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Knowledge of the peritoneal cavity and the peritoneal folds that subdivide it is useful in evaluating for the presence and spread of disease processes that affect the peritoneum. Many disease processes of the peritoneum and abdominal wall are well evaluated with MR imaging, especially as MR techniques improve. In some cases, information is obtained that is not available with other imaging techniques.
Invasiveness to the peritoneum reconstituted with a mesothelial cell line and Engelbreth-Holm-Swam extract by metastatic cancer cell lines of the uterine cervix, endometrium, and ovary was always higher than that by primary cell lines. The invasiveness by metastatic ovarian cancer cell lines was significantly stronger than that by the other gynecological primary or metastatic cell lines. In the clinical ovarian cancers studied, cancer cells from the metastatic lesion were more invasive than those from the primary lesion. This suggests that metastatic ovarian cancer cells might inherently possess strong invasiveness to the peritoneum. The assay system used in the present study is useful in investigating the clinical behavior and basic biology of peritoneal dissemination.
A case of malignant mesothelioma of the pleura and the peritoneum is reported. In April 1996, a 40-year-old men noticed sudden onset of back pain. Radiographic examinations and MRI revealed pleural effusions, ascites, ringed enhanced tumorous lesions in the right posterior diaphragm along the abdominal aorta, and marked thickening of the right diaphragm with moderate signal intensity. On thoracoscopic surgery, there were white small nodules on the intercostal parietal pleura. Tumor cells of a tubulopapillary pattern had large rounded nuclei and eosinophilic cytoplasms in a partially glandlike arrangement. Cytoplasms of tumor cells stained for alcian blue disappeared after hyaluronidase digestion. Immunohistochemical examinations showed positive staining for keratin but negative for CEA. Electron micrographs showed numerous long thin microvilli, desmosomes and intermediate tonofilaments. From these findings, malignant mesothelioma was diagnosed. The malignant mesothelioma cells of the pleura in this case were considered to disseminate the peritoneum directly through the diaphragm or its lymphatic canals. MRI and thoracoscopic surgery were useful for the demonstration of the pleural disseminations and abdominal invasions.
With rare exceptions, serous proliferations of the peritoneum are limited to women, whereas proliferations of mesothelial differentiation arise predominantly in men. The authors focus on the various types of serous and mesothelial proliferations of the peritoneum and pelvic lymph nodes. Discussion of each type focuses on clinical and morphologic features, histogenesis, differential diagnosis, and clinical outcome.
To investigate the immune environment of the peritoneal cavity, ICAM-1 (intercellular adhesion molecule) expression on the apical surface of the hepatic peritoneum of LPS (lipopolysaccharide) stimulated rats was analyzed ultrastructurally and chronologically with immunoTEM&SEM. ICAM-1 expression was restricted to the side of microvilli of the mesothelial cells. Microvilli demonstrated bulbous tips and included fuzzy coats and strands. Bulbous tips sometimes expressed the antigen, but fuzzy coats and strands did not. Intervillar cell surfaces lacked its expression. Although ICAM-1 expression increased eightfold 24 hr after stimulation, the selective expression remained unchanged. These results suggest that microvilli are closely associated with cell migration in the peritoneal cavity through adhesion molecules that establish a road for migration.
The surface antigens of peritoneal lymphocytes of healthy human individuals were studied. B lineage cells comprised 2.3% of the total peritoneal lymphocyte population. Although the majority of peritoneal cavity lymphocyte (PCL) T cells expressed alpha beta T cell receptor (TcR), up to 17% expressed gamma delta TcR. The majority of PCL exhibited markers of the thymus-dependent lineage (CD2+ CD3+ TcR alpha beta + CD4+ or CD8 alpha + beta +) and surface antigens associated with memory and activation (CD45RO+ CD11a+ CD18+ CD49d+ HLA-DR). Up to 92% of both CD4+ and CD8+ T cells bore CDw60, thus characterizing the T cell subset containing helper activity for mitogen-driven B cell differentiation. The majority of PCL T cells were CD8+ and, in addition, up to 60% of this population expressed the homodimeric CD8 alpha + beta -. Messenger RNA for the recombination activating gene RAG-1 was examined in CD3- PCL depleted of CD19+ lineage cells. The PCL population which comprised cells containing RAG-1 mRNA transcripts was CD19-, surface IgM-, cytoplasmic IgM- and CD2- CD3- CD4- CD8- CD56-. However, this population was CD7+ (approx. 75%), and contained both CD7- CD34+ (up to 3%) and CD7- CD34+ (up to 3%) cells. These findings are compatible with the hypothesis that the adult human peritoneum provides a microenvironment capable of supporting a thymus-indenpendent differentiation of T lymphocytes.
