Ascitic Cytology Research Articles

Gastric adenocarcinoma presenting as bloody ascites

A 71-year-old male presented to hospital with 3 months of increasing abdominal distention and pain. CT showed large volume ascites and gastric wall thickening in the antrum. He had no history of significant alcohol use or other risk factors for cirrhosis. He underwent paracentesis, and 3 litres of homogenously bloody ascites fluid was removed. Ascites cytology showed discohesive malignant cells. Upper endoscopy showed a 10 cm circumferential gastric mass. Biopsies revealed a diagnosis of gastric adenocarcinoma. The presence of homogenously bloody ascites can be a startling finding to healthcare providers. The differential diagnosis for bloody ascites includes hepatocellular carcinoma or other malignancy, hemorrhagic pancreatitis, perforated ulcers/varices, blunt trauma, and iatrogenic (suggested by recent paracentesis, transjuglar intrahepatic portosystemic shunt, or other procedure). The presence of bloody ascites in an otherwise relatively asymptomatic individual should prompt a search for malignancy. This case highlights a rare presentation of gastric adenocarcinoma as bloody ascites.

Incidence and predictive factors for recurrent clear cell ovarian carcinoma: results from a single center in Thailand.

ObjectiveWe aimed to study the incidence and predictive factors of recurrent clear cell ovarian carcinoma (CCC) and evaluate the oncological outcomes after recurrence.MethodsThis was a retrospective study of 134 CCC cases diagnosed between 2005 and 2020. Clinicopathological data and oncological outcomes were extracted and evaluated. Patients with co-malignancy, mixed pathological type, or incomplete data were excluded. Descriptive statistics, univariate and multivariable analyses, and Kaplan-Meier survival probability estimates were completed. A proportional hazards model was used to assess the association between the prognostic factors with progression-free survival (PFS), overall survival (OS), and post-recurrence survival.ResultsA total of 134 patients with CCC were enrolled. The incidence of recurrent CCC was 33.6% (45/134). The median PFS was 12.8 months (95% confidence interval [CI], 9.66–18.9) in the recurrence group and 3.3 months (95% CI, 1.15–4.4) in the refractory group. Residual tumor from surgical outcome, ascites cytology, and lymphovascular space invasion (LVSI) were independent prognostic factors for PFS. The significant variables were residual tumor (sub-optimal surgery vs. optimal surgery) (hazard ratio [HR], 2.68; 95% CI, 1.48–4.87; P=0.002), ascites cytology (positive vs. negative) (HR, 2.8; 95% CI, 1.58–4.98; P=0.002), and LVSI (positive vs. negative) (HR, 2.14; 95% CI, 1.18–3.86; P=0.04). The median post-recurrence survival was 13.96 months (95% CI, 10.61–26.2) in the recurrence group.ConclusionCCC has a high rate of recurrence. Sub-optimal surgery, positive ascites cytology, and LVSI indicated a worse prognosis for PFS. Optimal cytoreductive surgery is an important part of primary treatment to improve survival in patients with CCC.

The role of cytology in patients with peritoneal carcinomatosis under Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) treatment

Background: Cytology of ascites or peritoneal washing is routine part of intraoperative staging of peritoneal metastases. The aim of this study was to determine the added value of cytology in patients undergoing PIPAC.

Risk Of Malignancy Index 4 Performance as a Predictor Advanced Stage Epithelial Ovarian Carcinoma Used for Neoadjuvant Chemotherapy

The relatively low survival rate in patients with advanced-stage carcinoma ovaries requires early detection to improve treatment outcomes. The method currently used to determine the administration of neoadjuvant chemotherapy is ascites cytology and laparoscopic. This study aims to find a non-invasive technique in determining preoperative Neoadjuvant Chemotherapy administration, and that method can use as a predictor of advanced epithelial ovarian carcinoma. The benefit of this study is to help clinicians consider administering neoadjuvant chemotherapy with a Risk Of Malignancy Index 4 score. An analytical observational study with a retrospective cross-sectional type study with samples of all patients from January 2016 to January 2020 diagnosed at the dr. Saiful Anwar Hospital in Malang indonesia. The number of initial samples of this study is 106 samples. Between the results of the Risk Of Malignancy Index 4 score and the histopathological results, it finds that the p-value was less than 0.05 (p<0.05) indicates that the Risk Of Malignancy Index 4 score is very good for predicting advanced epithelial ovarian carcinoma. With a sensitivity of 86,2%, specificity of 87,5%, the cut of value Risk Of Malignancy Index 4 to be a predictor of advanced ovarian carcinoma is 2982. This study indicates that the Risk Of Malignancy Index 4 score is excellent for predicting the stage of Epithelial Ovarian Carcinoma. This cut-off value can reference preoperative neoadjuvant therapy to avoid morbidity and mortality due to the high risk of surgery.

