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Conventional white-light endoscopy (a) and narrow band imaging (b) reveal discoloration (yellow arrowheads), a finding suggestive of poorly differentiated early gastric cancer. [...]irregular microvascular structures and clearly demarcated lesion boundaries are observed on narrow band imaging, suggesting malignancy, like SRCC. Pathological findings. a Histological sections of a gastric biopsy stained with hematoxylin and eosin (H&E). (i) Low-power view (200x) showing overall tissue architecture and inflammatory infiltration. (ii) High-power view (400x) highlighting nuclear atypia, cytoplasmic changes, and possible signet ring cells. b Histological sections of a pleural biopsy stained with hematoxylin eosin (H&E). (i) Low-power view (200x) showing diffuse infiltration of tumor cells within fibrotic and adipose tissue. (ii) High-power view (400x) highlighting signet ring cells with mucin-filled cytoplasm and peripherally displaced nuclei, consistent with metastatic adenocarcinoma. Discussion Malignant pleural effusion is most commonly caused by lung cancer, followed by breast cancer, ovarian cancer, and lymphoma. There is one reported case in which untreated chylothorax changed in nature over time, suggesting that tumor progression into the intra-abdominal lymph nodes led to lymphatic obstruction and subsequent improvement of chylothorax [9]. Because a detailed evaluation