title: Protein-losing enteropathy cured by resection of adenomatous goiter: report of a case.
abstract: A 51-year-old Japanese woman presented to our hospital with systemic edema and general fatigue. Her serum albumin level was very low (1.5 g/dL). Technetium-99 m-human serum albumin ((99m)Tc-HSA) scintigraphy showed albumin leakage from the upper small bowel. Magnetic resonance lymphangiography showed dilated lymphatic vessels in the chest, whereas double-balloon enteroscopy (DBE) showed white villi and chyle leakage in the deeper part of the duodenal mucosa. A duodenal mucosa biopsy specimen revealed lymphangiectasia. She was diagnosed with protein-losing enteropathy (PLE). Treatment with a fat-restricted diet and tranexamic acid--previously reported to be effective against PLE--was attempted, but was ineffective. A thyroid tumor was simultaneously detected in her left neck, and was found to extend to the mediastinum on computed tomography. The tumor (size, >5 cm) was resected, and a pathological diagnosis of adenomatous goiter was made. The patient's serum albumin level increased to normal levels within 1 month postoperatively. After 6 months, (99m)Tc-HSA scintigraphy showed no albumin leakage from the gastrointestinal tract, and disappearance of white villi and chyle leakage on DBE. No lymphangiectasia was noted in the biopsy specimen. Adenomatous goiter was thus considered the cause of the PLE, possibly through lymph flow obstruction in the mediastinum.
authors.affiliation: Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan, jtakada-gifu@umin.ac.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Takada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Araki
authors.forename: Masaya
authors.initials: M
authors.lastname: Kubota
authors.forename: Takashi
authors.initials: T
authors.lastname: Ibuka
authors.forename: Makoto
authors.initials: M
authors.lastname: Shiraki
authors.forename: Masahito
authors.initials: M
authors.lastname: Shimizu
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
mesh_terms: D000236:Adenoma / Q000150:complications / Q000601:surgery*; D005260:Female; D006042:Goiter / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011504:Protein-Losing Enteropathies / Q000209:etiology / Q000628:therapy*; D013964:Thyroid Neoplasms / Q000150:complications / Q000601:surgery*
references.citation: Gastroenterology. 1989 Jun;96(6):1596-9
references.pmid: 2714582
references.citation: Pediatrics. 2002 Jun;109 (6):1177-80
references.pmid: 12042562
references.citation: Postgrad Med J. 1986 May;62(727):399-400
references.pmid: 3763551
references.citation: Gastroenterology. 1981 Jan;80(1):166-8
references.pmid: 7450403
references.citation: Eur J Gastroenterol Hepatol. 2005 Dec;17(12):1417-9
references.pmid: 16292099
references.citation: World J Clin Cases. 2014 Oct 16;2(10):528-33
references.pmid: 25325063
references.citation: J Clin Gastroenterol. 2012 Aug;46(7):575-80
references.pmid: 22138845
references.citation: Intern Med. 2008;47(24):2171-3
references.pmid: 19075545
references.citation: Ugeskr Laeger. 2009 Aug 31;171(36):2573-4
references.pmid: 19732551
references.citation: J Med Case Rep. 2013 Jan 14;7:19
references.pmid: 23316917
references.citation: Am J Gastroenterol. 2010 Jan;105(1):43-9; quiz 50
references.pmid: 19789526
references.citation: Hepatogastroenterology. 1997 Jan-Feb;44(13):133-8
references.pmid: 9058131