A large-scale multi-institutional study evaluating prognostic aspects of positive ascites cytology and effects of therapeutic interventions in epithelial ovarian cancer

Positive ascites cytology is a strong prognostic factor in patients with early-stage ovarian cancer (OvCa). However, limited information is currently available on the impact of positive ascites cytology on patient prognoses under each clinical background. We herein investigated the comprehensive impact of positive ascites cytology on patients with epithelial OvCa and the effectiveness of additional therapeutic interventions, including complete staging surgery and chemotherapy. Among 4730 patients with malignant ovarian neoplasms, retrospectively identified in multiple institutions, 1906 with epithelial OvCa were included. In the investigation of its effects on clinical factors using a multivariate analysis, positive ascites cytology correlated with a poor prognosis. Positive ascites cytology had a significantly worse prognosis than those with negative cytology in all subgroups except for patients with stage IV tumors and a mucinous histology. Chemotherapy may be effective in reducing the negative impact of positive ascites cytology on the prognosis of patients in terms of progression-free and overall survivals, while complete staging surgery did not improve the prognosis of patients with positive ascites cytology. Collectively, our findings suggested that positive ascites cytology had a negative impact on the prognosis of patients with epithelial OvCa, but not those with stage IV tumors or a mucinous histology.

Clinical Significance of Mesenteric Lymph Node Involvement in the Pattern of Liver Metastasis in Patients with Ovarian Cancer.

Mesenteric lymph node (MLN) involvement is often observed in ovarian cancer (OC) with rectosigmoid invasion. This study aimed to investigate the clinical significance of MLN involvement in the pattern of liver metastasis in patients with OC. We included 85 stage II-IV OC patients who underwent primary or interval debulking surgery. Twenty-seven patients underwent rectosigmoid resection, whose status of MLN involvement was judged from hematoxylin and eosin (H&E) staining of resected specimens. The prognostic significance of clinicopathological characteristics, including MLN involvement, was evaluated using univariate and multivariate analyses. MLN involvement was detected in 14/85 patients with stage II-IV OC. Residual tumor status, cytology of ascites, and MLN involvement were independent prognostic factors for progression-free survival (PFS; p = 0.033, p = 0.014, and p = 0.008, respectively). When patients were classified into three groups (no MLN, one MLN, two or more MLNs), the number of MLNs involved corresponded to three distinct groups in PFS (p = 0.001). The 3-year cumulative incidence of liver metastasis of patients with MLN involvement was significantly higher than that of patients without MLN involvement (61.1% vs. 8.9%, p < 0.001). MLN involvement was significantly associated with liver metastasis of hematogenous origin (p < 0.001) compared with peritoneal disseminated origin. MLN involvement is an important prognostic factor in OC, predicting poor prognosis and liver metastasis of hematogenous origin.

Diagnostic efficacy of ascites cell block for ovarian clear cell carcinoma.

Ascites cytology is important for determining the stage and treatment methods for ovarian clear cell carcinoma (CCC) as defined by the 2014 International Federation of Obstetrics and Gynecology classification. Patients with CCC who underwent surgery at our hospital between January 2012 and December 2019 and who received cytodiagnosis of their ascites using Papanicolaou (Pap) and May-Grünwald-Giemsa (MGG) staining, and cell block methods were identified. The cell block technique was performed using hematoxylin-eosin (H&E) staining and immunohistochemical staining for hepatocyte nuclear factor-1β (HNF-1β), estrogen receptor (ER), progesterone receptor (PR), and Wilms tumor-1 (WT-1). Cancer cells of CCC were defined as tumor cells that were positive for HNF-1β and negative for ER, PR, and WT-1. The diagnostic accuracy of ascites cytology using Pap and MGG staining and cell block methods was examined. Based on cytological data, our study included 17 patients: seven (41.1%) with malignant (MAL) ascites, eight (47.1%) with negative for malignancy (NFM), and two (11.8%) with atypia of undetermined significance (AUS) because of a few atypical cells based on Pap and MGG staining. Malignant cells diagnosed by cell blocks were detected in 7/7 patients with MAL ascites based on PAP and MGG staining, 2/8 (25.0%) patients with NFM, and 1/2 (50%) patients with AUS. These findings show that the cell block method combined with the immunohistochemical investigation may be useful for increasing the diagnostic accuracy of malignant cells in CCC.

