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This patient presented with a one-year history of slowly progressive, painless enlargement of her abdomen. She also had Milroy’sdisease (congenital hereditary lymphedema of the legs). Image at bottom right shows fluid from paracentesis (A) and a syringe filled with fluid fromculdocentesis.
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Obstructing the inferior vena cava and resulting in venous collaterals over the abdomen (image 1) and paraspinal area (image 3).Paracentesis yielded gallons of yellowish tumor fluid (A), while culdocentesis yielded only a small amount of serosanguineous ascitic fluid. In addition to thesubcutaneous metastases (arrows, images 1 and 2), note the numerous seborrheic keratoses that had suddenly appeared on her back—the sign of Leser-Trélat. Formore information on this sign, see Case 129.
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