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PubMed1995

CT of the mesentery, omentum, and peritoneum in children.

Primary abnormalities of the peritoneum are rare in children. However, there is frequent secondary involvement of the peritoneal cavity and its specialized folds, the mesentery and omentum, in the presence of infectious, neoplastic, and traumatic conditions that originate at other sites in the abdomen or pelvis. Computed tomography (CT) is usually the modality of choice for evaluation of complex abdominal or pelvic pathologic conditions. Peritoneal cavity abnormalities include peritoneal fluid, pneumoperitoneum, and hemoperitoneum; peritoneal abscesses and peritonitis; metastases; and bladder or bowel rupture and solid organ injury. Mesenteric and omental abnormalities include an increase in or infiltration of mesenteric and omental fat; mesenteric lymphadenitis; mid-gut malrotation and bowel herniation; a variety of infections; metastases, lymphoma, and lymphangioma; and mesenteric injury. Knowledge of the spectrum of abnormalities that involve the mesentery, omentum, and peritoneal cavity and the characteristic CT appearances of these abnormalities is essential for improved diagnosis of these conditions.

Child↗
PubMed2000

Solitary fibrous tumor of the peritoneum found in the prevesical space.

Solitary fibrous tumors (SFT) are well recognized in the pleura, but their rare occurrence at other sites has become appreciated only in recent years. We experienced a 68-year-old male patient who presented with frequency of urination and difficulty in voiding. Computed tomographic scan revealed a solid and cystic mass which measured 12 x 10 cm in the prevesical space. This tumor showed typical histopathologic features of SFT, and was immunostained positive for vimentin, CD34 and CD99. This is an extremely rare case of SFT arising from the parietal peritoneum found in the prevesical space.

Aged↗
PubMedDate not supplied

Papillary serous carcinoma of the peritoneum with paraaortic lymph node metastasis despite minimal intraperitoneal involvement: a case report.

UNLABELLED: BACKGROUND; Papillary serous carcinoma of the peritoneum (PSCP) is a tumor that produces widespread intraperitoneal lesions. Unlike serous ovarian adenocarcinoma, many aspects of its mode of progression and biologic characteristics are unclear. CASE: A 46-year-old woman with PSCP had no detectable ascites and minimal intraperitoneal involvement at the time of the diagnosis, but a paraaortic lymph node metastasis was present. Preoperative endometrial cytology was positive (suspicion of adenocarcinoma). The histologic diagnosis was poorly differentiated serous adenocarcinoma. Cytology of the peritoneal washings demonstrated positive findings, similar to those of endometrial cytology. After cytoreductive surgery, including lymph node dissection and platinum-based chemotherapy, the patient achieved long-term survival. CONCLUSION: PSCP can present with an early paraaortic lymph node metastasis. Endometrial cytology can be valuable in the diagnosis.

Adnexa Uteri↗
PubMedDate not supplied

Serous surface carcinoma of the peritoneum: useful role of cytology in differential diagnosis and follow-up.

OBJECTIVE: To determine the role of cytology in differentiating serous surface carcinoma of the peritoneum (SSCP) from other morphologically similar tumors, including ovarian carcinoma and other peritoneal lesions, and to define the value of cytology in the follow-up of patients with SSCP. STUDY DESIGN: Twenty-one ascitic fluids and seven peritoneal washings obtained from 19 patients with histologically confirmed SSCP were reviewed and their cytologic features tabulated and analyzed. RESULTS: Eighteen of the specimens were from initial diagnostic paracenteses or exploratory laparotomies. These showed mostly three-dimensional tumor cell clusters, as well as single malignant cells, with occasional papillae. The cytoplasm was abundant and often vacuolated. The cytomorphologic features of SSCP enabled differentiation from other conditions involving the peritoneal surface, including mesothelial hyperplasia, malignant mesothelioma, endometriosis and endosalpingiosis. However, there were no characteristic features that differentiated SSCP from metastatic serous carcinoma of the ovary. Four of the peritoneal washings were from second-look operations; in each of these cases the presence of tumor cells in the cytologic preparations correlated with positive biopsy results. Furthermore, six of the paracenteses were performed for recurrent ascites and enabled detection of recurrent disease, obviating the need for invasive procedures. CONCLUSION: Cytomorphologic examination of ascitic fluids and peritoneal washings serves a valuable role in the initial diagnosis of SSCP, in the detection of recurrent disease and as a useful adjunct to multiple biopsies in the second-look operation. It can differentiate SSCP from several other lesions but not from serous carcinoma of the ovary.

