Ascitic Cytology Research Articles

Biomarkers of malignant ascites—a myth or reality

Ascitic fluid aspirate cytology, although reasonably specific is not a good screening tool for malignant ascites due to poor sensitivity. Simple test(s) on ascitic fluid or serum which can help differentiate between benign and malignant causes of ascites will be a boon. Ascitic fluid lactate dehydrogenase, cholesterol, and ferritin are the candidate markers evaluated in this study. Ascitic fluid cytology was done on 30 patients of malignant ascites. The modalities used for diagnosing malignant ascites were positive peritoneal biopsy or CT scan evidence of hepatic metastases. Ascitic fluid biochemistry was done in all these 30 patients as well as 30 cases of non-malignant ascites. The parameters analysed were cholesterol, lactate dehydrogenase, and ferritin. The biochemical parameters were estimated in serum as well. Cytology had a sensitivity of 40% for the diagnosis of malignant ascites. Ascitic fluid cholesterol, lactate dehydrogenase, and ferritin had sensitivities of 70%, 74%, and 100%, respectively. Serum cholesterol, lactate dehydrogenase, and ferritin had sensitivities of 57%, and 91%, respectively. Hence, these biochemical markers in ascitic fluid as well as serum can be good screening tools for the diagnosis of malignant ascites.

Hollow spheroids in ascites of ovarian clear cell carcinoma: how are they formed and how do they behave?

Although the multicellular aggregates (spheroids) in malignant ascites are usually solid throughout, they sometimes have acellular hollow spaces, especially in ascites of ovarian clear cell carcinoma. The purpose of this study is to analyse the origin and behaviour of hollow spheroids. Archival cytological and histological specimens of 32 ovarian carcinomas, including 12 clear cell carcinomas, were reviewed. HAC-2, a clear cell carcinoma cell line, was injected into the abdominal cavity of nude mice for direct comparison of ascitic cytology and tumour histology. Spheroids that were collected from nude mice ascites were cultured in vitro to observe their behaviour. Five of six clear cell carcinomas with hollow spheroids showed spherule-like hyaluronan-rich stroma in their tumour tissue, whereas those without hollow spheroids did not. After heterotransplantation, both ascites and tumour imprints showed small or large hollow spheroids. Hyaluronan was detected in the former but not in the latter. The abdominal tumours showed compact spherule-like hyaluronan-rich stroma, enlarged oedematous stroma or intermediate stroma. In both size and hyaluronan status, small and large hollow spheroids were approximately comparable to spherule-like hyaluronan-rich stroma and oedematous stroma, respectively. During culture in vitro, hollow spheroids were maintained as hollow spheroids in suspension, and produced daughter hollow spheroids. The hollow space in the spheroids originates from spherule-like hyaluronan-rich stroma, where water trapping by hyaluronan causes enlargement of the space. The matrix within the hollow space serves as a scaffold that regulates cell polarity and matrix production.

Malignant peritoneal mesothelioma of the great omentum diagnosed by cytology of ascites: case report

Malignant peritoneal mesothelioma of the great omentum diagnosed by cytology of ascites: case report

Port-site metastasis of advanced primary peritoneal cancer after laparoscopic peritoneal biopsy: A case report

Due to the advancement in laparoscopic surgery in gynecology, laparoscopic surgery of patients with gynecologic malignancy is widely used. A 69-year-old woman who had elevated serum level of CA-125 and malignant ascites was transferred from general surgery after laparoscopic peritoneal biopsy. She complained about 2.5 cm sized abdominal wall mass which developed only 1week after surgery. With the impression of ovarian cancer with port-site metastasis, we performed debulking operation and abdominal wall mass excision. The final pathology confirmed primary peritoneal serous papillary adenocarcinoma. Whenever a female patient has elevated serum level of CA-125 and ascites cytology shows adenocarcinoma, she should be referred to gynecologic oncologists fiAnd considering the primary peritoneal or ovarian cancer, primary debulking operation by gynecologic oncolog ist is recommended.

