一名62岁的泰国男性患者，患有两年股骨双侧淋巴水肿和非创伤性左腋静脉血栓，出现进行性下肢、阴囊和腹部肿胀以及呼吸困难的症状。他否认任何胃肠道症状。最初，他的淋巴水肿被诊断为慢性丝虫病，因血液检测发现抗丝虫抗体呈阳性，但抗丝虫药物治疗未能改善症状。随后，他接受了卵巢静脉淋巴吻合手术和阴囊减压术，但症状仅有轻微缓解。进一步的检查发现双侧乳糜胸和乳糜性腹水，并发现转移性腺癌。患者之前手术的皮肤和阴囊活检组织学检查显示，恶性细胞浸润了淋巴管，并形成了葫芦花环细胞。胃镜检查揭示胃肿块，并通过活检确诊为术期IV的胃腺癌（葫芦花环细胞型）。随后，他接受了姑息化疗。为了处理乳糜泄漏，他被建议采用低脂饮食并补充肠外营养。尽管接受治疗，他仍发展出皮肤转移，后转为最佳支持治疗。患者于诊断后14个月去世。© 2023.日本胃肠病学会。

A 62-year-old Thai man with a 2-year history of bilateral lymphedema and an unprovoked left axillary vein thrombosis presented with progressive leg, scrotal, and abdominal swelling, and shortness of breath. He denied any gastrointestinal symptoms. His lymphedema had initially been diagnosed as chronic filariasis due to positive blood tests for anti-filarial antibodies; however, treatment with anti-filarial drugs failed to improve his symptoms. Subsequently, he underwent surgical lymphaticovenular anastomosis with scrotal reduction, which proved to be of limited symptomatic relief. Later investigations revealed bilateral chylothorax and chylous ascites, with the presence of metastatic adenocarcinoma. Histopathological examination of the patient's skin and scrotum biopsy from his previous surgery revealed invasion of the lymphatics by neoplastic cells with signet ring cell formation. Gastroscopy uncovered a gastric mass, and biopsy confirmed the diagnosis of stage IV gastric adenocarcinoma with signet ring cell. He later received palliative chemotherapy. For the management of chyle leakage, he was prescribed a very low-fat diet and supplemented with parenteral nutrition. Despite treatment, he developed cutaneous metastasis and was transitioned to best supportive care. The patient passed away 14 months after diagnosis.© 2023. Japanese Society of Gastroenterology.