Adult↗
PubMed1998

Phase II trial of intraperitoneal paclitaxel in carcinoma of the ovary, tube, and peritoneum: a Gynecologic Oncology Group Study.

PURPOSE: To determine the response rate of intraperitoneal (i.p.) paclitaxel in patients with small-volume residual carcinomas of the ovary, fallopian tube, or peritoneum. PATIENTS AND METHODS: Eligibility criteria included patients with one of the cancers noted above, with the largest residual disease 0.5 cm or less in maximum diameter at the end of second-look surgery, and prior treatment with systemic paclitaxel was permitted. The treatment plan was paclitaxel 60 mg/m2 i.p. weekly for 16 weeks, followed by surgical evaluation in patients without evidence of disease progression. RESULTS: Of 80 patients entered onto the study, 76 were eligible, of whom 86% were considered to be potentially cisplatin-sensitive. Although five patients (7%) did not complete the first course of therapy because of catheter leakage or blockade, 53 patients (70%) received all 16 planned courses. Only 14 patients (18%) received fewer than 11 courses. Treatment was well tolerated, which included only moderate abdominal pain (grade 2, 12 patients; grade 3, one patient) and minimal neutropenia (grade 2, three patients; grade 3, one patient). Of 28 assessable patients with microscopic disease at the start of i.p. therapy, 17 patients (61%) achieved a surgically defined complete response (CR). Only one of 31 patients (3%) with any macroscopic disease achieved a CR. Of the eligible patients, 18 of 76 (24%) achieved a CR. CONCLUSION: Salvage i.p. paclitaxel is tolerable and active in patients with microscopic residual disease. The impact of this treatment strategy on survival remains to be assessed in a phase III trial.

Aged↗
PubMed2001

Combination chemotherapy with carboplatin and docetaxel in the treatment of cancers of the ovary and fallopian tube and primary carcinoma of the peritoneum.

PURPOSE: Standard chemotherapy for advanced ovarian cancer currently includes a platinum agent (usually carboplatin) and paclitaxel. Because docetaxel is an active agent in platinum-resistant ovarian cancer, it is relevant to evaluate both the toxicity and efficacy of the combination of carboplatin and docetaxel in this clinical setting. PATIENTS AND METHODS: The Gynecologic Oncology Program of the Cleveland Clinic Taussig Cancer Center conducted a phase II trial of carboplatin (area under the concentration-versus-time curve of 6) and docetaxel (60 mg/m(2)), delivered every 3 weeks for six courses, in patients with ovarian and fallopian tube cancers and primary carcinoma of the peritoneum who had either received no prior chemotherapy or had experienced a treatment-free interval of greater than 2 years before developing disease recurrence. RESULTS: Fifty patients (median age, 57 years; range, 44 to 81 years) entered the trial (47 had had no prior chemotherapy). Our toxicity findings included the following: grade 4 neutropenia (64% of patients); hypersensitivity reactions (34%, none requiring discontinuation of therapy); peripheral neuropathy (6%). We had objective responses for 32 of 42 (81%) assessable patients. CONCLUSION: The combination of carboplatin and docetaxel is highly active in ovarian cancer, with the major toxicity being bone marrow suppression. Hypersensitivity reactions are frequent but do not prevent continuation of treatment. With the dose and schedule employed in this trial, neurotoxicity is uncommon. Defining a role for this regimen in routine clinical practice will require the conduct of randomized controlled clinical trials.

Adult↗
PubMed1997

Fiber-specific molecular features of tumors induced in rat peritoneum.

