Diagnosis Of Primary Peritoneal Carcinoma Research Articles

Diagnostic and prognostic value of HE4 in female patients with primary peritoneal carcinoma.

HE4 is a useful tumor marker for the diagnosis of ovarian, endometrial, and fallopian tube carcinoma. The aim of our study was to investigate the value of serum HE4 compared with CA125 in the diagnosis of primary peritoneal carcinoma and the estimation of treatment response and recurrence. Serum HE4 and CA125 concentrations were measured in both primary peritoneal carcinoma patients and benign gynecological disease controls. The treatment response and recurrence were assessed by serum HE4 and CA125 levels in primary peritoneal carcinoma patients. Serum HE4 and CA125 levels were significantly increased in primary peritoneal carcinoma patients compared with benign disease controls ( P<0.001). Compared with CA125, HE4 had lower sensitivity (84.2% vs. 94.7%), but higher specificity (99.2% vs. 85.3%); the combination of HE4 and CA125 led to higher sensitivity and specificity. In the receiver operating characteristic analysis, the area under the curve was 0.956 for HE4, for CA125 was 0.953, for HE4+CA125 was 0.979. Furthermore, HE4 and CA125 were closely associated with treatment response, and our results indicated that primary peritoneal carcinoma patients displayed a larger drop of HE4 compared with CA125 (75.8% vs. 61.5%). Combined with CA125, HE4 elevation better predicted recurrence in primary peritoneal carcinoma patients during the remission period after treatment. This study indicated that the detection of serum HE4 changes may enhance the effectiveness for detecting primary peritoneal carcinoma and estimating the outcome of treatment and recurrence in female primary peritoneal carcinoma patients.

Peritoneal Tuberculosis: A Retrospective Review of 20 Cases and Comparison With Primary Peritoneal Carcinoma

To evaluate the clinical features of peritoneal tuberculosis (TB) and to compare them with those of primary peritoneal carcinoma (PPC). We conducted a retrospective review of women with peritoneal TB who were managed at Samsung Medical Center from January 1996 to October 2006. As a control sample, patients with a diagnosis of PPC during the same period were also selected for comparison. During the study period, we identified 20 female patients with peritoneal TB. The median age was 39 years (range, 23-69 years), and the median cancer antigen 125 (CA-125) level was 448 U/mL (range, 32-1725 U/mL). Seventeen patients with PPC whom we examined were older, with a median age of 63 years (range, 50-73 years); their median CA-125 level was higher at 1848 U/mL (range, 42-14,380 U/mL). Compared with those of PPC, the radiologic findings of peritoneal TB indicated less severe involvement of the omentum and the mesentery (P = 0.03). Among the 20 patients who underwent operations, 6 (30%) underwent exploratory laparotomy; 12 (60%), diagnostic laparoscopy; and 2 (10%), laparoscopy converted to laparotomy because of severe adhesion. Frozen tissue sections revealed chronic granulomatous tissue reaction in 15 (83.3%) of 18 women with peritoneal TB. Maintaining a high index of suspicion is very important for the successful treatment of peritoneal TB, especially in developing countries. Age, CA-125 level, and omental involvement as identified by computed tomography may be helpful for the differential diagnosis of peritoneal TB and PPC.

Primary peritoneal carcinoma: a rare neoplasm with pleomorphic trophoblastic morphology

We report a case of primary peritoneal carcinoma with trophoblastic morphology in a 78-year-old woman, diagnosed by histological and immunohistochemical analysis of surgically resected specimens, including the omentum and part of the small bowel. Microscopically, the resected specimens showed diffuse infiltration of a poorly differentiated tumor. Numerous large, often multinucleated cells were seen, and mitotic figures were frequent. Immunohistochemical staining showed a positive reaction for most cytokeratins, EP4, EMA, CA-125, Glut1, WT1, beta-hCG and PLAP. We reached a diagnosis of primary peritoneal carcinoma with trophoblastic morphology. To our knowledge this morphology of a primary peritoneal carcinoma has not been described previously.

The Clinical Profile of Primary Peritoneal Carcinoma

Objective : To perform a retrospective analysis of the characteristics, the treatment modalities and the prognosis of primary peritoneal carcinoma. Methods : From January 2003 to June 2004, 5 patients with primary peritoneal carcinoma at the Department of Obstetrics and Gynecology, Yonsei University Medical Center were retrospectively reviewed for their demographic factors, past histories, presurgical assessments, types of surgery, the tumor markers, and types of adjuvant therapy employed. Results : The group consisted of 5 cases of primary papillary serous carcinoma of the peritoneum. The median age at diagnosis was 59 years. All patients were postmenopausal with a median menopausal period of 9.8 years. 1 patient had a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy. All patients had ascites and the abdominal distension was the most common presenting symptom. None of the patients presented with palpable pelvic mass on physical examination nor pelvic examination. All patients underwent gastrointestinal studies including 4 patients with abdomino-pelvic computed tomograpic scans, 2 patients with abdomino-pelvic magnetic resonance imaging studies, 3 patients with positron emission tomography. The magnetic resonance imaging findings were compatible with primary peritoneal carcinoma. The serum CA 125 levels of all 5 patients were elevated with median of 1421.6 U/ml. The serum CA 15-3 levels were also evaluated in 4 patients with median of 190 U/ml. All patients underwent surgery except 1 patient with a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy. Diagnostic laparoscopy with multiple peritoneal seeding biopsies was performed with this patient. Neoadjuvant chemotherapy was performed in 2 patients and postoperative adjuvant chemotherapy was given to all 5 patients. All 5 patients are alive with the follow-up period ranging from 2-15 months. Conclusion : Presurgical diagnosis of primary peritoneal carcinoma is very difficult although magnetic resonance imaging findings may be helpful. Aggressive treatment including maximal cytoreductive surgery with neoadjuvant and/or postoperative adjuvant chemotherapy is recommended for better prognosis of the disease.