Spouting Chylothorax in Gorham-Stout Disease

Clinical features and current management experience in Gorham-Stout disease: a systematic review

BACKGROUND

Gorham-Stout disease (GSD) is a rare complex lymphatic malformation. Since its initial description in 1838, only approximately 400 patients have been documented. There is currently no consensus on the diagnostic criteria or treatment options for GSD. The objective of this study was to review the clinical characteristics of patients with GSD and determine the current diagnostic and treatment models.

METHODS

A comprehensive search of the PubMed, Web of Science, Embase, and Cochrane Library databases was conducted to identify all relevant literature on GSD published over the decade from 2013 to 2023. The clinical information extracted from these publications was analyzed.

RESULTS

A total of 206 patients with GSD were included in the study, comprising 119 males, 81 females and 6 patients with unknown sex. The age of onset of patients was widely distributed, ranging from 0 to 77 years old. However, the majority of cases occurred in childhood (50.7%). Fifteen patients (10.3%) exhibited an onset age of less than 1 year. The average time from the onset of symptoms to diagnosis was 3.5 years. The number of patients with osteolysis in the axial bone was greater than that in the appendiceal bone (P < 0.05), and the number of patients with multiple osteolytic lesions was greater than that with single osteolytic lesions (77.2% vs. 22.8%). In general, GSD was more likely to occur in the spine (46.1%), ribs (28.6%), hip (23.3%), femur (18.4%), mandible (15.5%) and humerus (15.0%). Pain was the most common symptom, with 68.4% of patients reporting pain in the lesion area. Surgery (66.9%) and bisphosphonates (56.9%) are still the mainstream treatment methods, with a total of 33 (18.2%) patients receiving sirolimus. Pleural effusion was identified as a risk factor for patient mortality (P < 0.05).

CONCLUSIONS

GSD is most commonly observed in children, with a slight male predisposition. It commonly manifests as multiple osteolysis of the axial bone, with pain being the most common symptom. The presence of pleural effusion indicates a serious condition that requires close monitoring to prevent mortality. Despite the advent of novel therapeutic modalities, the management of GSD remains an area in need of further investigation.

Surgical treatment of Gorham-Stout disease combined with scoliosis: a case report and literature review

BACKGROUND

Gorham-Stout disease (GSD) is a rare disease characterized by osteolysis and lymphatic malformations. GSD involving the spine is exceptionally rare and lacks a standard cure. The aim of this article was to report a case of GSD with scoliosis treated via corrective surgery and medication. Clinical features, imaging data, treatment, and published GSD cases are discussed.

CASE PRESENTATION

: We report the case of a 14-year-old male with GSD (confirmed by pathology and genetic analysis of bone tissue due to a previous fracture), which mainly involved the spine and caused progressive scoliosis. Scoliosis was defined as a right upper thoracic curve with a Cobb angle of 61° and a left major thoracic curve with a Cobb angle of 50°. Preoperative magnetic resonance imaging of the spine in the T2-weighted phase showed wedge-shaped changes in T4-9, with substantial high signal and no intradiscal abnormalities. The patient successfully underwent scoliosis correction from T2-L2. After surgery, the patient was treated with sirolimus for osteoporosis, and the effect of the scoliosis correction remained stable after 2 years of follow-up. This case documented the rare phenomenon of spinal lamina chylous leakage caused by GSD. Corrective surgery combined with sirolimus achieved good results in the treatment of scoliosis caused by GSD.

CONCLUSION

This study provides an important reference for the diagnosis and treatment of GSD involved with spine.

Endothoracic lymphatic plexus‑hemiazygos vein anastomosis for chylothorax complicated with hepatocellular carcinoma: A case report

For patients with hepatocellular carcinoma and cirrhosis, the rupture of thin lymphatic vessel walls leads to a profuse outflow of lymph fluid. Typically, chyloperitoneum tends to precede the development of chylothorax in patients with cancer. The present study describes the case of a male patient with hepatocellular carcinoma who developed chylothorax without chyloperitoneum. Computed tomography showed lymphatic system developmental abnormalities with a large volume of leaked lymph fluid. Multiple thoracic duct ligations (TDLs) failed, but a side-to-end lymphatic venous anastomosis (LVA) surgery resolved the symptoms. To the best of our knowledge, there are no reports of chylothorax occurrence after cirrhosis further complicated by congenital lymphatic abnormalities in the English-language literature. In conclusion, LVA could be appropriate to treat chylothorax when TDL is ineffective as a remedial or even prophylactic intervention.