Abstract
Colorectal cancer is one of the most common forms of cancer. Spread of tumour to the peritoneal cavity may lead to seeding of cancer cells that adhere to and invade the peritoneal membrane causing peritoneal carcinomatosis. Matrix metalloproteinases (MMPs) play an essential role in cancer cell invasion and dissemination. The aim of this study was to evaluate the morphology and presence of matrix metalloproteinases in peritoneal carcinomatosis. Biopsy samples of the parietal peritoneum were taken from patients undergoing cytoreductive surgery for peritoneal carcinomatosis. The samples were fixed in formalin, dehydrated and embedded in paraffin prior to cutting into 4-µm slices. Staining with haematoxylin/eosin was used for morphology studies, and MMP-1, MMP-2 and TIMP-1 levels were evaluated using immunohistochemistry and light microscopy. The microscopically tumour-free areas of the peritoneal membrane were thin compared to the peripheral invasion zone and the areas invaded by tumour. Peritoneum invaded by tumour was richly vascularised and contained inflammatory cells. MMP-1 was expressed in tumour-free peritoneum and in the invasion zone between tumour and peritoneal tissue, but not in tumour-invaded areas. MMP-2 and TIMP-1 were mostly expressed in the proximity of blood vessels and inflammatory cells in tumour-invaded areas, but was not seen in tumour-free areas. MMPs play an important role in the process of cancer cell invasion of the peritoneum in peritoneal carcinomatosis. The peripheral zone of the tumour appears to be of importance for tumour invasion.
Highlights
The peritoneal membrane is a pivotal organ, lining the inside of the abdominal cavity, having a surface area of approximately 2 m2 in an adult person [1, 2]
A thin layer of mesothelial cells was seen covering the tumour-free peritoneum, and areas of peritoneum invaded by tumour (Fig. 2e–f)
Morphological evaluation of micrographs of the Htx/Eos stained slices showed inflammatory cells and rich vascularisation in the peritoneal areas invaded by cancer cells and in the immediate adjacent area
Summary
The peritoneal membrane is a pivotal organ, lining the inside of the abdominal cavity, having a surface area of approximately 2 m2 in an adult person [1, 2]. It consists of a monolayer of mesothelial cells lying on a basement membrane. Earlier studies found that 5–10% of all colorectal cancer (CRC) patients develop PC in the absence of systemic disease [4, 5], while others have observed numbers close to 20% [6]. PC has traditionally been regarded as a terminal disease with a short median survival time. Treatment continues to be both time- and resource-consuming, has high morbidity and can only be performed at certain clinics and on selected patients
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