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2.
BMC Cancer ; 21(1): 294, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743636

RESUMO

BACKGROUND: Standard treatment for malignant peritoneal mesothelioma has not been established, and systemic chemotherapy is administered according to malignant pleural mesothelioma. We previously reported the efficacy of cisplatin plus pemetrexed as first-line chemotherapy; however, the efficacy of second-line chemotherapy remains unknown. METHODS: We retrospectively evaluated patients with malignant peritoneal mesothelioma who started first-line systemic chemotherapy with platinum plus pemetrexed between March 2007 and February 2019 at the National Cancer Center Hospital. Patients who received second-line chemotherapy after failure of platinum plus pemetrexed were identified. We evaluated the efficacy of first- and second-line chemotherapy, and explored the prognostic factors. Survival outcomes were estimated using the Kaplan-Meier method, and between-group differences were compared using the log-rank test. Univariate and multivariate analyses were performed using Cox proportional hazards models. RESULTS: A total of 54 and 26 patients received platinum plus pemetrexed as first- and second-line chemotherapy, respectively (gemcitabine in 12 patients; taxane, six; nivolumab, three; and others, five). In all patients, the median overall survival and progression-free survival after first-line chemotherapy were 16.6 and 7.3 months, respectively. Among patients who received second-line chemotherapy, the median overall survival, progression-free survival, and second-line overall survival were 16.9, 3.2, and 9.9 months, respectively. Patients who received ≥6 cycles of platinum plus pemetrexed as first-line chemotherapy had longer overall survival after second-line chemotherapy than those who did not (hazard ratio, 0.23; 95% confidence interval: 0.06-0.82; p = 0.02). CONCLUSIONS: Second-line chemotherapy may be an option for refractory malignant peritoneal mesothelioma, especially in patients who have completed 6 cycles of platinum plus pemetrexed as first-line chemotherapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Mesotelioma/tratamento farmacológico , Neoplasias Peritoneais/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/farmacologia , Cisplatino/uso terapêutico , Resistencia a Medicamentos Antineoplásicos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Mesotelioma/diagnóstico , Mesotelioma/mortalidade , Mesotelioma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pemetrexede/farmacologia , Pemetrexede/uso terapêutico , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/patologia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Adulto Jovem
3.
Am J Cardiol ; 146: 134-136, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33548186

RESUMO

A 51-year-old woman with pseudomyxoma peritonei developed cardiac arrest 5 days after surgery. Acute echocardiography demonstrated pericardial tamponade. Emergency pericardiocentesis evacuated milky fluid and circulation was re-established. Analysis of the pericardial fluid suggested chylopericardium. In conclusion, this case demonstrates that chylopericardium may be life-threatening and underlines the importance of acute echocardiography in critical management of patients with unexplained shock.


Assuntos
Tamponamento Cardíaco/etiologia , Parada Cardíaca/etiologia , Derrame Pericárdico/etiologia , Pericardiocentese/métodos , Neoplasias Peritoneais/complicações , Pseudomixoma Peritoneal/complicações , Doença Aguda , Tamponamento Cardíaco/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Parada Cardíaca/diagnóstico , Humanos , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Neoplasias Peritoneais/diagnóstico , Pseudomixoma Peritoneal/diagnóstico , Tomografia Computadorizada por Raios X
4.
Cancer Sci ; 112(4): 1644-1654, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33576114