Gluteal muscle metastasis with peritoneal dissemination from gastric cancer during postoperative adjuvant chemotherapy: a case report

BackgroundSkeletal muscle metastasis from gastric cancer is rare and has a poor prognosis. We reported a case of gluteal muscle metastasis with peritoneal dissemination from gastric cancer during postoperative adjuvant chemotherapy.Case presentationA 64-year-old man with gastric cancer underwent distal gastrectomy with D2 lymph node resection. The pathological diagnosis was poorly differentiated adenocarcinoma and signet cell carcinoma, T3N3bM0, Stage IIIC. Metastases were found in all regional lymph nodes, except 11p. The resection margin was negative. S-1 plus docetaxel therapy was administered as postoperative adjuvant chemotherapy. Six month post-operation, the patient presented with right gluteal muscle tenderness and abdominal distension. Computed tomography revealed a solid mass in the right gluteal muscle, a disseminated nodule on the abdominal wall, and massive ascites. Pathological examination of the gluteal muscle revealed signet cell carcinoma, similar to the resected gastric cancer. The tumor was diagnosed as gastric cancer metastases. Ascites cytology was class V. Thereafter, the patient underwent one course of capecitabine plus cisplatin combined with trastuzumab. Radiation therapy was also administered to relieve the pain of gluteal muscle metastasis. However, chemoradiotherapy was ineffective, and the patient died 2 months after the recurrence.ConclusionsSkeletal muscle metastasis and peritoneal dissemination during adjuvant chemotherapy indicated a poor prognosis.

Primary Ovarian Carcinosarcoma: Cytological, Pathological, Immunocytochemical, and Immunohistochemical Features

Ovarian carcinosarcoma composed of high-grade carcinoma and sarcoma is an extremely rare neoplasm and typically occurs in postmenopausal women aged over 60 years. A 73-year-old female, gravida three para three, presented to our hospital with right lower abdominal pain. Right pelvic solid tumor with ascites was detected on pelvic ultrasound examination. She underwent hysterectomy, bilateral salpingo-oophorectomy and partial omentectomy, but the tumor had invaded to the right ureter, and some fragile tumor could not be taken (sub-optimal surgery). On the imprint and ascitic cytology specimens during operation, atypical cells suggestive of adenocarcinoma and spindle atypical cells with immunocytochemically vimentin positive were found. The resected tumor was histopathologically carcinosarcoma consisted of serous adenocarcinoma, chondrosarcoma and fibrosarcoma. Immunohistochemical analysis revealed that adenocarcinoma cells were positive for AE1/AE3 and fibrosarcoma cells stained with vimentin. The final diagnosis was the right ovarian carcinosarcoma (stage pT3CNxMx). Microsatellite instability was stable and BRCA1/2 mutations could not be found in the carcinosarcoma cells. The patient was given four cycles of chemotherapy with paclitaxel, carboplatin and bevacizumab regimen, and thereafter she was treated with the ifosfamide and cisplatin because of slight elevation of serum CA125.

Abstract 6470: Possibility of digital cytology of intraoperative ascites and lavage fluid in patients with colorectal cancer

