Malignant Ascites
New Concepts in Pathophysiology, Diagnosis, and Management
Naeem Aslam, MD;
Christopher R. Marino, MD
Arch Intern Med. 2001;161:2733-2737.
Malignant ascites is a manifestation of advanced malignant disease that
is associated with significant morbidity. Mainstays of treatment include diuretics
and recurrent large volume paracentesis. Although lymphatic obstruction has
been considered the major pathophysiologic mechanism behind its formation,
recent evidence suggests that immune modulators, vascular permeability factors,
and metalloproteinases are contributing significantly to the process. These
new observations offer the opportunity for development of new, more targeted
therapies for the treatment of malignant ascites. This article uses a clinical
case to highlight the problem, then reviews these new concepts in the pathophysiology
of malignant ascites formation. The diagnosis and management of this challenging
medical problem are subsequently discussed, with emphasis on how these new
pathophysiologic insights are being applied to the development of novel therapies
that may soon change how we manage this troubling clinical condition.
From the Department of Medicine, University of Tennessee Health Science
Center (Drs Aslam and Marino), and the Medical Service, Veterans Affairs Medical
Center (Dr Marino), Memphis.
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