A Rare Case of Non Hodgkin Lymphoma Presenting as Chylous Ascites

Background: NHL typically presents with painless variable lymphadenopathy or mass , constitutional symptoms of fever , night sweats and weight loss. Ascites in a patient of NHL is an atypical presentation , Chylous ascites being a extremely rare presentation (1:20,000) resulting from leakage of lipid rich lymph in peritoneal cavity. Presentation: A 52 year old female presented with complaints of gradually progressive abdominal distension associated with abdominal pain. Bladder bowel habits were normal. No history of fever, swelling anywhere else in the body or trauma. On examination abdomen was distended and shifting dullness was present.Ascitic fluid analysis revealed milky white fluid with 7600 cells with all lymphocytes, triglyceride level of 1243mg/dl and positive for sudan IV stain. Other biochemical parameters were normal. Abdominal ultrasound revealed gross ascites with multiple enlarged retroperitoneal lymphnodes. CECT abdomen was done which revealed well defined multilobulated mass of 5.2x10x8.9cm in retroperitonem encasing abdominal aorta with multiple enlarged retroperitoneal, mesentric, left external iliac, bilateral inguinal lymphnodes with moderate ascites. Laparoscopic guided diagnostic FNAC of retroperitoneal Lymph node was done which revealed B cell Non hodgkin lymphoma. After appropriate staging(Ann arbor stage III) and risk stratification, the patient was counselled for chemotherapy(RCHOP regimen). After 6 cycles of chemotherapy , patient showed marked clinical improvement and repeat CECT-chest and abdomen showed significant reduction in lymphadenopathy and ascites. Conclusion: In a patient presenting with chylous ascites , the absence of a traumatic history warrants a prudent consideration for malignancy