Figure 1 Clinical findings and laboratory examination of the patient. A: Nails and toenails were thickened and yellow, with increased curvature. Edema was found in both lower limbs, especially in the right side; B: No tumor cells or granulomatous structures were found in hematoxylin and eosin staining images (400×) of pleura, pleural effusion, peritoneal effusion and axillary lymph nodes; C: Computed tomography (CT) images showed bilateral pleural effusions(orange arrows), pericardial effusions (yellow arrow), and peritoneal effusions (blue arrow); positron emission tomography (PET)/CT images showed enlarged axillary (orange triangle) and mediastinal (yellow triangle) lymph nodes and ethmoid sinusitis (blue triangle); D: Radionuclide lymphoscintigraphy showed that lymphatic vessels of the right lower limb were interrupted, the imaging agent (99Tc-antimony sulfide colloid) was accumulated in the subcutaneous tissue (orange arrows) and collateral circulation appeared in the lymphatic vessels below the left knee (yellow arrows).