RESUMO

The clinical efficacy of DNA cytology test (CY) in gastric cancer (GC) has been retrospectively proposed using cancer-specific methylation of cysteine dioxygenase type 1 (CDO1). We confirmed the clinical utility of DNA CY in a prospective cohort. Four hundred GC samples were prospectively collected for washing cytology (UMIN000026191), and detection of the DNA methylation of CDO1 was assessed by quantitative methylation-specific PCR in the sediments. Endpoint was defined as the match rate between conventional CY1 and DNA CY1 (diagnostic sensitivity), and the DNA CY0 rate (diagnostic specificity) in pStage IA. DNA CY1 was detected in 45 cases (12.5%), while CY1 was seen in 31 cases (8.6%) of 361 chemotherapy-naïve samples, where the sensitivity and specificity of the DNA CY in the peritoneal solutions were 74.2% and 96.5%, respectively. The DNA CY was positive for 3.5/0/4.9/11.4/58.8% in pStage IA/IB/II/III/IV, respectively (P < .01). In the multivariate analysis, DNA CY1 was independently correlated with pathological tumor depth (pT) (P = .0012), female gender (P = .0099), CY1 (P = .0135), P1 (P = .019), and carcinoembryonic antigen (CEA) (P = .036). The combination of DNA CY1 and P factor nearly all covered the potential peritoneal dissemination (P1 and/or CY1 and/or DNA CY1) (58/61:95.1%). DNA CY1 had a significantly poorer prognosis than DNA CY0 in GC patients (P < .0001). DNA CY1 detected by CDO1 promoter DNA methylation has a great value to detect minimal residual disease of the peritoneum in GC clinics, representing poor prognosis as a novel single DNA marker.


Assuntos
Líquido Ascítico/patologia , DNA/genética , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Idoso , Biomarcadores Tumorais/genética , Cisteína Dioxigenase/genética , Citodiagnóstico/métodos , Metilação de DNA/genética , Feminino , Humanos , Masculino , Estadiamento de Neoplasias/métodos , Neoplasias Peritoneais/genética , Peritônio/patologia , Prognóstico , Regiões Promotoras Genéticas/genética , Estudos Prospectivos , Neoplasias Gástricas/genética
5.
Jpn J Clin Oncol ; 51(2): 205-212, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33556170

RESUMO

PURPOSE: Computed tomography of the abdomen and pelvis is a useful imaging modality for identifying origin and extent of ovarian cancer before primary debulking surgery. However, the International Federation of Gynecology and Obstetrics staging for ovarian cancer is determined based on surgico-pathological findings. The purpose of this study is to determine whether computed tomography staging can be the surrogate for surgico-pathological International Federation of Gynecology and Obstetrics staging in advanced ovarian cancer undergoing neoadjuvant chemotherapy. METHODS: Computed tomography staging was compared with surgico-pathological International Federation of Gynecology and Obstetrics staging in primary debulking surgery arm patients in a randomized controlled trial comparing primary debulking surgery and neoadjuvant chemotherapy (JCOG0602). The cancer of primary debulking surgery arm was identically diagnosed regarding the origin and extent with the cancer of neoadjuvant chemotherapy arm before accrual, using imaging studies (computed tomography and/or magnetic resonance imaging), cytological examination (ascites, pleural effusion or tumor contents fluid) and tumor marker (CA125 > 200 U/mL and CEA < 20 ng/mL). Institutional computed tomography staging was also compared with computed tomography staging by central review. RESULTS: Among 149 primary debulking surgery arm patients, 147 patients who underwent primary debulking surgery immediately were analyzed. Positive predictive values and sensitivity of computed tomography staging for surgical stage III disease (extra-pelvic peritoneal disease and/or retroperitoneal lymph node metastasis) were 99%. Meanwhile, positive predictive values for the presence of small (≤2 cm) extra-pelvic peritoneal disease were low; <20% in omentum. Accuracy of institutional computed tomography staging was comparable with computed tomography staging by central review. CONCLUSIONS: Preoperative computed tomography staging in each institution can be the surrogate for surgico-pathological diagnosis in stage III disease of ovarian cancer patients undergoing neoadjuvant chemotherapy without diagnostic surgery, but reliability of diagnosis of stage IIIB disease is inadequate.Clinical trial registration: UMIN000000523(UMIN-CTR).