POEMS: A Rare Cause of Low SAAG Refractory Ascites

Purpose: Clinical Case: 67yo WF with no known liver disease presented with refractory ascites, LE edema, and acute renal failure. Six months before admission she developed peripheral neuropathy, ascites, right-sided pleural effusion and shortness of breath. Diuretic therapy led quickly to renal dysfunction requiring diuretic discontinuation and a requirement for serial therapeutic paracenteses. She underwent pleurodesis for her pleural effusion. A right heart catheterization revealed mild pulmonary hypertension but normal cardiac function. PMHx: hypothyroidism. SocHx: no alcohol. FHx: no liver disease. PE: cachectic-appearing, no jaundice or scleral icterus, no stigmata of chronic liver disease. Abd: distended, moderate ascites, NT, no palpable hepatosplenomegaly. Ext: 1+ edema to knees bilaterally. Neuro: significantly decreased lower extremity vibratory and pinprick sensation. Labs: WBC 3,500/mL, HCT 31%, Plt 224,000/mL, alb 2.6 g/dL; liver function tests were normal. Diagnostic paracentesis performed on admission revealed a SAAG of 0.4. CEA, CA 19-9, CA-125 and ascitic cytology, AFB stain, and amylase were all normal. CT of chest/abd/pelvis done to screen for malignancy and/or carcinomatosis showed hepatosplenomegaly and sclerotic bone lesions of sternum, clavicle, and iliac wings. EGD and colonoscopy were nondiagnostic, including small bowel biopsies for celiac disease and rectal biopsies for amyloid. An SPEP and IFE showed a monoclonal M spike of 0.5g/dL with lambda light chain present. Nerve conduction studies confirmed a severe diffuse demyelinating sensorimotor polyneuropathy in the lower extremities. Further testing showed low levels of FSH and LH. Severe symptomatic bradydysrhythmias with syncope in the hospital required pacemaker implantation. Given her polyneuropathy, hepatosplenomegaly, endocrinopathy, monoclonal gammapathy and sclerotic bone changes, concern for POEMS syndrome was raised. A bone marrow biopsy was consistent with multiple myeloma. She was discharged home with plans to initiate therapy for multiple myeloma. Discussion: POEMS syndrome is a rare paraneoplastic syndrome secondary to a plasma cell dyscrasia. It is associated with polyneuropathy, organomegaly, endocrinopathy of various forms, monoclonal gammopathy, and skin changes. The acronym POEMS captures several dominant features of the syndrome but other important features may include elevated levels of VEGF, sclerotic bone lesions, ascites, pulmonary hypertension, and cardiac conduction disturbances. Treatment is directed at the underlying plasma cell dyscrasia. In this case, ascites was one of the main presenting features. Therefore, POEMS syndrome needs to be included in the differential diagnosis of low SAAG ascites.

Peritoneal Seeding and Subsequent Progression of Mantle Cell Lymphoma after Splenectomy for Debulking

Peritoneal seeding after abdominal surgery is a well known route of metastasis in intra-abdominal solid tumours. Direct mechanical contamination, local peritoneal trauma and subsequent inflammation, postoperative immunosuppression, and laparoscopic surgery are the proposed predisposing factors for this type of metastasis. These factors probably result in enhanced adhesion or growth of tumour cells. However, this route of metastasis has not yet been reported for lymphomas. Here, we report the first case of peritoneal seeding of lymphoma cells after an abdominal surgery. A 47-year-old man with mantle cell lymphoma had ascites because of infiltration of the liver. He underwent debulking splenectomy. The postoperative ascites cytology and control abdominal computed tomography imaging both confirmed peritoneal involvement and lymphoma progression. Demonstration of negative peritoneal involvement before surgery and close timing of peritoneal involvement after splenectomy suggested to us that the debulking surgery was the main cause of peritoneal seeding of lymphoma cells in our case. Factors similar to those in solid tumour seeding may also be valid for lymphomas. Peritoneal seeding and consequent disease progression may be a potential complication of abdominal surgery in lymphoma with extensive intra-abdominal involvement.

腹水細胞診にみられた虫垂杯細胞カルチノイドの１例

We report a case of appendiceal goblet-cell carcinoid with malignant cells in ascites. A woman in her 30s having appendiceal goblet-cell carcinoid was found to have atypical cells in ascites cytology. Tumor cells had a high N/C ratio and eosinophilic cytoplasm. Signet-ring-cell-like cells with abundant cytoplasmic mucin were also seen. Immunohistochemically, tumor cells in ascites were positive for synaptophisin and chromogranin A.