Abstract Introduction: In patients with colorectal cancer, the results of intraoperative peritoneal cytology do not affect the prognosis. One of the reasons is the low sensitivity of peritoneal cytology. Thus, improving the sensitivity of peritoneal cytology may improve the accuracy of prognostic prediction. Digital cytology (dCytology), which detects genetic mutations in ascites or abdominal lavage fluid using digital polymerase chain reaction (PCR), is a new method by which to evaluate peritoneal cytology. In this study, we evaluated the sensitivity and clinical significance of dCytology. Methods: We included patients with clinical T3-T4 colorectal cancer who underwent surgery from November 2018 to November 2019 in our department. In patients with ascites, ascitic fluid was collected at the start of surgery. In patients without ascites, lavage fluid was collected using 50 mL of physiological saline. Half of the liquid was used for conventional cytology, and the other half was used for dCytology. DNA was extracted from the supernatant and intraperitoneal free cells and from the cancer tissue. Circulating tumor DNA was extracted from the preoperative plasma. Digital PCR was performed on cancer tissue, supernatant DNA, intraperitoneal free cell DNA, and circulating free DNA (cfDNA) using a KRAS multi-probe. Results: This study included 150 patients, 75 of whom had KRAS mutation in their tissues. Among them, dCytology was positive in 45 patients (60%, pStage I/II/III/IV/recurrence/unresectable: 6/22/23/16/4/4). Thirty patients had right-sided colon cancer, 20 had left-sided colon or upper rectal cancer, 7 had lower rectal cancer, and 4 had recurrent disease. Conventional cytology was positive in 11 of the 45 patients (24%), and dCytology was positive in 7 of the 11 patients. cfDNA was positive in 19 patients, and dCytology was positive in 10 of the 19. Four patients, including two patients with positive dCytology but negative conventional cytology, developed recurrence disease. Two of the four patients developed liver metastasis but no peritoneal dissemination. Discussion: The sensitivity of dCytology was higher than that of conventional cytology. Our results suggest that tumor cells can exist in the abdominal cavity of patients with colorectal cancer. Interestingly, dCytology was positive even for patients in whom the tumor was not exposed on the outside of the colon wall (T3) and in whom the tumor was not located in the abdominal cavity (Rb). Citation Format: Koji Ueda, Takeshi Yamada, Michihiro Koizumi, Seiichi Shinji, Akihisa Matsuda, Ryo Ohta, Goro Takahashi, Masahiro Hotta, Kohki Takeda, Keisuke Hara, Sho Kuriyama. Possibility of digital cytology of intraoperative ascites and lavage fluid in patients with colorectal cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6470.

Correction to: Diagnostic impact of ascites cytology in 941 patients: malignancy rates and time of detection in ovarian cancer relative to other tumor types

Unfortunately we did not explain the type of sample collection in "materials and methods".

Is cell block technique useful to predict histological type in patients with ovarian mass and/or body cavity fluids?

ABSTRACTThe cell block (CB) technique is a generalized method utilized for the diagnostic evaluation of body cavity fluids. Ascites cytology is one of the most important diagnostic processes for epithelial ovarian cancer. However, in clinical practice, the usefulness of the CB method to diagnose this tumor remains unelucidated. Between 2008 and 2017, 15 peritoneal or pleural fluid samples obtained from patients with ovarian or peritoneal carcinoma or other gastrointestinal malignancies were preoperatively subjected to a diagnostic evaluation to predict the histological type and original organ. The CBs were made from 10% formalin neutral buffer solution fixed sediments of fluid samples after cytological smears were made by conventional method. Four-μm thickness sections were prepared from the cell blocks and stained with immunohistochemical method, using 16 kinds of antibodies and hematoxylin eosin staining method. The cellularity, architectural patterns, and morphological details were also studied. The median (range) age of patients was 73 (35–87) years. The clinical features were identified as follows: pleural effusion in 4, ovarian mass in 7, peritoneal dissemination in 12, para-aortic nodal swelling in one, and liver tumor in one (some overlapping). Five patients had a history of prior malignancy. Finally, we could accurately diagnose the histological type in 9 patients based on subsequent biopsy, surgery, and autopsy. In all 9 women, the clinical diagnosis, CB diagnosis and final pathological diagnosis were consistent. The CB technique may be a helpful modality for evaluating fluid cytology to obtain a final histopathologic diagnosis.

Diagnostic impact of ascites cytology in 941 patients: malignancy rates and time of detection in ovarian cancer relative to other tumor types.

