Abundant Ascites Research Articles

Preemptively planned en bloc resection of an extensive right adrenal pheochromocytoma involving the right hepatic division, caval thrombus and segmental caudal vena cava in a dog with Budd−Chiari‐like syndrome

Surgical resection is the treatment of choice for canine adrenal pheochromocytomas (PHEOs). Information on en bloc resection of adrenal PHEO with tumour thrombus, right hepatic division and segmental caudal vena cava (CVC) running through the adrenal tumour and right hepatic division is limited. To describe the preemptively planned en bloc resection of an extensive right adrenal PHEO involving the right hepatic division, the caval thrombus and the segmental CVC in a dog with Budd-Chiari-like syndrome (BCLS). A 13-year-old castrated male miniature dachshund was referred for surgical treatment due to anorexia, lethargy and severe abdominal distension caused by abundant ascites. Preoperative computed tomography (CT) revealed a large mass in the right adrenal gland with a large caval thrombus obstructing the CVC and hepatic veins, which caused BCLS. Additionally, collateral vessels were formed between the CVC and azygos veins. No findings suggested obvious metastases. Based on CT findings, an en bloc resection of the adrenal tumour with caval thrombus, right hepatic division and segmental CVC was planned. The preoperatively planned resection was feasible; the tumour was completely resected grossly. The operation time and total Pringle manoeuvre time were 162min and 16min 56 s, respectively. There was no postoperative hindlimb oedema, renal dysfunction, ascites or abdominal distention. The patient's clinical signs, including appetite, fully improved. Hospitalization lasted 16 days. However, the patient died on the 130th postoperative day due to suspected metastases and cachexia. Even in case of an extensive infiltration of adrenal PHEO causing BCLS, an en bloc resection might be successfully achieved based on the preoperative CT findings speculating the collateral vessels formed for caudal venous return.

Hepar Lobatum Carcinomatosum: A Rare Complication Discovered After an Episode of Digestive Hemorrhage

Aims: Show the importance of imaging in the diagnosis and follow up of Hepar Lobatum Carcinomatosum (HLC) in the context of a breast neoplasia. Presentation of case: We report a case of an episode of upper GI hemorrhage, in a 54 year old female patient, with chronic abdominal pain and asthenia. The CT scan showed a dysmorphic liver, with irregular contours, multiple capsular retractions, associated with abundant ascites. Discussion and Conclusion: HLC is defined as an acquired non-cirrhotic liver deformity secondary to liver metastases during a neoplasia, most often of the breast. The clinical presentations are not very specific and often late, and represented by signs of liver failure associated or not with portal hypertension in all its manifestations. Imaging in HLC, especially CT scan, shows similarities to a cirrhotic liver with hepatic dysmorphia, caudal lobe enlargement and segment IV atrophy. The presence of capsular retraction resulting in lobulated liver contours with reduced liver volume. It is therefore important to know the existence of this extensive form of secondary liver involvement and the set of complications that can arise.

Successful percutaneous transhepatic lymphangiography and embolization for intractable hepatic lymphorrhea after laparoscopic distal gastrectomy: a case report

BackgroundHepatic lymphorrhea is a rare and serious complication of surgery for digestive tract cancers and is thought to occur as a result of lymph node dissection of the hepatoduodenal ligament. This complication results in the accumulation of lymphatic fluid, which may in turn lead to nutritional disorders, immune deficiency, and circulation insufficiency. However, there is currently no standard strategy for treating this condition.Case presentationA 49-year-old woman with alcoholic liver damage underwent laparoscopic distal gastrectomy with lymph node dissection for early gastric cancer. Abundant ascites persisted postoperatively, and the fluid was suspected to indicate hepatic lymphorrhea. The patient was re-admitted on postoperative day 26 due to the onset of a brain infarction caused by dehydration. Various conservative treatments for hepatic lymphorrhea were ineffective. She underwent percutaneous transhepatic lymphangiography and embolization on postoperative day 81, with obvious effect. Computed tomography images demonstrated complete disappearance of ascites.ConclusionsPostoperative hepatic lymphorrhea is a rare and serious complication of radical surgery for digestive tract cancers. The current case suggests that percutaneous transhepatic lymphangiography and embolization may be a rational treatment option when conservative treatments fail.