Assuntos
Neoplasias das Tubas Uterinas/diagnóstico por imagem , Neoplasias das Tubas Uterinas/diagnóstico , Oncologia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Idoso , Procedimentos Cirúrgicos de Citorredução , Feminino , Humanos , Japão , Linfonodos/patologia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia , Reprodutibilidade dos Testes
6.
Ann R Coll Surg Engl ; 103(2): e53-e55, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559560

RESUMO

Inflammatory myofibroblastic tumours (IMTs) are rare tumours with unpredictable biological behaviour ranging from benign to locally invasive and rarely, distant metastasis. While neurofibromatosis type 1 (NF1) may manifest with gastrointestinal soft tissue tumours, this is the first report in the literature that describes an IMT occurring in a NF1 patient who presented with intestinal obstruction. Our patient presented with intestinal obstruction secondary to an obstructing terminal ileum mesenteric tumour. En bloc bowel resection was performed, with histology revealing an IMT and an adjacent neurofibroma. The resection margins were clear and the patient was free of recurrence at six months.


Assuntos
Obstrução Intestinal/etiologia , Mesentério/patologia , Neoplasias de Tecido Muscular/diagnóstico , Neurofibromatose 1/complicações , Neoplasias Peritoneais/diagnóstico , Humanos , Obstrução Intestinal/cirurgia , Masculino , Mesentério/diagnóstico por imagem , Mesentério/imunologia , Mesentério/cirurgia , Pessoa de Meia-Idade , Neoplasias de Tecido Muscular/etiologia , Neoplasias de Tecido Muscular/imunologia , Neoplasias de Tecido Muscular/cirurgia , Neoplasias Peritoneais/etiologia , Neoplasias Peritoneais/imunologia , Neoplasias Peritoneais/cirurgia , Tomografia por Raios X , Resultado do Tratamento
7.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370959

RESUMO

A 65-year-old woman with a previous history of bilateral salpingo-oophorectomy had peritoneal cysts, increasing in size over 15 years and an increasing cancer antigen 19-9 (CA 19-9) level. The size of the cysts eventually reached 86 mm and 70 mm. As malignant transformation of endometriosis was suspected, we performed peritoneal cystectomy and hysterectomy. Histopathology revealed seromucinous borderline tumours (SMBTs) derived from endometriosis. One month after surgery, her CA 19-9 level had decreased. It is rare for SMBT to occur after bilateral salpingo-oophorectomy; surgical management is the best treatment at present.


Assuntos
Cistos/cirurgia , Endometriose/complicações , Neoplasias Epiteliais e Glandulares/diagnóstico , Neoplasias Peritoneais/diagnóstico , Salpingo-Ooforectomia , Idoso , Antígeno CA-19-9/sangue , Cistos/etiologia , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Histerectomia , Imagem por Ressonância Magnética , Neoplasias Epiteliais e Glandulares/sangue , Neoplasias Epiteliais e Glandulares/etiologia , Neoplasias Epiteliais e Glandulares/cirurgia , Neoplasias Peritoneais/sangue , Neoplasias Peritoneais/etiologia , Neoplasias Peritoneais/cirurgia
9.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370977

RESUMO

Neuroendocrine neoplasms of the gallbladder occur infrequently, with the diagnosis being incidental in most cases. We present a case of an 81-year-old African American woman who initially presented with acute suppurative cholecystitis, found on pathology to have a moderately differentiated infiltrating adenocarcinoma. A partial hepatic resection with periportal lymph node dissection was planned which was subsequently aborted intraoperatively due to the presence of diffuse carcinomatosis. Pathology of the cancerous lesions revealed neuroendocrine carcinoma. Gallbladder neuroendocrine tumours demonstrate no specific clinical features. Given its often late presentation, neuroendocrine tumours of the gallbladder pose a therapeutic and prognostic challenge.


