Abstract
IntroductionMalignant ascites is often a sign of a terminal stage in several malignant diseases. To control ascites, drainage and intra-abdominal chemotherapy are often used in those patients but eradication of ascites is difficult and prognosis is poor.Case presentationA 55-year-old woman was admitted to our hospital on 26 January 2007 with dyspnea, abdominal distention and oliguria. Abdominocentesis revealed peritoneal carcinomatosis resulting from abdominal recurrence from lung cancer. To alleviate the dyspnea and abdominal distention, we drained the ascites aseptically and infused them intravenously back into the patient after removal of tumor cells by centrifugation, and then concentration by apheresis. After the drainage of ascites, we intraperitoneally infused activated killer cells and dendritic cells from the patient's tumor-draining lymph nodes, together with 4.5 × 105U interleukin-2 in 50 ml saline by 2.1 ml/hour infuser balloon.Drastic decreases in the tumor cell count and in ascite retention were observed after several courses of ascites drainage, intravenous infusion and intraperitoneal immunotherapy. The plasma protein level was maintained during the treatment notwithstanding the repeated drainage of ascites. Cell surface marker analysis, cytotoxic activities against autologous tumor cells and interferon-gamma examination of ascites suggested the possibility that these effects were mediated by immunological responses of activated killer cells and dendritic cells infused intraperitoneally.ConclusionCombination of local administration of immune cells and infusion of concentrated cell free ascites may be applicable for patients afflicted with refractory ascites.
Highlights
Malignant ascites is often a sign of a terminal stage in several malignant diseases
Combination of local administration of immune cells and infusion of concentrated cell free ascites may be applicable for patients afflicted with refractory ascites
We report on a patient with peritoneal carcinomatosis caused by a recurrence of lung cancer that was successfully treated with abdominocentesis, reinfusion of concentrated ascites and adoptive immunotherapy with dendritic cells and activated killer cells
Summary
Drainage and intra-abdominal chemotherapy are applied in most cases. Complete eradication of ascites is difficult, and the prognosis of advanced cases of ascites is generally 2 to 3 months. (a) Papanicolaou stain of ascites on 9 February 2007 (before treatment). (b) Papanicolaou stain of ascites on 18 April 2007 (after treatment). Most of the infiltrates are small lymphocytes and carcinoma cells are not present. Cell surface marker analysis indicated that most of the cells were CD4- and CD3-positive T cells (data not shown). Informed consent for this therapy was obtained from the patient. She died 10 months after the initiation of this therapy. We obtained written informed consent for publication of this case report from the patient's next-of-kin. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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