Bradykinin mediated gastrointestinal edema as a cause of abdominal attacks in patients with hereditary angioedema due to C1-inhibitor deficiency.

Hereditary angioedema (HAE) due to C1-inhibitor (C1-INH) deficiency is a rare hereditary disease characterized by recurrent subcutaneous or submucosal angioedema due to uncontrolled bradykinin production caused by C1-INH dysfunction. Submucosal gastrointestinal swellings provoking abdominal attacks are common and mimic acute abdomen, thus constituting a diagnostic challenge. We aimed to investigate the difficulties in diagnosing abdominal attacks in patients with C1-INH-HAE and to assess the diagnostic value of medical history, the course of the attack, abdominal imaging, and treatment efficacy. The retrospective analysis of diagnostic problems and treatment complications of abdominal attacks in 274 patients with C1-INH-HAE were performed. The value of history, laboratory findings, prodromal symptoms and course of attacks and imaging were assessed. Abdominal attacks were confirmed in 274 of the 322 patients (85%; 190 women and 84 men; age, 4-70 years). In 49% of cases, the abdominal attack was the first and the only symptom for years. The simultaneous presence of marginal erythema (45% of cases), subcutaneous edema (30%), and pharyngo-laryngeal edema (10%) facilitated the diagnosis of an abdominal attack due to C1-INH-HAE. Abdominal attacks manifested with recurrent acute abdominal symptoms lasting 2 to 5 days. The disease course was characterized by the phase of progressive prodromal symptoms followed by peak symptoms and spontaneous symptom resolution. Abdominal imaging often revealed abundant ascites and limited bowel edema. In 60 cases (22%), the diagnostic difficulties resulted in exploratory laparotomy, which was inconclusive in 48 patients (80%). The attacks usually subsided within 2 hours from the administration of recommended drugs (plasma-derived C1-INH, recombinant C1-INH or icatibant). We conclude that recurrent abdominal attacks lasting a few days and resolving spontaneously were common symptoms of C1-INH-HAE. Abdominal imaging revealed transitional fluid or bowel edema. The effectiveness of recommended drugs as plasma-derived C1-INH, recombinant C1-INH or icatibant confirmed the diagnosis.

LES HEPATHOPATHIES CHRONIQUES ET GROSSESSE A PROPOS DUN CAS

We report the case of a 44-year-old multiparous patient with 3 previous pregnancies during her fourth pregnancy, at 33 WA the patient presented signs of decompensation of a previously unknown chronic liver disease. During her last months of pregnancy the diagnosis was made after the appearance of signs of hepatocellular insufficiency aggravated by hepatic encephalopathy in the immediate postpartum period. Abdominal ultrasound revealed a liver of chronic hepathopathy with abundant ascites and portal hypertension. Further abdominal CT scan confirmed the presence of a dysmorphic liver with bumpy contours associated with collateral perigastric venous circulation and homogeneous splenomegaly. The evolution was favorable marked by the delivery of a healthy female new born baby and the resumption of a normal state of consciousness of the woman.

Demons-Meigs Syndrome: A Case Report at the Fatick Regional Hospital

Demons-Meigs syndrome combines a benign tumor of the ovary with thoracic and abdominal effusion, it is a rare disease whose pathophysiological mechanism is not yet well understood. This rare syndrome often gives rise to fear of ovarian neoplasia due to the existence of ascites and the significant elevation of CA 125. In this observation, we report the case of Demons-Meigs syndrome diagnosed in a 36-year-old young woman who presented with pleural and peritoneal effusion syndrome with an ovarian mass and a CA 125 level = 406.6 IU/ml. Laparotomy performed revealed very abundant ascites, the uterus and tubes were healthy, no suspicious peritoneal lesions, the left ovary is healthy, a right ovarian mass of 300 × 150 mm. A right annexectomy was performed. The operative suites were simple with drying of the effusions. The control CA 125 returned to normal after 6 months of follow-up. A pathological anatomy result is a fibrothecoma. Demons-Meigs syndrome has a good prognosis; treatment is based on removal of the ovarian tumor.