Overexpression of Aurora B is associated with poor prognosis in epithelial ovarian cancer patients

Recent studies have indicated that Aurora B expression is related to cell proliferation and prognosis in many cancers, but its association with epithelial ovarian carcinoma is not fully understood. Therefore, we examined the Aurora B kinase expression in epithelial ovarian cancer patients. Using immunohistochemistry, the expression levels of Aurora B and phosphohistone H3 (Ser(10)) (mitosis-specific marker) were measured in 156 patients with epithelial ovarian cancer. The expression levels of Aurora B at the protein and messenger RNA levels were examined using Western blotting and reverse transcriptase polymerase chain reaction. In total, 53 tumorous ovarian samples (34.0%) showed Aurora B overexpression, which was significantly higher than that found in the 15 normal ovarian tissue samples (0%, p = 0.006). The overexpression of Aurora B was also significantly higher in cases showing phosphohistone H3 (Ser(10)) overexpression (44.3% vs. 27.4%, p = 0.03). In addition, the expression of Aurora B in poorly and moderately differentiated carcinomas of the ovary was significantly higher than in well-differentiated carcinomas (53.6% vs. 28.2% vs.10.0%, respectively, p = 0.02). The overexpression of Aurora B was significantly higher in cases with lymph node metastasis (p = 0.01) and a positive ascites cytology (p = 0.008). Overall, the Aurora B overexpression group demonstrated a significantly shorter progression-free survival (p = 0.001) and overall survival (p = 0.023) than the Aurora B low expression group using univariate analysis (log-rank statistic). Aurora B is an effective predictor of aggressive epithelial ovarian carcinoma in terms of differentiation, metastasis, and prognosis.

Management of ascites due to gastrointestinal malignancy

Ascites is the pathological accumulation of fluid within the abdominal cavity. The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach and pancreas. Symptoms include abdominal distension, nausea, vomiting, early satiety, dyspnea, lower extremity edema, weight gain and reduced mobility. There are many potential causes of ascites in cancer patients, including peritoneal carcinomatosis, malignant obstruction of draining lymphatics, portal vein thrombosis, elevated portal venous pressure from cirrhosis, congestive heart failure, constrictive pericarditis, nephrotic syndrome and peritoneal infections. Depending on the clinical presentation and expected survival, a diagnostic evaluation is usually indicated as it will impact both prognosis and the treatment approach. Key tests include serum albumin and protein and a simultaneous diagnostic paracentesis, checking ascitic fluid, WBCs, albumin, protein and cytology. Median survival after diagnosis of malignant ascites is in the range of 1 to 4 months; survival is apt to be longer for ovarian and breast cancers if systemic anti-cancer treatments are available.

P16INK4a expression in cytology of ascites and response to chemotherapy in advanced ovarian cancer

The aim of this study is to investigate p16INK4a expression by immunocytochemistry for ascites in advanced ovarian cancer and explore the possibility to predict chemotherapeutic response and prognosis. The immunocytochemical study was performed on cytology of ascites obtained from 37 Stage III or Stage IV ovarian cancer patients with measurable disease before platinum/taxane-based first-line chemotherapy following primary cytoreductive surgery or as neoadjuvant chemotherapy. Twenty-one of 21 (100%) responders and 6 of 16 (44%) nonresponders showed p16INK4a immunopositivity (p < 0.001). Immunopositivity was frequently observed in serous adenocarciomas (17 of 18, 94%). Overall survival was significantly better in immunopositive cases compared with immunonegative cases (p = 0.0006). For subcellular localization, cytoplasm was diffusely positive in immunopositive cases (n = 27), 12 of which showed stronger nuclear immunostaining and demonstrated superior overall survival. In vitro expression of p16INK4a protein was also examined for both parent chemosensitive and acquired chemoresistant ovarian cancer cell lines. Chemosensitive KF28 parent cells showed stronger nuclear staining compared with chemoresistant KFr13Tx cells showing stronger cytoplasmic staining by immunocytochemistry, which were also confirmed by western blotting. Our data suggest that p16INK4a expression in cytology of ascites is a candidate marker in prediction of the primary response to chemotherapy and prognosis.

