Multiple Serous Effusion Combining With Warburg Effect:A Case Report Of Diffuse Large B-cell Lymphoma And Literature Review

Objective:To explore the clinical diagnosis and treatment of a case of diffuse large B-cell lymphoma(DLBCL),presenting as multiple serous effusion combining with Warburg effect.Methods:Clinical data of a DLBCL case were retrospectively analyzed.A 51-year-old male was admitted due to abdominal pain and distension for 1 month,and right chest pain for recent 7 days.CT scan,PET-CT scan and thoracoscopy were conducted.Database including CKNI and Pubmed were searched for relevant studies published during 2010 and 2016 with key words such as "large B-cell lymphoma,hypoglycemia,lactic acidosis,tumor".Results:CT scan showed pleural effusion and ascites,and echocardiography suggested slight pericardial effusion.PET-CT scan indicated high uptake ratio of 18-Fluoro-2-deoxyglucose(18-FDG)of both bilateral pleura and peritoneum.Blood glucose tests showed the patient had low sugar at a minimum of 1.17mmol/l,while blood lactic acid was abnormally high.The LDH in pleural effusion was 5185 U/L,and CA-125 was 3251 U/L.Cytological examination of pleural effusion found lymphoblast and prolymphocyte.Thoracoscopic biopsy of the pleura confirmed the diagnosis of DLBCL.Remission was observed after 3 cycles of chemotherapy.Totally 605 studies involving 3981 DLBCL patients were included in the literature review.Of all cases,108 presented serous effusion,and 30 involved multiple serous cavities.Of the 15 cases presenting both hypoglycemia and lactic acidosis,13 were NHL cases(4 were confirmed DLBCL;3 were Burkitt lymphoma;2 were T cell lymphoma,and 4 were not mentioned).Conclusions:DLBCL characterized by multiple serous effusion complicated with Warburg effect is rather rare in clinical practice.Thoracoscopy is effective for the diagnosis and differentiation of similar lymphomas presenting multiple serous effusion.