Adult Granulosa Cell Tumor in a Young Woman: A Case Report and Literature Review

Granulosa cell tumors belong to the group of stromal and sex cord tumors of the ovary. The adult type is the most common type and usually occurs during the perimenopausal period while the juvenile type mostly affects young women. This is a report of a 26 years old woman who presented an adult type of granulosa cells tumor, with review of the literature. She complained abdominal pain and distension associated with abundant ascites and underwent a right adnexectomy. The pathology examination diagnosed an adult granulosa cell tumor. The two entities of granulosa cell tumors (juvenile and adult types) are distinguished by their characteristic morphological aspects on histological examination allowing diagnostic orientation.

A Case of Well-Differentiated Papillary Mesothelioma of the Male Peritoneum: Successful Treatment by Systemic Chemotherapy

Well-differentiated papillary mesothelioma of the peritoneum (WDPMP) is a rare subtype of epithelioid mesothelioma, which is usually seen in young women without a history of asbestos exposure, and generally, has an indolent course. The relative rarity of this neoplasm in males prompted us to report this case of a well-differentiated papillary mesothelioma of the peritoneum in a 36-year-old man.The patient, who had no history of asbestos exposure, presented with abdominal pain and ascites of unknown etiology. Computed tomography showed abundant ascites with nodules of the peritoneal cavity. Laparoscopic examination revealed a large number of white miliary nodules diffusely covering the peritoneum. Pathology revealed a diagnosis of well-differentiated papillary mesothelioma of the peritoneum, based on histomorphology and immunohistochemistry. The patient started chemotherapy with cisplatin and pemetrexed. After six cycles of chemotherapy, the effectiveness of this chemotherapy was checked by only the computed tomography. PET scan was not used because it is not routinely recommended in WDPMP. Few data are currently available in the literature regarding the performance of the PET scan in WDPMP. Nine months later, the patient was free of symptoms.Based on reviewing the literature and our observations in this case, consultation of other pathologists is highly recommended to discern WDPMP from other disseminated peritoneal diseases, in order to offer the most effective and safe therapeutic strategy. Chemotherapy should be strongly considered if the tumor is unresectable and accompanied by symptoms. Cisplatin and pemetrexed chemotherapy could be a promising therapeutic choice.

A Primary Peritoneal Serous Carcinoma Metastasizing to the Stomach Mimicking a Submucosal Tumor: A Potential Pitfall of Clinical Diagnosis

A primary peritoneal serous carcinoma (PPSC) usually presents as peritoneal dissemination. We report a case of gastric metastasis from PPSC mimicking a primary gastric submucosal tumor (SMT). A 62-year-old woman presented to our hospital with abundant ascites, omental caking, and normal-sized ovaries. Cellblock analysis of ascite specimens indicated high-grade serous Mullerian carcinoma. Gastrointestinal endoscopy detected a 4-cm SMT, which was not gastric cancer, on the gastric antrum. A clinical diagnosis of PPSC was rendered. After chemotherapy, the gastric SMT reduced in size. Following this, the patient underwent complete resection of the residual tumors including gastric SMT. Pathological examination revealed that the gastric lesion was metastasis from PPSC. The assumption that an SMT lesion is a benign primary gastric tumor not requiring surgical resection may hinder optimal tumor debulking. Therefore, preoperative biopsy should be considered, if the situation allows. J Med Cases. 2016;7(11):480-483 doi: http://dx.doi.org/10.14740/jmc2664w

Primary peritoneal serous carcinoma, an extremely rare malignancy: A case report and review of the literature.

Primary peritoneal serous carcinoma (PPSC) is an extremely rare malignancy that was first described in 1959. This type of cancer arises from the peritoneal epithelium and is similar to serous ovarian carcinoma. A diagnosis of PPSC is typically made based on the Gynecology Oncology Group criteria; however, a correct differential diagnosis of PPSC is difficult preoperatively. The current study describes the case of a 66 year-old female patient presenting with abdomen distension. A computed tomography (CT) scan revealed abundant ascites in the abdominal cavity and omental infiltration. The results of positron emission tomography/CT showed hot uptake in the greater omentum. Furthermore, preoperative serum cancer antigen-125 levels were 1,032 U/ml. Upon surgical exploration, a whitish mass and nodule were found in the greater omentum. Therefore, omentectomy was performed. Pathological examination of the resected specimen revealed a diagnosis of PPSC. PPSC is extremely rare with few cases cited in the current literature. The present study describes a rare case of PPSC with a review of the literature.