Lymphoma Presenting as Peritoneal Lymphomatosis with Ascites

Multiple intra-abdominal organ infiltration or disseminated peritoneal lymphoma receives much less attention than peritoneal carcinomatosis in clinical practice. This may be due to its relatively infrequent occurrence. In this report, an 89-year-old woman was diagnosed with disseminated peritoneal lymphoma with gastric and rectal involvement and marked ascites. Flow cytometry of the surface markers for ascites showed positive results for CD19, CD20 and CD45. Biopsy of the stomach and rectum were all reported to show diffuse large B-cell lymphoma. The cytology of ascites is a simple and effective method for making a diagnosis from adequate samples with time limitations. The management of this disease depends on the individual case. It must be kept in mind that differential diagnosis from other pathologic entities with similar imaging features or high ascitic fluid adenosine deaminase levels is difficult because of considerable overlap of clinical features. To prolong the survival of patients with peritoneal lymphomatosis, diagnosis should be made as early as possible.

Leptin levels in the differential diagnosis between benign and malignant ascites

To evaluate the role of leptin levels in the differential diagnosis of ascites. Ascitic leptin, TNFalpha and serum leptin levels were measured in 77 patients with ascites (35 with malignancies, 30 cirrhosis and 12 tuberculosis). Control serum samples were obtained from 20 healthy subjects. Leptin and TNFalpha levels were measured by ELISA. Body mass index (BMI) and percentage of body fat (BFM) by skin fold measurement were calculated for all patients and control groups. Peritoneal biopsy, ascites cytology and cultures or biochemical values were used for the diagnosis of patients. In patients with malignancies, the mean serum and ascites leptin levels and their ratios were significantly decreased compared to the other patient groups and controls. In tuberculosis peritonitis, ascitic fluid TNFalpha levels were significantly higher than malignant ascites and cirrhotic sterile ascites. BMI and BFM values did not distinguish between patients and controls. In patients with malignant ascites, levels of leptin and TNFalpha were significantly lower than in patients with tuberculous ascites.

Ascites and epithelial ovarian cancers: a reappraisal with respect to different aspects

Ascites is a common finding in patients with epithelial ovarian cancer (EOC). Clinico-pathologic correlations with respect to the presence of ascites, positive cytology and prognostic role of ascites, and the impact of ascitic volumes were not previously studied extensively. A total of 372 patients with EOC were retrospectively evaluated with respect to presence and amount of ascites, cytologic findings, and survival. Two groups were compared by using Chi-square, Student's t and Mann-Whitney U, binary logistic regression, Kaplan Meier and Cox-regression analysis tests, where appropriate. Omental metastasis (P < 0.001; OR: 3.21, 95% CI = 1.945-5.297) and mean number of metastatic lymph nodes (P= 0.008; OR: 1.063, 95% CI = 1.016-1.112) were significantly related with presence of ascites. Evaluation of ascitic volume at different thresholds revealed lymphatic-omental metastasis, and also the disease stage to be significantly different among patient groups at lower threshold values and the positive cytology and high-grade diseases at higher threshold values. In conclusion, presence of ascites correlates with both the intraperitoneal and also the retroperitoneal tumor spread. Amount of ascites has different correlations with the clinico-pathologic factors depending on the thresholds chosen. At lower volumes, lymphatic and omental metastasis seems to correlate with the development of ascites. Once ascites develops, tumor grade seems to be important for larger ascites volumes. Neither the presence of ascites or its volume nor the cytologic positivity was an independent predictor of survival.

EUS-guided paracentesis for the diagnosis of malignant ascites

EUS and EUS-guided fine-needle aspiration (EUS-FNA) have well-defined roles in the diagnosis and staging of GI and pancreaticobiliary malignancy. Malignant ascites usually represents peritoneal carcinomatosis, increases disease stage, and portends a poor prognosis. There are limited data regarding the yield of EUS-guided paracentesis (EUS-P) for the diagnosis of malignant ascites. To determine the usefulness of EUS-P for the diagnosis of malignant ascites. Prospective case series. Tertiary referral academic center. Those presenting for EUS examination for suspected or proven malignancy over a 16-month period were evaluated prospectively for the presence of ascites. EUS-P was performed via a transgastric or transduodenal approach if ascites was detected. Sensitivity, specificity, positive predictive value, and negative predictive value of EUS-P for diagnosing malignant ascites. Six hundred twenty-nine patients were studied. Twenty-five patients with ascites who met inclusion criteria comprised the study cohort. The mean volume of ascites aspirated was 6.8 mL (range, 1-20 mL). Sixty-four percent (16 of 25) of EUS-P samples revealed malignant cytology. Of the group with negative ascitic cytology, 67% (6 of 9) had a proven malignancy. There was one false-negative cytology result. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS-P for diagnosing malignant ascites was 94%, 100%, 100%, and 89%, respectively. The complication rate was 4%; 1 patient developed bacterial peritonitis after EUS-P. The study did not address cost savings in patient care based on the diagnosis of malignant ascites. EUS-P is highly sensitive and specific for diagnosing malignant ascites. The finding of malignant ascites significantly alters patient management, so an active search for ascites and use of EUS-P should be incorporated into the diagnosis and staging of upper GI and pancreaticobiliary malignancy.