Cytological analysis of ascitic fluid is an important tool for diagnosis, staging, and prognostic assessment in patients with cancer, but more detailed information is needed regarding malignancy rates and the time sequence in which ascites develops for different sites of cancer origin. Especially, an increased early tumor diagnosis may improve the acceptance for cytological examinations for the tumor patients in oncological practice. Ascites specimens from patients who were treated at Bayreuth Hospital from 2006 to 2015 were reevaluated retrospectively and correlated with clinical reports. 580 of all 941 ascitis specimens (61.6%) were from patients with malignancies with predominant appearance of gastrointestinal and gynecological tumors in 516/580 (89%) patients. Histologically, 549 (94.6%) were carcinomas, 23 (4%) hematological malignancies, 5 (0.9%) mesotheliomas and 3 (0.5%) were melanomas. Malignant ascitic fluid was noted in 298 of the 580 (51.4%) patients with cancer, thus the overall malignancy rate in the ascites specimens examined was 298/941 (31.7%). The most frequent malignancy rate for gynecological tumors we obtained in ovarian cancer with 85.7% and in the upper gastrointestinal tract with 77.8% for Barrett's carcinoma and 61,4% for gastric carcinoma. Regarding time of detection, malignant ascitic fluid was noted as a separate finding, prior or simultaneous to the histological diagnosis of cancer in 225/298 patients (75.5%). An outstanding earliest occurrence was found in ovarian carcinoma in 94.9% and in the gastrointestinal tract in pancreatic carcinoma in 66.7%. Tumor staging was the main important clinical question in our single center study of ascitic fluid, especially for patients with gastrointestinal and gynecological malignomas. The highest malignancy rate and earliest time of tumor detection caused the leading importance for ovarian tumors in malignant ascitic fluid. Moreover, the application of immunostains in our study allowed in 75.5% of all tumor patients a correct initial diagnosis, which is important for further clinical therapy.

Upregulation of cyclase-associated actin cytoskeleton regulatory protein 2 in epithelial ovarian cancer correlates with aggressive histologic types and worse outcomes.

Cyclase-associated actin cytoskeleton regulatory protein 2 (CAP2) regulates actin dynamics to control cell cycles and cell migration. CAP2 overexpression contributes to cancer progression in several tumor types; however, the role of CAP2 expression in ovarian cancer remains unclear. This study aimed to clarify the significance of CAP2 expression in epithelial ovarian tumor. We evaluated CAP2 expression in ovarian cancer cell lines using quantitative real-time polymerase chain reaction, western blotting and immunocytochemistry and examined the effect of CAP2 silencing in migration and proliferation assays. CAP2 immunohistochemistry was conducted using tissue specimens from 432 ovarian carcinoma patients; a further 55 borderline and benign 65 lesions were analyzed. CAP2 expression levels were defined as low, intermediate or high, for correlation analysis with clinicopathological factors. CAP2 expression was significantly higher in cell lines from Type II ovarian cancer than in those in Type I, and knockdown of CAP2 showed decreased migration and proliferation. Higher levels of CAP2 expression in human tissues were associated with Type II histology, residual lesion, lymph node metastasis, ascites cytology and higher clinical stage. High CAP2 expression levels were observed in 26 (23.4%) of 111 Type II ovarian cancers and in 16 (5.0%) of 321 Type I cancers but not in any borderline or benign lesions. Multivariate analyses showed that CAP2 expression in ovarian cancer is an independent prognostic factor for recurrence-free survival (P=0.019). CAP2 expression is upregulated in aggressive histologic types of epithelial ovarian cancer and serves as a novel prognostic biomarker for patient survival.

The accuracy of ascites cytology in diagnosis of advanced ovarian cancer in postmenopausal women prior to neoadjuvant chemotherapy.

To evaluate the accuracy of ascites cytology in the diagnosis of epithelial ovarian cancer among postmenopausal women. Ascites samples of women older than 51 years sent for cytology evaluation at our institution between 2010 and 2015 were retrospectively compared to final histology. The sensitivity, specificity, negative, and positive predictive values were calculated. Immunohistochemistry stain results were collected to determine diagnostic profiles. A total of 551 patients, 51 years and over had both cytology and diagnostic histology samples. Of those, 161 patients had pathology confirmed ovarian tumors, 155 of which were malignant. Of the 155 cases of ovarian cancer, 125 patients had malignant cells on cytology examination (true positive); in 30 cases, ascites was negative for malignancy (false negative). In six cases both ascites and final pathology were negative for malignancy (true negative). There were no cases of positive cytology and negative final pathology (ie, no false-positive cases). The sensitivity, specificity, positive, and negative predictive value for cytology diagnosis of ovarian cancer were 80.6%, 100%, 100%, and 16.7%, respectively. Immunohistochemistry was done on cell blocks in 79 cases of ovarian cancer, 75 (94.9%) had profiles diagnostic for ovarian origin. Ascites cytology for postmenopausal women older than 51 years with immunohistochemistry is highly accurate in diagnosis of ovarian cancer. Neoadjuvant chemotherapy can be safely prescribed based on paracentesis evaluations. : Video Summary:http://links.lww.com/MENO/A570.

