-year-old woman was admitted for one year of lower abdominal pain, with a 5-year history of uterine fibroids. During laparoscopic hysterectomy, about 1000 mL of milky ascites and thickened mesentery were observed. Ascitic triglyceride was 9.62 mmol/L and the ether test was positive, confirming CA. Pathology showed uterine leiomyomas with mesenteric lymphocytic infiltration. Further gastroduodenal biopsy revealed grade 2 follicular lymphoma. The patient received 10 cycles of obinutuzumab plus corticosteroids and remained stable without recurrence of ascites. Conclusion: Chylous ascites associated with uterine leiomyoma is rare. When encountered without common causes such as cirrhosis or surgery, CA caused by occult lymphoproliferative disorders should be considered. Multidisciplinary management and targeted treatment of the primary disease are essential for better outcomes.