Feasibility study of neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) for stage III/IV ovarian, tubal and peritoneal cancers: Japan Clinical Oncology Group study JCOG0206

15020 Background: Retrospective analyses revealed that survival of ovarian cancer patients treated with NAC followed by IDS was comparable with those treated by standard treatment starting with primary debulking surgery. The purpose is to assess the safety and efficacy of the NAC setting treatment and also to know whether we can accurately diagnose the cancer by imaging studies, cytologic findings and tumor markers without diagnostic laparoscopy (DLS). Methods: The study was performed as a multi-institutional non-randomized phase II trial. Eligibility included stage III/IV müllerian carcinoma (MC) such as ovarian, tubal and peritoneal carcinomas diagnosed by imaging studies (CT and/or MRI), cytology of ascites, pleural effusions or fluids obtained by tumor centesis, CA125 &gt;200 U/ml and CEA&lt;20 ng/ml. After study enrollment, DLS is performed to confirm tumor origin, histology and stage. Four cycles of combination of paclitaxel (175 mg/m2, 3h) and carboplatin (AUC 6) are administered as NAC, followed by IDS and additional 4 cycles of chemotherapy. Primary endpoint is proportion of clinical complete remission (% cCR) with CA 125&lt;20 U/ml among all stage III/IV MC confirmed by DLS (expected % cCR of 40% and threshold % cCR of 20%). Major secondary endpoint is positive predictive value (PPV) of clinical diagnoses concerning origin, histology and stage (expected PPV&gt;90%, then DLS will be omitted in the next phase III study). The planned sample size was 56 eligibles, which gives 10% or lower Bayesian posterior probability that PPV is &lt; 90% in case of three false positives. Results: Fifty six patients were enrolled between Jan/2003 and Feb/2004. All patients had accurate pre-DLS diagnosis concerning origin and histology. In 53 (PPV 94.6%) of 56 patients, tumor stage was accurately diagnosed. Twenty nine (62%) of 47 patients who underwent IDS had complete resection without residual tumors. Nineteen (%cCR 36%) among 53 patients with stage III/IV MC achieved cCR at completion of planned treatment. Conclusions: NAC starting without DLS followed by IDS for advanced MC is a promising treatment to be compared with the current standard treatment in a phase III study. [Table: see text]

Immunocytochemical detection using CDX2

Although ascites cytology is important for therapeutic strategies, it is difficult to distinguish cancer infiltration from reactive mesothelial proliferation in some patients. In this study, the authors applied CDX2 immunocytochemistry to improve diagnostic accuracy. The authors examined the distribution of CDX2 expression in carcinoma specimens using paraffin-embedded tissues from various organs from 549 cancer patients. CDX2 immunostaining was applied to the 116 ascites specimens. CDX2 expression was detected in a restricted range of cancers, with the vast majority of them originating from the gastrointestinal tract and pancreas. When applied to ascites specimens, no positive reactions were detected in any of the 81 cytology-negative and molecular genetic analysis-negative specimens. By contrast, 28 of 35 specimens diagnosed as suspicious for malignancy or malignancy showed a positive reaction. Furthermore, the authors found that a nuclear-positive reaction was easily evaluated, even with a high level of background staining, and single cancer cells in 10(6) normal cells could be detected. Results suggest that CDX2 is a specific and sensitive marker to detect gastrointestinal and pancreatic malignancies in ascites cytology.