Molecular markers such as mutational spectra or mRNA expression patterns may give some indication of the mechanisms of carcinogenesis induced by fibers and other carcinogens. In our study, tumors were induced by application of crocidolite asbestos or benzo[a]pyrene (B[a]P) to rat peritoneum. DNA and RNA of these tumors were subjected to analysis of point mutations and to investigation of mRNA expression patterns. With both assays we found typical features depending on the type of carcinogen applied. The analysis of point mutations in the tumor suppressor gene p53 revealed mutations in the B[a]P-induced tumors. However, in the tumors induced by crocidolite asbestos that were of the same tumor type as those induced by B[a]P, mutations in p53 were not detectable. Every mutation detected on the DNA level causes an amino acid substitution within one of the functional domains of the tumor suppressor protein. Therefore, these mutations seem to be of biological relevance for tumor progression and indicate a difference in the carcinogenesis regarding the type of the carcinogenic substance. An additional specificity of crocidolite-induced tumors was detectable by analyzing the mRNA expression of the tumor suppressor gene WT1, which is known to be expressed in human mesothelial and mesothelioma cells. A relatively high amount of WT1 mRNA was measured by quantitative competitive reverse transcription-polymerase using RNA extracted from crocidolite-induced tumors. However, WT1 seems to be expressed on a rather low level in tumors induced by B[a]P.

Abdominal Neoplasms↗
PubMed2000

Distinct allelic loss patterns in papillary serous carcinoma of the peritoneum.

Tumor and normal tissues from 55 patients with papillary serous carcinoma of the peritoneum (PSCP) were analyzed. Polymerase chain reaction amplification of tandem repeat polymorphism was used to screen for loss of heterozygosity (LOH). We mapped 22 oligonucleotide primers to chromosomes 1p, 3p, 6q, 7q, 9p, 11p, 17p, 17q, and Xq. Germline BRCA1 mutation status of 43 patients was determined previously. High frequencies (> 30%) of LOH in PSCP were observed on 6q, 9p, 17p, 17q, and Xq. Compared with allelic loss of serous epithelial ovarian carcinoma (SEOC), the frequency of LOH was significantly lower in PSCP on 1p, 7q, 11p, 17p, and 17q. Of 43 cases screened for germline BRCA1 mutations, 9 cases were identified with mutations. The frequencies of LOH were not significantly different among the BRCA1-related and BRCA1-unrelated PSCP cases. The high LOH rate identified on 6q, 9p, 17p, 17q, and Xq in PSCP suggests that candidate tumor suppressor genes residing in these regions may be important for the development of the tumor. Compared with allelic loss of SEOC, PSCP exhibits a significantly lower frequency of LOH on chromosomes 1p36, 7q31.3, 11p15.1, 17p13.1, and 17q21. An increase in susceptibility to the acquisition of allelic loss in BRCA1-related PSCP cannot be identified.

Alleles↗
PubMed2005

Primary clear cell adenocarcinoma of the peritoneum.

We report on a very rare case of peritoneal clear cell adenocarcinomas. A 49-year-old Japanese woman underwent hysterectomy and bilateral salpingo-oophorectomy for endometrial endometrioid adenocarcinoma grade III, which was composed of undifferentiated carcinoma cells (98%) and tubular carcinoma cells (2%). No clear cell adenocarcinoma elements were noted in this tumor. Two peritoneal cystic tumors were detected by imaging modalities around the stomach and spleen, 15 months and 21 months after the follow-up period of the endometrial carcinoma, respectively. These two tumors were surgically resected. They were cystic tumors encapsulated by fibrous capsules and showed the same morphologies. They showed proliferation of carcinoma cells arranged in solid nest, tubular, and papillary patterns. They showed clear cytoplasm positive for periodic acid-Schiff stain, hobnail cells, and occasional hyaline globules. The morphologies fulfilled the criteria of clear cell adenocarcinoma. The morphologies and immunohistochemical findings of the two peritoneal clear cell adenocarcinomas were different from those of endometrial carcinoma. We believe that the two clear cell adenocarcinomas are not metastatic lesions from the endometrial carcinoma of the uterus, and that they are primary clear cell adenocarcinomas of the peritoneum. Our case was characterized by cyst formations and encapsulation in addition to the common histological features of clear cell adenocarcinoma of the uterus and ovary.

Adenocarcinoma, Clear Cell↗
PubMedDate not supplied

CA125-positive papillary tumor of the peritoneum.

