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Images of Memorable Cases: Case 8

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk. E-mail the authors

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Case_8-pres1-1.jpg Case_8-pres1-2.jpg

Case_8-pres1-3.jpg Case_8-pres1-4.jpg

This patient presented with a one-year history of slowly progressive, painless enlargement of her abdomen. She also had Milroy’s disease (congenital hereditary lymphedema of the legs). Image at bottom right shows fluid from paracentesis (A) and a syringe filled with fluid from culdocentesis.

Case_8-diag1-1.jpg1Case_8-diag1-2.jpg2

Case_8-diag1-3.jpg3

Obstructing the inferior vena cava and resulting in venous collaterals over the abdomen (image 1) and paraspinal area (image 3). Paracentesis yielded gallons of yellowish tumor fluid (A), while culdocentesis yielded only a small amount of serosanguineous ascitic fluid. In addition to the subcutaneous metastases (arrows, images 1 and 2), note the numerous seborrheic keratoses that had suddenly appeared on her back—the sign of Leser-Trélat. For more information on this sign, see Case 129.

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