Assuntos
Carcinoma Neuroendócrino/diagnóstico , Colecistite Aguda/etiologia , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar/patologia , Neoplasias Peritoneais/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma Neuroendócrino/secundário , Carcinoma Neuroendócrino/terapia , Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Evolução Fatal , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/terapia , Cuidados Paliativos na Terminalidade da Vida , Humanos , Diagnóstico Ausente , Estadiamento de Neoplasias , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Tomografia Computadorizada por Raios X
10.
Medicine (Baltimore) ; 99(40): e22493, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019445

RESUMO

RATIONALE: Gastrointestinal stromal tumors that present outside the gastrointestinal tract are known for extra-gastrointestinal stromal tumors (EGISTs) and they share the same morphological and immunohistochemical characteristics with gastrointestinal stromal tumors. Here we report a rare case of diffuse primary EGIST arising at peritoneum. PATIENT CONCERNS: A 57-year-old male presented to the hospital with abdominal pain and right lower abdominal tenderness. DIAGNOSIS: The core needle puncture biopsy showed epithelial-like cells and the nuclei were ovoid and focally elongated. Immunohistochemical examination was consistent with a primary EGIST of the peritoneum. INTERVENTIONS: The patient was treated with Imatinib mesylate. OUTCOMES: Five months later, there is no complication resulting from treatment. The follow-up abdominal contrast-enhanced CT showed the lesion was significantly decreased in size, and was evaluated as partial response. The patient continued the treatment with Imatinib as prescribed by the oncologist. LESSONS: EGISTs are rare and should be considered in the differential diagnosis of the peritoneal tumors and immunohistochemistry helps to confirm the diagnosis. Further study with longer follow-up is desired to characterize these uncommon tumors.


Assuntos
Tumores do Estroma Gastrointestinal/patologia , Neoplasias Peritoneais/patologia , Antineoplásicos/uso terapêutico , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Mesilato de Imatinib/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/tratamento farmacológico
11.
Medicine (Baltimore) ; 99(31): e20963, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756083

RESUMO

BACKGROUND: The aim of study was to develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) of patients with pseudomyxoma peritonei (PMP) and compare the predictive accuracy with the American Joint Committee on Cancer (AJCC) staging system. METHODS: Data of 4959 PMP patients who underwent surgical resection were collected between 2004 and 2015 from the Surveillance Epidemiology and End Results (SEER) database. All included patients were divided into training (n = 3307) and validation (n = 1652) cohorts. The Kaplan-Meier method and Cox proportional hazard model were applied. Nomograms were validated by discrimination and calibration. Finally, concordance index (C-index) was used to compare the predictive performance of nomograms with that of the AJCC staging system. RESULTS: According to the univariate and multivariate analyses of training sets, both nomograms for predicting OS and CSS combining age, grade, location, N stage, M stage, and chemotherapy were identified. Nomograms predicting OS also incorporated T stage and the number of lymph nodes removed (LNR). The calibration curves showed good consistency between predicted and actual observed survival. Moreover, C-index values demonstrated that the nomograms predicting both OS and CSS were superior to the AJCC staging system in both cohorts. CONCLUSION: We successfully developed and validated prognostic nomograms for predicting OS and CSS in PMP patients. Two nomograms were more accurate and applicable than the AJCC staging system for predicting patient survival, which may help clinicians stratify patients into different risk groups, tailor individualized treatment, and accurately predict patient survival in PMP.


Assuntos
Nomogramas , Neoplasias Peritoneais/diagnóstico , Pseudomixoma Peritoneal/diagnóstico , Adulto , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Estadiamento de Neoplasias/mortalidade , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/cirurgia , Prognóstico , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Pseudomixoma Peritoneal/mortalidade , Pseudomixoma Peritoneal/cirurgia , Reprodutibilidade dos Testes , Programa de SEER , Análise de Sobrevida , Adulto Jovem
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(5): 492-498, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842430