High expression of maternal embryonic leucine-zipper kinase (MELK) impacts clinical outcomes in patients with ovarian cancer and its inhibition suppresses ovarian cancer cells growth ex vivo.

ObjectiveMaternal embryonic leucine zipper kinase (MELK) is receiving an attention as a therapeutic target in various types of cancers. In this study, we aimed to evaluate the prognostic significance of MELK expression in ovarian cancer using clinical samples, and assessed the efficacy of a small molecule MELK inhibitor, OTS167, using patient-derived ovarian cancer cells as well as cell lines.MethodsExpression levels of MELK in 11 ovarian cancer cell lines were confirmed by western blotting. Inhibitory concentration of OTS167 was determined by colorimetric assay. MELK messenger RNA (mRNA) expression was evaluated in 228 ovarian cancer patients by quantitative polymerase chain reaction. Growth inhibition of OTS167 was also evaluated using freshly-isolated primary ovarian cancer cells including spheroid formation condition.ResultsMELK mRNA expression was significantly higher in ovarian cancer than in normal ovaries (p<0.001), and high MELK mRNA expression was observed in patients with advanced stage, positive ascites cytology and residual tumor size. Patients with high MELK mRNA expression showed shorter progression-free survival (p=0.001). Expression of MELK was also confirmed in 10 of 11 ovarian cancer cell lines tested, and the half maximal inhibitory concentration of MELK inhibitor, OTS167, ranged from 9.3 to 60 nM. Additionally, OTS167 showed significant growth inhibitory effect against patient-derived ovarian cancer cells, regardless of their tumor locations, histologic subtypes and stages.ConclusionsWe demonstrated MELK as both a prognostic marker and a therapeutic target for ovarian cancer using clinical ovarian cancer samples. MELK inhibition by OTS167 may be an effective approach to treat ovarian cancer patients.

Fertility-sparing surgery and oncologic outcome among patients with early-stage ovarian cancer ~propensity score- matched analysis~

BackgroundThe aim of this study was to investigate how much the risks of recurrence and death are increased as a consequence of selecting fertility-sparing surgery (FSS) in young women with epithelial ovarian cancer (EOC).MethodsAfter a central pathological review and search of the medical records from 14 collaborating hospitals, a non-randomized, observational cohort study was conducted between 1987 and 2015, including 1183 women with stage I EOC. Finally, a total of 285 patients with stage I EOC at reproductive age were recruited. Oncologic outcomes were compared between the FSS (N = 101) and radical surgery (RS) group (N = 184) using a propensity score (PS)-matching technique to adjust for relevant risk factors: the age, substage, histological type, grade, CA125 values, ascites cytology, ascites volume, and chemotherapy.ResultsDuring 66.0 months (median) of follow-up, 42 patients (14.7%) developed recurrence, and 31 patients (10.9%) died. In the original cohort, there was no significant difference in overall survival (OS) or recurrence-free survival (RFS) between the FSS and RS groups {Log-rank: OS (P = 0.838), RFS (P = 0.377)}. In the PS-matched cohort after adjustment for multiple clinicopathologic factors, there was no significant difference in RFS or OS between the FSS and RS groups {RFS (FSS vs. RS), HR: 1.262 (95% CI: 0.559–2.852), P = 0. 575; OS (FSS vs. RS), HR: 1.206 (95% CI: 0.460–3.163), P = 0.704}.ConclusionsAfter adjustment for clinicopathologic factors, FSS in itself may not worsen the oncologic outcome in young women with early-stage EOC. A large-scale clinical study is necessary to validate the findings.

