A80-4-55 From Abdomen to Thorax: Unveiling Müllerian Carcinoma Through Bilateral Pleural Effusions

Background Pleural effusions are a prevalent problem in pulmonary practice, and they are often caused by heart failure, infection, or cancer. However, bilateral pleural effusions as the first manifestation of Müllerian cancer are exceedingly rare. Our case highlights the role of pulmonologists in identifying extrathroacic malignancies. Case Presentation A 52-year-old female with hypertension and hyperlipidemia exhibited non-exertional chest discomfort; her initial evaluation in the emergency department was unremarkable. But a month later, she started to have more trouble breathing, pain all over her body, early satiety, a dry cough, and weight loss. Chest X-ray showed pleural effusions on both sides, and a thoracentesis yielded minimal fluid, likely due to loculation. CT abdomen was done due to abdominal pain, and it showed considerable amounts of ascites, abdominal masses and moderate-to-large pleural effusions on both sides. Paracentesis showed exudative fluid. Biopsy of the abdominal tumor revealed high-grade cancer positive for PAX8, WT1, CK7, and GATA3, indicative of a Müllerian primary. Patient was started on systemic chemotherapy. Discussion This case exemplifies the diagnostic challenge of respiratory symptoms secondary to occult intra-abdominal malignancy. Exudative pleural effusions of unknown origin should necessitate investigation for gynecologic malignancies, especially in postmenopausal women. Unsuccessful thoracentesis demonstrates the inadequacy of drainage in loculated or minor effusions, emphasizing the necessity of systemic therapy upon diagnosis. Conclusion A high level of vigilance should be maintained especially in patients with extrathoracic malignancies with bilateral pleural effusions. Early diagnosis for high-grade malignancies is crucial.