A Primary Peritoneal Serous Carcinoma Metastasizing to the Stomach Mimicking a Submucosal Tumor: A Potential Pitfall of Clinical Diagnosis

A primary peritoneal serous carcinoma (PPSC) usually presents as peritoneal dissemination. We report a case of gastric metastasis from PPSC mimicking a primary gastric submucosal tumor (SMT). A 62-year-old woman presented to our hospital with abundant ascites, omental caking, and normal-sized ovaries. Cellblock analysis of ascite specimens indicated high-grade serous Müllerian carcinoma. Gastrointestinal endoscopy detected a 4-cm SMT, which was not gastric cancer, on the gastric antrum. A clinical diagnosis of PPSC was rendered. After chemotherapy, the gastric SMT reduced in size. Following this, the patient underwent complete resection of the residual tumors including gastric SMT. Pathological examination revealed that the gastric lesion was metastasis from PPSC. The assumption that an SMT lesion is a benign primary gastric tumor not requiring surgical resection may hinder optimal tumor debulking. Therefore, preoperative biopsy should be considered, if the situation allows. J Med Cases. 2016;7(11):480-483 doi: https://doi.org/10.14740/jmc2664w

Omental actinomycosis misdiagnosed as ovarian cancer peritonei

With reference to the report by Kim et al [1], we also experienced a rare case of omental actinomycosis. Kim et al [1] reported pelvic actinomycosis with abundant ascites comparable to cancer. Our case provides an educational tip for the gynecologist who has to manage pelvic actinomycosis misdiagnosed as ovarian cancer. A 49-year-old woman was transferred from a local clinic with a working diagnosis of right ovarian cancer and multiple myomas. The patient was para 5-2-2-3 and the family history was noncontributory. She was postmenopausal. She had not taken a gynecological examination for almost 5 years. The pelvic examination revealed a huge uterus, an intrauterine device (IUD) that had been inserted for 10 years, and motion tenderness of the cervix. The physical examination revealed mild diffuse abdominal tenderness. We removed the IUD during the pelvic examination. The following laboratory results were reported: white blood count 15.1 103/mL; hemoglobin/hematocrit 11.9 g/dL/33.9%; platelets 637 103/mL; prothrombin time international normalized ratio 1.10; activated partial thromboplastin time 28.2 seconds; carcinoembryonic antigen 2.2 ng/mL; and CA125 84.8 U/mL. Computed tomography (CT) revealed what appeared to be right ovary cancer with a secondarily perforated appendix or a ruptured malignant mucinous neoplasm of the appendix and multiple uterine myomas (Figures 1A and 1B). Ultrasonography revealed multiple uterine myomas. An exploratory laparotomy revealedmultiple abscesses in the omentumand a periappendiceal abscess involving the cecum and terminal ileum. At surgery, no tumor-likemasswas seen in the omentum, ovary, or any pelvicorgan.Thereweremultipleomentalabscesses.

A Case of Pseudomyxoma Peritonei in a 69 Years Old Woman and Review of Literature

Pseudomyxoma peritonei (PMP) is a rare neoplasm characterized by the production of abundant mucin or gelatinous ascites with involvement of the peritoneal surface and omentum. Usually it is associated with benign or malignant mucinous tumor of the appendix or ovary but there are also cases described with other side as colon, rectum, stomach, gallbladder, biliary tract and so on The overall incidence is 1-2 per million per year, it is more common in women than in men (male: female ratio: 9:11). Signs and Symptoms of PMP are very a specific for this reason this disease is often discovered incidentally during other surgical procedure or diagnostic procedure of other pathology. Treatment ranges from debulking to hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS). In this article we want to describe a case of PMP discovered during a diagnostic laparoscopy in a 69 years old woman with a specific symptoms and a diagnosis of peritoneal carcinomatosis at CT SCAN and to review the literature about this rare pathology.