2070 A Case of Clear Cell Carcinoma Arising from Cystic Adenomyosis Treated with Laparoscopic Surgerya Case of Clear Cell Carcinoma Arising from Cystic Adenomyosis Treated with Laparoscopic Surgery

Study Objective Ovarian cancer arising from benign endometriotic has been widely reported. cystic adenomyoma is a rare form of adenomyosis. And clear cell carcinoma arising from cystic adenomyosis is even more unusual. Here we report a case of clear cell carcinoma arising from cystic adenomyosis treated with laparoscopic surgery. Design Case report. Setting A tertiary care hospital. Patients or Participants 41-years-old Japanese woman, gravida 4 paras 2. Two years ago, she was pointed out an index finger size cystic lesions in the uterine posterior wall. Interventions Laparoscopic surgery. Measurements and Main Results At her follow-up visit, she did not complain of any particular symptoms, but enlargement of the cystic lesion was pointed out by the transvaginal ultrasound. MRI was performed, and MRI findings revealed that the cystic lesion was cystic adenomyosis with a mural nodule in the cyst. Moreover, the nodule showed slight enhancement with contrast images and high-intensity on diffusion-weighted images in MRI. These findings were suspected malignancy. We performed laparoscopic hysterectomy. Postoperative pathological findings are adenomyosis with clear cell carcinoma within the mural nodule was diagnosed as clear cell carcinoma. We performed laparoscopic bilateral oophorectomy and pelvic lymph node dissection under the laparoscopic surgery as additional surgery. No residual tumor and metastasis was observed, and cytology of ascites was negative. Her final diagnosis was endometrial cancer stage IB, pT1BN0M0, since the nodule was in the outer half of the uterine myometrium. After the second surgery, she suffered from chylous ascites for three months. Adjuvant chemotherapy with paclitaxel and carboplatin was performed after ascites was disappeared. Conclusion Although carcinoma arising from cystic adenomyosis is rare, the enlargement or the appearance of nodules might be suspicious findings of carcinoma arising from cystic adenomyosis. And laparoscopic surgery was useful for diagnosis and treatment of this rare condition.

Peritoneal Metastases from Breast Cancer: A Scoping Review.

Breast cancer is the leading cause of cancer deaths amongst American women aged 20 to 59. While the incidence of breast cancer has been increasing, its mortality rates have significantly declined from 1989 to 2016. As a result, the number of survivors considerably increased. This impacts the detection and management of recurrences. Peritoneal metastases from breast cancer is a rare and challenging clinical presentation. There is a lack of knowledge syntheses and specific recommendations for the management of breast cancer peritoneal metastases. This review aims to determine the pattern of spread, prognosis, diagnosis, and role of surgery in this subset of patients.Relevant studies were searched in PubMed and Web of Science between April and June 2019. Included studies were written in English and reported data on breast cancer peritoneal or gastrointestinal metastases. Articles published before 1990, case reports, editorials, and articles with no full text available were excluded. Data abstraction was performed for citation information, population, sample, methods, relevant results, mentioned limitations, and study design.The search identified 505 unique reports. A total of 21 articles were included in the synthesis. Sixteen articles were observational studies, four were experimental, and one article was a proof-of-concept study. Amongst all observational studies, the diagnostic methods and criteria for breast cancer carcinomatosis were particularly heterogeneous, including ascites cytology, biopsy, surgical exploration, and various computed tomography (CT) findings. The majority of pathology and imaging reports demonstrated that breast cancer peritoneal metastases are mainly associated with invasive lobular carcinoma (ILC) and the following intrinsic subtypes: HER2-enriched, luminal B and basal-like. Experimental studies demonstrated that peritoneal metastases can be studied using breast cancer xenograft models. Somatic loss of both p53 and E-cadherin was associated with ILC peritoneal spread. Studies on prognosis and treatment highlighted that peritoneal metastases were associated with a poorer prognosis than other metastatic sites. In terms of surgical management, there is a paucity of data on the outcomes of hyperthermic intraperitoneal chemotherapy (HIPEC) in these patients. However, included studies suggested a role for cytoreductive surgery in selected patients when there is no residual disease after the procedure.This review summarizes data on the development, diagnosis, prognosis, and treatment of breast cancer peritoneal and gastrointestinal metastases. Patients’ survival is significantly reduced in comparison with other distant metastatic sites. A deeper understanding of the invasion mechanisms and the role of surgery will be important.

Diagnosis of filariasis by cytology of unexplained ascites

Diagnosis of filariasis by cytology of unexplained ascites