The majority of peritoneal T lymphocytes have been shown to be CD8+ and to co-express CDw60. Expression of CDw60 characterizes CD8 T cells capable of secreting interleukin (IL)-4 and supporting IgG production by B cells. We analyzed at the clonal level the functional cytokine profile of CD8+ T lymphocytes from the normal human peritoneum. While the majority of the clones produced interferon (IFN)-gamma and exhibited high alloantigen-specific cytolytic activity, some clones secreted IL-4 and IL-5 but no detectable IFN-gamma. These Th2-type CD8+ T cell clones provided substantial B cell help for IgG and IgA synthesis and exhibited reduced cytolytic activity. Our results suggest that distinct subsets of CD8+ T cell may occur in different immune compartments.
In male Wistar rats of the BD I strain, mononuclear macrophages and multinucleate giant cells obtained from the peritoneum 1 day to 5 weeks after implantation of coverslips coated with dermoid cyst sebum, were examined by light microscopy and immunofluorescence microscopy, using antibodies specific for actin and tubulin and also by scanning and transmission electron microscopy. In activated mononuclear macrophages, microtubules radiate from the centrioles, situated in the perinuclear area, into the cytoplasm and the major cell processes. Microfilaments form a dense meshwork beneath the plasmalemma. When mononuclear macrophages fuse to form multinucleate giant cells, the initially unordered ("Foreign body") syncytia still reveal the original distribution patterns of centrioles, microtubules and microfilaments similar to those seen in the individual cells. In the ordered (Langhans) multinucleate giant cell all centrioles are accumulated in a main pluricorpuscular central group. Centrioles are the initiating and organising centres in the formation of microtubules. From the centrioles microtubules extend into the entire cytoplasm of the syncytium as a uniformly organised, stellate, radial system. The centrosphere, which is characteristic for ordered multinucleate giant cells, seems free from microfilaments, which form a ring-shaped woven network encircling the nuclei. Depolymerisation and inhibition of microtubules upon exposure to colchicine, indicates that both the organisation of the cytoplasm and the cellular movements depend on the undisturbed coordination of centrioles, microtubules and microfilaments. This applies also to the fusion of mononuclear macrophages to form syncytia, the ordering processes within multinucleate giant cells, and the function of ordered giant cells.
During the healing phase of a chemical peritonitis, one or several skeletal muscle fibers develop, de novo, in the peritoneum of the adult of weanling rat diaphragm. One week after the initial injury the new muscle fibers are narrow and have central nuclei and cross-striations. The fibers increase progressively in caliber and the nuclei take up a subsarcolemmal location. The newly formed muscle fibers are separated from the intrinsic diaphragmatic muscle by an elastic membrane and by a hand of hyaline connective tissue. They are separated from the peritoneal surface by a zone of granulation tissue. Most new fibers are oriented at right angles to the intrinsic diaphragmatic muscle fibers. Their location and orientation suggest an origin from mesothelium or from fibroblasts in the granulation tissue rather than from the intrinsic diaphragmatic muscle. A similar phenomenon can be induced in the pleura on the other side of the diaphragm. In contrast, damage to the diaphragmatic muscle by injection of aluminum lactate does not engender myogenesis in the location described despite active regeneration in the intrinsic muscle.
Single photon emission computed tomography (SPECT) has been shown to be of value in estimating the radiation dose to the peritoneum from 32P therapy. Simple dosimetry calculations, assuming uniform irradiation of tissue, indicate that radiation doses of approximately 40 Gy to the peritoneal surface are achieved. However, the images show that the radionuclide distribution is non-uniform, giving rise to radiation dose variations of at least a factor of 10.
After association on chorioallantoic membrane (CAM) of an embryonic bird testis with pigmented peritoneum from a Japanese quail embryo, numerous melanocytes penetrate in its interstitial tissue. If, instead of a testis, an ovary is transplanted under similar conditions, then the melanocytes may be found in the medulla or between the secondary sex cords at the rim of the ovary.
A 66-year-old Japanese man who had undergone a subtotal gastrectomy for gastric cancer 1 year earlier, and was asymptomatic, underwent a computed tomography scan during a detailed follow-up examination, which revealed a pancreatic mass. Abdominal ultrasonography showed a solid tumor containing a cystic lesion, and abdominal magnetic resonance demonstrated a tumor with low intensity on T1-weighted images and high intensity on T2-weighted images. Although an abdominal angiography added no new information to help in establishing a preoperative diagnosis, it showed an avascular mass. An endoscopic retrograde pancreatograhy showed compression and deviation of the body part of the pancreatic duct, and dilatation of its caudal part. At laparotomy, an elastic soft tumor was found to originate from the peritoneum of the omental bursa in front of the pancreas. The tumor was encapsulated and solid. The solid lesion consisted of spindle-shaped cells, but no atypical cells were observed. The histological findings were diagnostic of a benign solitary fibrous mesothelioma, which is extremely rare. The patient is currently well and disease-free more than 5 years after this operation.
Although many substances have been tested in the search for an ideal dural substitute, an entirely satisfactory material has still not been found. The authors report an experimental study involving the closure of dural defects in rabbits with biomaterials developed from pig peritoneum and pericardium. Macroscopic and histologic examination, performed over a period between 15 and 45 days after implantation showed slight or no adhesion between the graft material and the cortex. No infection, CSF leakage, fistula or toxicity was noticed. The results demonstrated that these biomaterials could be used as satisfactory dural substitutes.