Pelvic actinomycosis with abundant ascites, pleural effusion, and lymphadenopathy diagnosed with endometrial biopsy and treated with medication only

ObjectivePelvic actinomycosis almost always presents as a “dry” type, and pelvic actinomycosis with ascites is extremely rare. We present an unusual case of pelvic actinomycosis with ascites, pleural effusion, and lymphadenopathy. Because of these atypical clinical features, a malignant process such as ovarian cancer or peritoneal carcinomatosis was suspected, but an endometrial biopsy revealed pelvic actinomycosis, which was treated without surgical intervention. Case reportA 50-year-old Korean woman presented to our clinic with a 3-month history of abdominal pain and weight loss. An abdominopelvic computed tomography scan demonstrated ascites, pleural effusion, bilateral adnexal tubular structures, several enlarged lymph nodes in the paraaortic area, and diffuse peritoneal infiltration. Ultrasonography showed fluid collections measuring 2.7 cm in the cul-de-sac, 2.42 cm in the right paracolic gutter, and 3.13 cm in the left paracolic gutter. Endometrial/endocervical specimens showed marked chronic inflammation with sulfur granules, with a colony of filamentous organisms consistent with Actinomyces infection. The patient underwent antibiotic treatment for 6 months and recovered without complications or adverse events in the 13 months of follow up. ConclusionPelvic actinomycosis should always be considered in patients with a pelvic mass and peritoneal infiltration, especially in the presence of intrauterine device use, despite the fact that abundant ascites, pleural effusion, and lymphadenopathy almost never accompany pelvic actinomycosis. Endometrial/endocervical biopsy may yield a diagnosis without an invasive procedure and should be performed. Because of the excellent response to penicillin, medical treatment alone is an effective method to eradicate pelvic actinomycosis without the need for surgical intervention.

A "kiss" before conception: triggering ovulation with kisspeptin-54 may improve IVF.

A 30-year-old primigravid (G1P000) female with infertility secondary to her partner's oligospermia and her chronic anovulation presented 13 days after an oocyte retrieval for in vitro fertilization (IVF) with a positive home pregnancy test, abdominal distention, a 5-pound weight gain, nausea, shortness of breath, and reduced urinary frequency. Her IVF cycle included the usual cocktail for gonadotropin stimulation and was uncomplicated, except for excessively stimulated ovaries that led to a peak estradiol level of 6,000 pg/ml and the retrieval of 30 oocytes. Her past history was relevant only for anovulation due to polycystic ovarian syndrome (PCOS), though her preprocedure body mass index was normal at 21 kg/m2. Pelvic ultrasound revealed abundant ascites and enlarged ovaries, at 8 cm average diameter. Serum human chorionic gonadotropin (hCG) concentration was 200 mIU/ml; she was hemoconcentrated (hemoglobin 16 g/dl), with normal liver function and coagulation testing. An ultrasound guided, transvaginal paracentesis removed 4 liters of straw-colored fluid, resulting in significant short-term symptom relief.

Mesotelioma peritoneal maligno con afectación uterina

Malignant mesothelioma of the peritoneum is an infrequent tumor that is difficult to diagnose and usually behaves aggressively. We present the case of an 80-year-old woman with a pelvic mass of uterine origin, peritoneal carcinomatosis and abundant ascites. Histologic study of the mass was requested and palliative chemotherapy was started because of the advanced stage of the disease. A minilaparotomy was performed and multiple biopsies were taken. Histologic and immunochemistry studies were compatible with a mixed (epithelial and sarcomatoid) malignant mesothelioma of the peritoneum. Prognosis was poor and palliative care was provided. The patient died 15 days after surgery.In women with involvement of the genital organs, it is important to make a differential diagnosis with serous tumors of gynecologic origin because the chemotherapy protocols differ.