RESUMO

Objective: To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer, and to investigate the efficacy of bidirectional intraperitoneal and systemic (BIPS) chemotherapy for the recurrence. Methods: The descriptive case series study was conducted. Case inclusion criteria: (1) gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy; (2) postoperative adjuvant chemotherapy was administered; (3) no other distant metastasis except recurrence of peritoneal metastasis; (4) age of 18-75 years; (5) Eastern Cooperative Oncology Group (ECOG) performance-status score≤2; (6) pretreatment evaluation suggested that surgery and chemotherapy could be tolerated. Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study. There were 6 males and 2 females with the median age of 52 (38-68) years. They received laparoscopy or laparotomy first, and then were evaluated with reference to the Sugarbaker peritoneal cancer index (PCI) and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association. A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment. All the patients received intraperitoneal 20 mg/m(2) of paclitaxel (PTX) via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m(2) of PTX at day 1 and day 8, meanwhile 80 mg/m(2) of Tigio was orally administered per day for 14 consecutive days, followed by 7 days of interval. Follow-up ended on December 15, 2019. Results: Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery, 1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction, and the remaining 7 cases underwent laparoscopy successfully and the recurrence of peritoneal metastasis was clearly diagnosed. Two patients with ovarian metastasis underwent laparoscopic bilateral adnexectomy. The median follow-up time was 17.5 (1.5 to 39.0) months, the median number of BIPS chemotherapy course was 11 (1 to 30), and the median survival time (MST) after BIPS chemotherapy was 17.0 months. The major adverse reaction in BIPS treatment was mainly myelosuppression, of which grade 3/4 leukopenia and neutropenia developed in 1 and 2 cases respectively. No BIPS-related death occurred. The MST of gastric cancer after radical gastrectomy was 40.0 months. Conclusions: Laparoscopy is a safe and feasible method for diagnosing the recurrence of peritoneal metastasis of gastric cancer. BIPS chemotherapy is effective and safe for its treatment and deserves further study.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Gástricas/patologia , Administração Oral , Adulto , Idoso , Antineoplásicos Fitogênicos/administração & dosagem , Feminino , Gastrectomia , Humanos , Infusões Parenterais , Laparoscopia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/tratamento farmacológico , Paclitaxel/administração & dosagem , Neoplasias Peritoneais/secundário , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
13.
Artigo em Chinês | MEDLINE | ID: mdl-32536066

RESUMO

Objective: To explore the relationship between the new Tumor-Node-Metastasis (TNM) staging system and the serum CA125 level with the prognosis of malignant peritoneal mesothelioma (MPeM) . Methods: The clinical data of 74 patients with MPeM diagnosed by pathology and immunohistochemistry were collected from January 2005 to June 2016 in Cangzhou Central Hospital. According to the results of CT-peritoneal carcinoma index (PCI) , the tumor load was divided into T1 (PCI 1-10) , T2 (PCI 11-20) , T3 (PCI 21-30) and T4 (PCI 31-39) , combined with lymph node metastasis and extraperitoneal metastasis, a new TNM staging system was established. And serum CA125 level was measured in the same time. The median survival time of patients with MPeM, the effect of the new TNM staging system, and serum CA125 levels on their prognosis were retrospectively analyzed. Results: Among the 74 patients with MPeM, 25 (33.8%) cases were males and 49 (66.2%) cases were females. There were 8 cases with systemic chemotherapy, 8 cases with heated intraperitoneal chemotherapy, and 1 case with combination chemotherapy. 10 cases were T1, 22 cases were T2, 27 cases were T3, 15 cases were T4, 12 cases had lymph node metastasis and 10 cases had distant metastasis. The median survival time of T1, T2, T3 and T4 were 12, 10, 6 and 3 months respectively. There were 38 (77.6%) cases with high serum CA125 in all 49 cases who have been tested for CA125. The median survival time of positive group and negative group were 6 months and 11 months respectively. 68 (91.9%) patients had died by the end of collecting data. The median survival time was 8 months. Univariate analysis showed that there were significant differences in survival time between patients with different CT-PCI stages, serum CA125 levels, and with or without lymph node and extraperitoneal metastasis (P<0.05) . Multivariate analysis showed that CT-PCI was independent risk factors for the prognosis of MPeM (HR=2.203, 95%CI: 1.475-3.289) . Conclusion: The new TNM staging system and serum CA125 are important for the prognosis of patients with MPeM. Early detection, early diagnosis and comprehensive treatment can improve the survival time of patients with MPeM.


