Not What It Seems

      Sometimes, a seemingly clear sign can point you in the wrong direction. A 74-year-old woman presented with a diagnosis of presumed metastatic breast cancer. Over the previous 3 months, she had experienced increasing abdominal girth, a 15-pound unintentional weight loss, and bilateral swelling of the lower extremities, which was more pronounced on the left side. A vague intermittent burning pain in her lower abdomen often radiated into her groin, but she reported no change in bowel or bladder function. She also complained of tight pressure in both legs with occasional shooting pains into her thighs. In the preceding week, she had noticed increased dyspnea on exertion, even with minimal effort.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hamrick-Turner J.E.
        • Chiechi M.V.
        • Abbitt P.L.
        • Ros P.R.
        Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT.
        Radiographics. 1992; 12: 1051-1068
        • Runyon B.A.
        • Hoefs J.C.
        Peritoneal lymphomatosis with ascites.
        Arch Intern Med. 1986; 146: 887-888
        • Kim Y.
        • Cho O.
        • Song S.
        • et al.
        Peritoneal lymphomatosis: CT findings.
        Abdom Imaging. 1998; 23: 87-90
        • Horger M.
        • Muller-Schimpfle M.
        • Yirkin I.
        • et al.
        Extensive peritoneal and omental lymphomatosis with raised CA 125 mimicking carcinomatosis: CT and intraoperative findings.
        Br J Radiol. 2004; 77: 71-73
        • Kaufman Z.
        • Eliashiv A.
        • Shpitz B.
        • et al.
        Primary gastrointestinal lymphoma: a review of 21 cases.
        J Surg Oncol. 1984; 26: 17-21
        • Lynch M.A.
        • Cho K.C.
        • Jeffrey Jr, R.B.
        • et al.
        CT of peritoneal lymphomatosis.
        AJR Am J Roentgenol. 1988; 151: 713-715
        • Silverman P.M.
        • Baker M.E.
        • Cooper C.
        • Kelvin F.M.
        Computed tomography of mesenteric disease.
        Radiographics. 1987; 7: 309-320
        • Spencer J.A.
        • Swift S.E.
        • Wilkinson N.
        • et al.
        Peritoneal carcinomatosis: image-guided peritoneal core biopsy for tumor type and patient care.
        Radiology. 2001; 221: 173-177
        • Sevinc A.
        • Camci C.
        • Turk H.M.
        • Buyukberber S.
        How to interpret serum CA 125 levels in patients with serosal involvement?.
        Oncology. 2003; 65: 1-6
        • O’Riordan D.K.
        • Deery A.
        • Dorman A.
        • Epstein O.E.
        Increased CA 125 in a patient with tuberculous peritonitis: case report and review of published works.
        Gut. 1995; 36: 303-305
        • Almakdisi T.
        • Massoud S.
        • Makdisi G.
        Lymphomas and chylous ascites: review of the literature.
        Oncologist. 2005; 10: 632-635
        • Cardenas A.
        • Chopra S.
        Chylous ascites.
        Am J Gastroenterol. 2002; 97: 1896-1900
      1. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Non-Hodgkin’s Lymphoma. Version 2, 2006. Available at: Accessed February 28, 2007.

        • Marcus R.
        • Imrie K.
        • Belch A.
        • et al.
        CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma.
        Blood. 2005; 105: 1417-1423