Acute Cholecystitis Induced Esophageal Necrosis

Purpose: Acute esophageal necrosis (AEN), colloquially referred to as “black esophagus,” is extremely rare. Retrospective case series over 45 years document only 95 patients with AEN. The hallmark presentation on EGD is diffuse circumferential black mucosa found in the distal third of the esophagus. Here we describe the first case of AEN caused by cholecystitis. A 65 y/o male with hepatitis C decompensated cirrhosis presents with coffee-ground emesis and severe abdominal pain. He recently had an uncomplicated sphincterotomy and stent placement for choledocholithiasis. Labs show WBC 36.9 K/μL, Hgb 9.2 g/dL (baseline 13), platelets 97 K/μL, INR 2.5, Cl 81mmol/L, and lactic acid 18.7 mmol/L. Serum lipase, amylase, CPK, and transaminases were normal. CT reveals an intact biliary stent with pneumobilia, markedly distended gallbladder, abundant ascites, and a thick-walled esophagus. EGD demonstrates circumferential necrotic appearing mucosa from mid to distal esophagus. Ascites grew Citrobacter, Klebsiella; blood grew Klebsiella, Staph. Antibiotics, albumin, TPN were started. Repeat paracentesis reveal WBC 8660, 89% PMNs with growth of Klebsiella, Pseudomonas, and Vancomycin resistant Enterococcus. Patient was intubated for hypoxia. A hydropic gallbladder with thickened edematous wall, pericholecystic fluid, and sludge seen on ultrasound. Peritoneal fluid amylase and bilirubin were normal. During percutaneous choleycstostomy tube placement, cholangiogram confirmed no filling of the cystic duct consistent with cholecystitis; cultures revealed identical organisms as in peritoneal fluid. His overall septic course decompensated and palliative care was pursued. The patient passed. AEN is caused by significant hypoperfusion resulting in profound ischemia. Upper gastrointestinal bleeding is the most common presenting symptom. AEN is diagnosed clinically and treatments are conservative in nature: optimize perfusion, nutrition, and treat infection if present. Our case is unique as AEN was due to bacterial peritonitis from cholecystitis, leading to a massive ischemic event.Figure: No Caption available.

Free Air in the Abdomen

An 85-year-old woman presented with abdominal fullness and loss of appetite for 1 day. She came to the Emergency Department (ED) due to progressive, diffuse abdominal pain. A history of peptic ulcer disease and a T-spine compression fracture were noted. Due to severe back pain, non-steroidal anti-inflammatory drugs and steroids were prescribed for pain control. In the ED, the temperature was 38.5°C, and leukocytosis (white blood cell count 18,960/mm3; 80% neutrophils) was noted. The physical examination revealed diffuse abdominal pain with peritoneal signs. A radiograph of the kidneys, ureter, and bladder showed distended loops of bowel and an ileus. An abdominal computed tomography scan showed abundant ascites with intra-abdominal free air (Figure 1). Small air bubbles in the uterine cavity was also noted (Figure 2). Under the impression of peritonitis and suspected hollow organ perforation, a diagnostic laparoscopy was performed. At the time of laparoscopy, purulent ascites was noted (> 300 mL). No peptic ulcer perforation was noted. Inspection of the bowel from the ligament of Treitz to the rectum revealed no bowel lesions. In the pelvic cavity, the uterus was noted to have a fundal perforation, 1 cm in diameter (Figure 3). The final diagnosis was pyometra (Video 1), and a total hysterectomy with bilateral salpingo-oophorectomy was performed.Figure 2Abdominal computed tomography showed much ascites with intra-abdominal free air (arrow 1). A small air bubble in the uterus cavity provided a clue for pre-operative diagnosis of pyometra (arrow 2).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Spontaneous perforation of pyometra with purulent fluid exuding from the lesion on compression was noted.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The etiology of pyometras varies; most pyometras result from occlusion of the cervical canal secondary to malignant or benign tumors, radiation cervicitis, atrophic cervicitis, puerperal infections, and congenital anomalies (1Inui A. Nitta A. Yamamoto A. et al.Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: report of a case.Surg Today. 1999; 29: 935-938Crossref PubMed Scopus (31) Google Scholar). Spontaneous perforation of the uterus is thought to occur at a site of degenerative or necrotic changes after a pyometra develops, due to impairment of natural drainage via the cervix. Generalized peritonitis after spontaneous perforation of a pyometra is very rare (2Yildizhan B. Uyar E. Sişmanoğlu A. et al.Spontaneous perforation of pyometra.Infect Dis Obstet Gynecol. 2006; 2006 (26786)Crossref PubMed Scopus (55) Google Scholar). Establishing a pre-operative diagnosis for pyometras is usually difficult because the classic symptoms of vaginal discharge, lower abdominal pain, and uterine enlargement are all non-specific. In our case, small air bubbles in the uterine cavity provided a clue for the correct pre-operative diagnosis. A pelvic examination was not performed in our patient pre-operatively because pneumoperitoneum (the presence of free air on the abdominal computed tomography scan) led us to incorrectly diagnose perforation of the gastrointestinal tract. In patients who have generalized peritonitis caused by perforated pyometra with a pneumoperitoneum, anaerobic bacteria are usually detected by culture, but only Escherichia coli was detected in our patient. E. coli infections are considered to be caused by the anatomic relationship between the vagina and anus, and the decrease in lactobacilli accompanied by lowering estrogen levels in elderly women (3Ou Y.C. Lan K.C. Lin H. et al.Clinical characteristics of perforated pyometra and impending perforation: specific issues in gynecological emergency.J Obstet Gynaecol Res. 2010; 36: 661-666Crossref PubMed Scopus (35) Google Scholar). When peritonitis caused by perforated pyometra is diagnosed, emergency surgery is indicated. Although this condition is very rare, it must be considered in the differential diagnosis of generalized peritonitis in elderly women. Download .mpg (18.48 MB) Help with mpg files Video 1Much dirty fluid accumulated in the peritoneal cavity. Spontaneous perforation of pyometra with purulent fluid exuding from the lesion on compression was noted.

