LYMPHOCYTOPENIA WITH LYMPH EXTRAVASATION FROM ABNORMAL LYMPHATTCS: ITS OCCURRENCE WITH CHYLOUS ASCITES AND CHYLOTHORAX

Abstract

Lymphocytopenia develops with severe lymph loss and depletion of lymphocyte
bearing lymph. Cannulation and protracted drainage of the thoracic duct in laboratory animals and man are invariably associated with lymphocytopenia (1-6). Concurrently the lymphocytes become progressively immature and it is possible to confuse them with malignant lymphoma cells.

We have observed the clinical counterparts of these phenomena in patients with
severe lymph depletion associated with recurrent chylous effusions. Four such patients are reported. Each had severe protracted recurrent cbylous effusions associated with lymphocytopenia. The lymphocytopenia was attributed to the depletion of lymphocytes associated with persistent loss of lymph into the body cavities. In two patients actual leakage from the lymphatics was demonstrated by lymphography. In the other two, the presence of chylous effusions was direct evidence of lymph extravasation.

In two patients, as the lymph extravasation persisted the lymphocytes exhibited such increasing immaturity that the possibility of malignancy was raised. The explanation lay however, in the progressive immaturity of the lymphocytes which coincided with the protracted lymph effusions.