A 71-year-old female visited our outpatient unit with chief complaints of anorexia and a sense of abdominal distension. The abnormalities found after admission were conspicious increases in CA125 levels in serum and ascites as well as anemia, accelerated erythrocyte sedimentation and increased serum LDH. The patient underwent an emergency operation for ileus. The histological diagnosis was serous papillomatous cancer. Immunohistologic staining of the cancer tissue demonstrated the production of CA125. In this very rare the remnant of the Müllerian duct in the peritoneum is thought to have been cancerous.

Aged↗
PubMedDate not supplied

Malignant mesothelioma of peritoneum.

A 57-year-old man with malaise, ascites, and abdominal pain was found to have a peritoneum studied with numerous, small nodular tumor masses. Light microscopy revealed an anaplastic malignant tumor of uncertain differentiation. Mucin stains were negative. Electron microscopy revealed pleomorphic tumor cells with diffusely distributed cytoplasmic tonofilaments and well-developed true desmosomes. No long, thin, branching microvilli were present, yet tumor cells were strongly positive for both callus keratin (polyclonal) and monoclonal cytokeratin (AE1/3) in a diffuse cytoplasmic distribution (a pattern corresponding to the diffuse cytoplasmic tonofilaments). Tumor cells were negative for Leu-M1 and carcinoembryonic antigen. The findings were most consistent with malignant mesothelioma, and additional questioning, after tissue diagnosis, revealed a work history of asbestos exposure.

Cell Transformation, Neoplastic↗
PubMedDate not supplied

Malignant epithelial mesothelioma of the peritoneum: observations on a problem case.

A 71-year-old asbestos-exposed male with symptoms suggestive of asbestosis for the previous 8 years presented with abdominal distension and ascites. Clinically, a diagnosis of mesothelioma carcinoma was made. Light microscopy of an omental biopsy failed to advance the diagnosis: The tumor was a solid, papillary, and glandular neoplasm lacking mucin and hyaluronidase-sensitive Alcian blue staining material. Immunohistochemistry gave positive results for Ber-EP4, LeuM1, and CEA, markers, favoring carcinoma. Electron microscopy revealed processes in channels and lumina, which were long, slender, and uncoated with a length: diameter ratio of 19.7. A few possessed small rootlets. A glycocalyx and glycocalyceal bodies were not seen. Other features included tonofibrils, a basal lamina, and desmosomes. The patient died 3 months following the onset of abdominal symptoms. Autopsy findings included solid and papillary tumor throughout the peritoneum, but no intrinsic tumor of the gastrointestinal tract or elsewhere. Arriving at a final diagnosis was complicated by immunohistochemistry, which favored carcinoma, and ultrastructure, which suggested mesothelioma. Taking into account all lines of evidence, it was concluded that the tumor was probably a mesothelioma but one with some features developed to an extent more typical of carcinoma.

Aged↗
PubMed1988

Benign cystic mesothelioma of the peritoneum: immunohistochemical and ultrastructural features in a child.

Benign cystic mesothelioma of the peritoneum is a well-defined but rare entity. A total of 35 instances have been reported, almost all in adults, the majority females. Cystic mesotheliomas have, until recently, been labeled cystic lymphangiomas or lymphohemangiomas. We report the case of a 14-year-old boy who, despite only subtotal resection of his abdominal mass, is well and recurrence free 9 months after surgery. The role of immunohistochemistry and electron microscopy in diagnosis is emphasized.

Adolescent↗
PubMed2006

Severe intracranial hypertension in slit ventricle syndrome managed using a cisterna magna-ventricle-peritoneum shunt.

OBJECT: Severely increased intracranial pressure (ICP) can be life threatening in patients who had previously undergone shunt treatment but who do not experience ventricular enlargement. The authors analyzed the utility of placing shunts into the cisterna magna concurrently with ventricular shunts in patients who were not candidates for lumboperitoneal (LP) shunt placement. METHODS: Ten patients treated with cisterna magna-ventricle-peritoneum (CMVP) shunts for complex problems of shunt function were reviewed retrospectively. All patients had documented increases in ICP and ventricles that did not expand despite life-threatening increases (> 80 mm Hg in one case) in ICP. Between 1995 and 2003, 10 patients (four males and six females, age range 4-32 years) were identified as having life-threatening increases in ICP despite small or slit-like ventricles on imaging studies. Each episode was documented with intraparenchymal pressure monitoring. All patients had documented ventricular catheter failures at the time of the intervention, and all had undergone at least one previous attempt to treat the condition with a valve upgrade and replacement of the ventricular catheter. Three patients had achondroplasia, four had spina bifida, and three had a preexisting Chiari malformation Type I. All patients improved after the procedure, and none suffered permanent complications. For at least 48 hours after surgery, all patients underwent intraparenchymal monitoring of ICP (an intraparenchymal monitor was used that documented normal ICP). CONCLUSIONS: The CMVP shunts are an excellent option for patients who are not candidates for LP shunts but who have high ICP and ventricles that do not enlarge at shunt failure. The ability to access the spinal fluid in the cortical subarachnoid space presumably accounts for this success.