Assuntos
Mesotelioma , Neoplasias Peritoneais , Antígeno Ca-125/análise , Feminino , Humanos , Masculino , Proteínas de Membrana/análise , Mesotelioma/diagnóstico , Estadiamento de Neoplasias , Neoplasias Peritoneais/diagnóstico , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
14.
Anticancer Res ; 40(5): 2933-2939, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366445

RESUMO

BACKGROUND/AIM: Peritoneal fluid (PF) cytology is critical for distinguishing high-grade serous carcinoma (HGSC) from metastatic disease in patients with breast carcinoma who present with peritoneal carcinomatosis (PC). CASE REPORT: A 50-year-old woman underwent surgery and adjuvant therapy for pT1N0 grade 2/2 luminal A breast carcinoma. Sixteen months postoperatively, palliative chemotherapy was administered following a pleural biopsy and diagnosis of metastatic carcinoma. The patient developed PC despite chemotherapy. PF cytology specimens suggested metastatic carcinoma. However, we observed a papillary cellular arrangement during the review of cytology slides. HGSC was confirmed by immunocytochemistry showing positive paired box 8 (PAX8) and Wilms' tumor 1 (WT1) expression and negative GATA-binding protein 3 expression. CONCLUSION: In patients with breast carcinoma history, an awareness of characteristic cytomorphology of HGSC, including a papillary pattern with positive PAX8 and WT1 immunoreactivity, is essential to prevent the misdiagnosis of such cases and in ensuring accurate treatment and management.


Assuntos
Neoplasias da Mama/diagnóstico , Citodiagnóstico/métodos , Neoplasias Peritoneais/diagnóstico , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Neoplasias Peritoneais/patologia
15.
Ceska Gynekol ; 85(1): 35-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32414283

RESUMO

OBJECTIVE: Describe the case of echinococcal disease in gynecological practice and point out the complications of its diagnosis. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Faculty Hospital Trenčín, Slovakia. CASE REPORT: The case is presented in an immunosuppressed patient with peritoneal carcinomatosis, mild Ca 125 elevation and increased CRP presenting as a finding of gynecological etiology with histopathological outcome and conclusion of parasitic disease - echinococcosis (hydatidosis). CONCLUSION: In the differential diagnosis of peritoneal carcinomatosis and ascites, especially in immunosuppressed patients with a positive social (or epidemiological) history, the possibility of rare parasitic diseases such as echinococcosis, which resembles malignant tumors, should be considered.


Assuntos
Equinococose/diagnóstico , Adulto , Ascite/diagnóstico , Proteína C-Reativa , Antígeno Ca-125/sangue , Diagnóstico Diferencial , Equinococose/sangue , Equinococose/parasitologia , Feminino , Humanos , Fragmentos de Peptídeos/sangue , Neoplasias Peritoneais/diagnóstico , Eslováquia
17.
Eur Radiol ; 30(7): 3968-3976, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32125516