In vitro culture of peritoneal explants of neonatal rats after previous application of agents simulating wound antisepsis is a sensitive screening method for the determination of the tissue compatibility of local wound antiinfectives. Two test models are differentiated: (1) separated peritoneal explants as a model for chronic or deep wounds and (2) peritoneum in situ in the experimental animal with subsequent extraction and cultivation of the explants. Considering the present state of knowledge the following conclusions can be drawn regarding antisepsis of wounds: Lavasept (0.1%) may be classified as the agent of choice for deep and chronic wounds, for drip-suck irrigation and for antiinfective lavage of body cavities inclusively for peritoneal lavage (0.05%). Taurolidin is antiseptically effective in long term application (> 6 h), and because of its antitoxic effect as well as lack of cytotoxicity it is especially suitable for peritoneal lavage. Betaisodona solution is very well suited for superficial contaminated wounds and can be used in a dilution of 1:10 for short-term rinsing of deep wounds, including body cavities but not for peritoneal lavage. Ethanol causes no inhibition of explant growth and therefore retains its importance in wound antisepsis.
The incidence of primary malignant neoplasms of the pleura, the pericardium and the peritoneum in Germany has been rising since about the mid-1980s. A continuing rise is expected until about 2020, predominantly due to the peak of asbestos processing in Germany between 1965 and 1980. About 90% of the mesotheliomas stored in the files of the German Mesothelioma Registry in Bochum are asbestos related and therefore possibly due to occupational exposure that may be compensated by the professional associations. More than 500 mesotheliomas annually can be diagnosed in the German Mesothelioma Registry. In this first part of the series on mesotheliomas, current concepts on etiology and pathogenesis as well as diagnostic procedures and standards are discussed. At the present, specific chromosomal or genetic defects that constantly give rise to a mesothelioma are not known. The initiation and progression of malignant mesotheliomas is a highly complex mechanism that is based on individual genetic alterations. A reliable diagnosis is the basis for therapeutic, prognostic and medicolegal consequences; in general, it can be achieved by thoracoscopic inspection with selected biopsy. Surgery may gain a more important role in the therapy of malignant tumors of serosal membranes not only in palliative, but also in potential curative approaches if the diagnosis can be made at earlier tumor stages.
A novel method of removal of a walled off foreign body in the peritoneum using the percutaneous nephroscope is presented.
Strong anionic sites, as recognized by deposition of cationic colloidal iron even at pH 1.5, were distributed on the free surfaces of the mesothelia of the mouse pleura, pericardium, and peritoneum. Methylation inhibited colloidal iron staining on the surface, and successive saponification restored it. Digestion with neuraminidase or hydrolysis of sialic acid with H2SO4 erased the colloidal iron staining. Lectin Limax flavus agglutinin (LFA), which is specific for sialic acid, labeled the free surface of the mesothelium. All these findings strongly suggested that the surface substance contained sialic acid. Moreover, prior treatment with LFA inhibited the mesothelial surface stain with colloidal iron. In transmission electron microscopy, the colloidal iron (pH 7.3)-stained substance took the shape of fine strands of 50-300 nm in length. These characteristics of the substance on the mesothelial surface correspond well with biochemical properties of membrane-associated sialomucin, whose strong and abundant negative charges produce repulsive forces between facing serosal surfaces. This may contribute to prevent serosal adhesion and to reduce friction during movements of organs.
BACKGROUND: Monocyte chemoattractant protein-1 (MCP-1), a CC chemokine, is a potent attractant of monocytes both in vitro and in vivo. However, its role in the repair of peritoneal injury is not well established. This study characterizes MCP-1 expression in surgical wounds following peritoneal abrasion in a murine model. METHODS: Twenty-five C57 BL6 female mice underwent a 2-cm midline laparotomy with mechanical abrasion of the right peritoneal wall. The mice were sacrificed at various times ranging from 0 to 7 days. Hemotoxylin and eosin stained sections and tissue extracts were made using peritoneal samples from abraded and unabraded areas in each mouse. An enzyme-linked immunosorbent assay was performed on the specimens to quantitate MCP-1 expression. Values were compared using a t-test. RESULTS: At baseline, there was minimal expression of MCP-1 (<5 pg/mg protein). Following surgery, MCP-1 levels at abraded sites were significantly higher than those at both baseline and unabraded sites at all times up to a week following surgery. Histologic evaluation revealed peritoneal thickening and leukocytic infiltration of only abraded surfaces. CONCLUSION: MCP-1 is highly expressed in peritoneum following laparotomy with peritoneal abrasion. Elevations in MCP-1 levels are identified within 6 h of surgery and persist for up to 1 week. The histologic differences between abraded and unabraded areas may be attributable to differences in MCP-1 expression. Further studies using recombinant MCP-1 and anti-MCP-1 antibody may elucidate this relationship.