Adolescent↗
PubMed1989

Benign cystic mesothelioma of the peritoneum--a case report.

A case of benign cystic mesothelioma in a 53-year-old woman is presented. The patient had abdominal pain and a palpable mass for 4 days. This mass was noticed incidentally by an obstetrician. A computed tomographic scan of the abdomen and pelvic sonography showed a cystic mass, 6 x 4 cm, in the right lower quadrant close to the cecum and suggested cystadenocarcinoma of the ovary. Operation showed that the mass involved peritoneum in region of the appendix. Complete removal of the mass was done. Grossly it consisted of multilocular cyst containing clear, serous, gelatinous fluid. The light microscopic examination revealed that this lesion consisted of cystic spaces of various size and intervening connective tissue stroma. The cells lined the cysts varied from flattened to cuboidal with occasionally a picket-fence or hobnailed appearance in areas. Brush borders were seen on the luminal surface of some cells. Electron microscopic examination confirmed that the cells were mesothelial origin. This lesion mimics cystic lymphangioma of the abdomen grossly and light microscopically, from which differential features are discussed.

Female↗
PubMed2001

Carbohydrate antigen 19-9 and carcinoembryonic antigen immunostaining in benign multicystic mesothelioma of the peritoneum.

A 58-year-old Italian man was incidentally discovered to have an elevated carbohydrate antigen 19-9 (CA-19-9) level of 132 U/mL on routine blood testing. Multisystem imaging studies revealed multiple benign-appearing cysts of the liver and single cysts in the pancreas and kidney parenchyma. Throughout 14 months, fluctuations were observed in the elevated serum CA-19-9 levels from 99 to 450 U/mL. Serum carcinoembryonic antigen (CEA) and other tumor markers were normal. Laparoscopy disclosed multiple cystic lesions on the surface of the liver, on the serosal surface of the ileum, and in the mesentery. Electron microscopy characterized the cells as mesothelial. The pathologic diagnosis was benign multicystic mesothelioma of the peritoneum (BMMP). Aspirated fluid from the liver cyst revealed CA-19-9 levels at 28 500 U/mL, strongly linking the elevated serum CA-19-9 levels with mesothelial cyst secretion. Immunostaining was positive for CA-19-9, CEA, and cancer antigen 125 (CA-125). We believe this is the first documented instance of CA-19-9 and CEA secretion in BMMP.

CA-19-9 Antigen↗
PubMed1997

[Clinical obeservation of improved passing peritoneum extraperitoneal cesarean sectron].

One hundred and fifty puerperas who had indications for cesarean section and factors associated with intrauterine infection were random divided into three groups and adopted three different operative proccdures which were improved passing peritoneum extraperitoneal, extraperitoneal and low segement cesarean section respectively. Three were 50 puerperas in each group, seven paremeters were observed during and after operation. The results showed that the mean times of three groups from cutting skin to fetal head delivered were 19.5, 22.6 and 19.9 minutes respectively (P < 0.05), the mean operative times were 58.04, 68.2 and 72.0 minutes in proper urder (P < 0.01). Gastrointestinal function recovery mean times were 26.6, 26.0 and 47.9 hours (P < 0.01) in sequence. Postoperative morhidity rates were 10%, 12% and 24% (P < 0.01) in order. Postoperative comlicatins were 0%, 26% and 6% (P < 0.01). There were no significant difference both in newborn one minute Apgar grading and blood loss volume during the operation in three groups. Improved passing peritoneun extraperitoneal cesarean section is a simple, convenient, safe and practical oprative method. It is especially applied to those cases who have a bad form of uterine hypomere and factors of intrauterine infection.

Adult↗