Multiple primary malignant neoplasms — case report

Abstract The synchronous occurence of primary carcinomas of endometrium and ovary is well recognized. Malignant peripheral nerve sheath tumours (MPNSTs) may also rarely occur in patients diagnosed with malignancies of the female genital tract. We report a rare case of synchronous primary carcinomas of endometrium and ovary, followed by a metachronous retroperitoneal MPNST. Ascites cytology and endometrial biopsy, followed by hysterectomy and bilateral adnexectomy, were performed to remove the synchronous tumors. Histology was suggestive of synchronous endometrial endometrioid carcinoma and ovarian mucinous adenocarcinoma. After the removal of the retroperitoneal tumor, a MPNST was diagnosed by immunohistochemistry. The patient developed two consecutive vaginal tumors diagnosed as metastases of the previously diagnosed endometrial carcinoma. Although synchronous tumors of endometrium and ovary were relatively early staged and consequently had a favorable prognosis, subsequently occuring implants along the lower genital tract and the metachronous MPNST added up to a poor prognosis.

Second-line treatment for Helicobacter pylori eradication after sequential therapy failure: a pilot study

A 64-year-old woman was admitted to the hospital for abdominal fullness and constipation. In the pelvic cavity, an abdominal CT scan revealed massive ascites showing malignancy on histological examination. Upper GI endoscopy revealed type 3 gastric cancer from the anglus to the cardia. A barium-enema showed a stenotic lesion at the sigmoid colon due to peritoneal dissemination. An abnormally high CA125(1,400 mg/ml) level was detected in serum. We performed systemic chemotherapy of TS-1, CDDP and peritoneal infusion of docetaxel on the nonresected gastric cancer with peritoneal dissemination. After 2 cycles, cytology of ascites revealed no malignancy, and the serum CA125 value regained its normal level. After 3 cycles, the killer cell effect was recognized by laparoscopic examination and the stenotic change of sigmoid colon had almost disappeared. The patient clinically achieved good QOL by this method, which was very effective for nonresected gastric cancer with peritoneal dissemination.

Preoperative manometry is not a predictor of postoperative dysphagia in chagasic achalasia

We report a case of gastric cancer with peritoneal recurrence that responded to chemotherapy with paclitaxel and TS-1. A 62-year-old woman, who underwent total gastrectomy for advanced gastric cancer 2 years and 6 months ago, was admitted to our hospital with a chief complaint of abdominal distention and intestinal obstruction due to a large amount of ascites. Cytology of ascites revealed peritoneal dissemination, and chemotherapy with bi-weekly paclitaxel (90 mg/body) was begun. Clinical symptoms, including ascites and intestinal obstruction, were improved only after the second administration of paclitaxel. As she was able to take food orally, she was placed on combined chemotherapy consisting of tri-weekly paclitaxel (9 0 mg/body-120 mg/body: day 1) and TS-1 (80 mg/day: day 1-14) and 1 or 2 weeks rest. The patient had no signs or symptoms of peritoneal metastasis or toxicity except for general fatigue and watery eyes 1 year and 8 months after the diagnosis of peritoneal metastasis. Paclitaxel and TS-1 therapy was thought to be an effective chemotherapy against recurrent gastric cancer with peritoneal dissemination.

Long-term follow-up and prognostic factor analysis in clear cell adenocarcinoma of the ovary

There were a few reports of a large number of patients with clear cell adenocarcinoma (CCA) of the ovary because of the low incidence of CCA. This study compared the clinical factors affecting long-term survival of patients with CCA to those with serous cystadenocarcinoma (SCA). One hundred and seventy-eight CCA and 311 SCA patients treated between 1987 and 2000 were retrospectively evaluated. Differences in survival rates were calculated using log-rank test and Cox's proportional hazards analysis was used to identify independent prognostic factors. The ratio of stage I was significantly higher than that of SCA. There was no significant difference of 8-year survival rate in each stage between CCA and SCA. However, the patients with stage IIIb or IIIc CCA showed significantly worse prognosis than those with SCA. Positive peritoneal or ascitic cytology, the presence of residual tumor, more than 100 ml ascites were demonstrated to have the significant impact on survival by univariate analysis. Multivariate analysis demonstrated that stage, more than 100 ml ascites, and the presence of residual tumor were significant prognostic factors of CCA overall survival. Distribution of stage and substage differed between CCA and SCA in this study. Thus, substaging is quite important for comparison of prognoses between histologies, and CCA showed poorer prognoses than serous adenocarcinoma in stages IIIb and IIIc.