Abstract 551: A potent and selective cFMS inhibitor regulates the tumor macrophage microenvironment leading to tumor growth inhibition

Abstract Increasing evidence suggests that interactions between tumor cells, stromal cells, macrophages and the extracellular matrix are pivotal to the processes of tumorigenesis, metastasis, and neovascularization. Macrophages within the tumor microenvironment are thought to facilitate cancer progression, making them intriguing targets for therapy. Colony stimulating factor 1 (CSF-1) and its receptor, cFMS, play a central role in the development of mononuclear phagocytes, recruitment of macrophages to tumors, and differentiation and function of osteoclasts. We have developed an orally active, selective small-molecule cFMS inhibitor for cFMS. This molecule inhibits cFMS cellular activity (IC50 = 9 nM) in vitro and inhibits cFMS phosphorylation in a transfected cell line grown in nude mice (ED50 = 3 mg/kg). Our compound also inhibits CSF-1-mediated osteoclast differentiation and function (IC50 values of = 4 nM and 58 nM, respectively). To further explore the potential of our selective inhibitor for the treatment of cancer, we evaluated anti-tumor activity in several preclinical models. We first explored the effect on the murine ovarian cancer cell line, ID8. ID8 cells injected intraperitoneally into nude mice form multiple peritoneal tumor deposits and abundant ascites. Macrophage infiltration in the ID8 ascites was markedly lowered in mice treated with a cFMS inhibitor. Using MCF-7, a human breast adenocarcinoma cell line that has been shown to produce M-CSF, a daily oral dose with 100 mg/kg of our inhibitor for 21 days significantly reduced tumor growth and was accompanied by a marked reduction in tumor-associated macrophages. These findings support the potential of a selective inhibitor of cFMS to favorably impact human cancers by modulating tumor-associated macrophage functions. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 551. doi:10.1158/1538-7445.AM2011-551

Amiloidosis peritoneal AA. Presentación de un caso que simula carcinomatosis peritoneal

Amyloidosis is a group of deposition diseases that are classified according to the type of fibers accumulated and their characteristics. It can affect any organ. The clinical presentation depends on the organs and systems involved. We present the case of a patient with a history of Hashimoto's thyroiditis and systemic symptoms who presented with abdominal pain. Physical examination detected a palpable mass in the umbilical region. CT showed thickening of the wall of the colon with infiltration of the adjacent peritoneum and extension to the root of the mesentery with abundant ascites. The histological diagnosis was peritoneal AA amyloidosis.