RESUMO

OBJECTIVES: Peritoneal carcinomatosis (PC) is a prognostically relevant metastatic disease which may be difficult to depict in postoperative patients, particularly in early stages. This study aimed to determine whether PC could be diagnosed more accurately when using a combination of spectral detector CT (SDCT)-derived conventional images (CI) and iodine overlay images (IO) compared with CI only. METHODS: Thirty patients with PC and 30 patients with benign peritoneal alterations (BPA) who underwent portal-venous abdominal SDCT were included. Four radiologists determined the presence/absence of PC for each patient and assessed lesion conspicuity, diagnostic certainty, and image quality using 5-point Likert scales. Subjective assessment was conducted in two sessions comprising solely CI and CI/IO between which a latency of 6 weeks was set. Iodine uptake and HU attenuation were determined ROI-based to analyze quantitative differentiation of PC/BPA. RESULTS: Specificity for PC was significantly higher when using CI/IO compared with using CI only (0.86 vs. 0.78, p ≤ 0.05), while sensitivity was comparable (0.79 vs. 0.81, p = 1). In postoperative patients, the increase in specificity was the highest (0.93 vs. 0.80, p ≤ 0.05). Lesion conspicuity was rated higher in CI/IO (4 (3-5)) compared with that in CI only (3 (3-4); p ≤ 0.05). Diagnostic certainty was comparable (both 4 (3-5); p = 0.5). CI/IO received the highest rating for overall image quality and assessability (CI/IO 5 (4-5) vs. CI 4 (4-4) vs. IO 4 (3-4); p ≤ 0.05). Area under the receiver operating characteristics curve (AUC) for quantitative differentiation between PC and BPA was higher for iodine (AUCIodine = 0.95, AUCHU = 0.90). CONCLUSIONS: Compared with CI, combination of CI/IO improves specificity in the assessment of peritoneal carcinomatosis at comparable sensitivity, particularly in postoperative patients. KEY POINTS: • Combination of iodine overlays and conventional images improves specificity when assessing patients with peritoneal carcinomatosis at comparable sensitivity. • Particularly in postsurgical patients, iodine overlays could help to avoid false-positive diagnosis of peritoneal disease. • Iodine overlays alone provided inferior image quality and assessability than conventional images, while the combination of both received the highest ratings. Iodine overlays should therefore be used in addition to and not as a substitute for conventional images.


Assuntos
Iodo/metabolismo , Neoplasias Peritoneais/diagnóstico , Peritônio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veia Porta , Curva ROC
18.
BMJ Case Rep ; 13(3)2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32188614

RESUMO

Mesenteric lymphangioma is a benign cystic tumour of the lymphatic vessels that occurs rarely in adults. Due to the infrequency of cases and the insidious presentation, these tumours can be diagnosed late and become massive. Resection of mesenteric lymphangioma in its entirety is the recommended management in order to prevent recurrence. This case report describes the finding of a massive mesenteric lymphangioma (dimensions 420×470×100 mm) in a young man, the investigations leading to diagnosis, and the subsequent surgical management. The substantial size of this tumour produced considerable challenges for the surgical team, including involvement of adjacent small bowel and mesenteric vasculature. Preoperative diagnosis and assessment of the anatomy was pivotal in achieving a complete resection and a good patient outcome.


Assuntos
Linfangioma/diagnóstico , Mesentério , Neoplasias Peritoneais/diagnóstico , Dor Abdominal/etiologia , Adulto , Diagnóstico Diferencial , Humanos , Linfangioma/complicações , Linfangioma/diagnóstico por imagem , Linfangioma/cirurgia , Masculino , Neoplasias Peritoneais/complicações , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
19.
Gynecol Oncol ; 157(2): 398-404, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32063274

RESUMO

OBJECTIVE: To compare the efficacy of ascitic fluid cell block (ACB) with that of core needle biopsy (CNB) or the CA125/CEA ratio in diagnosing primary tubo-ovarian cancer in female patients with peritoneal carcinomatosis (PC) with ascites. METHODS: This retrospective study examined female patients with PC with ascites who had available results for ACB, peritoneal tumor CNB, and the CA125/CEA ratio. Several measures of the accuracy of ACB and the CA125/CEA ratio were calculated and compared, with CNB as the reference standard. RESULTS: Of 81 patients with available results, 57 were clinically diagnosed with primary tubo-ovarian cancer. Overall, 52, 47, and 64 patients were diagnosed via CNB, ACB, and CA125/CEA ratio > 25, respectively. CNB and ACB identified the cancer origin in 91.4% and 82.7% cases, respectively. The concordance ratio of the immunohistochemical findings between ACB and CNB was 93.6%. Two patients with inconclusive CNB results were diagnosed with primary tubo-ovarian cancer via ACB. The sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio were 86.5%, 93.1%, 95.7%, 79.4%, and 12.5, respectively, for ACB and 94.2%, 48.3%, 76.6%, 82.4%, and 1.82, respectively, for CA125/CEA ratio > 25. CONCLUSIONS: ACB is not inferior to CNB in diagnosing primary tubo-ovarian cancer; the two methods complement each other. ACB can substitute CNB in diagnosing primary tubo-ovarian cancer in selected PC patients. ACB is superior to a CA125/CEA ratio of >25 in diagnosing primary tubo-ovarian cancer. ACB is effective, reliable, and convenient for diagnosing primary tubo-ovarian cancer in PC patients with ascites.


Assuntos
Adenocarcinoma/patologia , Líquido Ascítico/patologia , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/patologia , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Antígeno Ca-125/sangue , Antígeno Carcinoembrionário/sangue , Feminino , Humanos , Proteínas de Membrana/sangue , Pessoa de Meia-Idade , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/diagnóstico , Neoplasias Peritoneais/sangue , Neoplasias Peritoneais/diagnóstico , Estudos Retrospectivos
20.
Eur Radiol ; 30(6): 3101-3112, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32065287

RESUMO

PURPOSE: Detection of peritoneal metastases (PM) is key in the staging and management of gastrointestinal and ovarian cancer patients. The purpose of this meta-analysis was to determine the diagnostic performance of CT, PET(CT), and (DW)MRI in detecting PM. METHODS: A literature search in Pubmed, Embase (Ovid), and Scopus was performed (January 1997-May 2018) to identify studies reporting on the accuracy of imaging PM in the diagnostic workup of gastrointestinal or ovarian cancers. Inclusion criteria were region-based or patient-based studies comprising > 15 patients, surgery/histology/radiological follow-up as a reference standard, and sufficient data to construct a 2 × 2 contingency table. Two observers performed data extraction. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated using a bivariate random-effects model and hierarchical summary operating curves (HSROC) were generated. RESULTS: Of 3457 citations retrieved, twenty-four articles met all inclusion criteria. Thirty-seven datasets could be extracted for analysis including 20 for CT, 10 for PET(CT), and 7 for (DW)MRI. The pooled sensitivity, specificity, and DOR for the detection of PM for region-based studies for CT were 68% (CI, 46-84%), 88%(CI, 81-93%), and 15.9 (CI, 4.4-58.0) respectively; 80% (CI, 57-92%), 90% (CI, 80-96%), and 36.5 (CI, 6.7-199.5) for PET(CT), respectively; 92% (CI, 84-96%), 85% (CI, 78-91%), 63.3 (CI, 31.5-127.3) for (DW)MRI. In the patient-based group, not enough studies were included to make a pooled analysis for (DW)MRI and PET(CT). CONCLUSION: (DW)MRI and PET(CT) showed comparable diagnostic performance for the detection of peritoneal metastases in ovarian and gastrointestinal cancer patients. Since MRI is more widely available than PET(CT) in clinical practice, this potentially is the imaging method of choice in most centers in the future. KEY POINTS: • Detection of peritoneal metastases plays an important role in the accurate staging of cancer patients, however, there is no accepted reference standard for the imaging of peritoneal metastases • This meta-analysis shows that (DW)MRI provided the highest sensitivity for the detection of peritoneal metastases in ovarian and gastrointestinal cancer patients • Although (DW)MRI and PET(CT) show a comparable overall diagnostic performance, (DW)MRI seems to be the imaging method of choice since it is more available in daily practice than PET(CT).


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Peritoneais/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Radiografia/métodos , Humanos , Metástase Neoplásica , Neoplasias Peritoneais/secundário
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