Omental Cake Research Articles

Investigating the causes and pattern of peritoneal involvement in CT scan and comparison with ultrasound findings in peritoneal conditions: A two-center, cross-sectional study.

Ultrasound and computed tomography (CT) scans can be used as methods to help make a more accurate diagnosis in diseases involving the omentum and peritoneum. The present study was conducted to determine etiology and CT scan pattern of peritoneal involvement and compare it with ultrasound findings. Patients referred to Ghaem and Imam Reza hospitals who had undergone CT scans and had involvement of peritoneum in abdominal CT scans were included in the study. The findings identified in the CT scan were recorded. According to the underlying cause determined by laparotomy or laparoscopy sample, each disease's most common pattern of involvement and types of patterns were examined. An ultrasound was conducted for every patient and the obtained information was analyzed. A total of 101 patients were included in the study, of which 61 patients (59.8%) were female and the rest were male. The most common involvement patterns in CT scans included nodular (37.6%), mixed (21.8%), and omental cake (17.8%), respectively. In 80 patients (79.2%), CT scan findings were consistent with ultrasound, but in 21 patients (20.8%), CT scan findings were not visible in ultrasound. The most common diagnoses of the patients were colorectal adenocarcinoma and gastric adenocarcinoma (20 cases, 19.8% each), followed by ovarian and uterine adenocarcinoma (19 cases, 18.8%). The most common patterns of involvement of peritoneum in CT scans include nodular pattern, mix, and omental cake. The most common diseases that lead to the involvement of peritoneum are gastrointestinal cancers, uterine and ovarian cancers, and peritonitis.

#348 : Primary Broad Ligament Endometrioid Carcinoma – A Case Report of a Rare Entity

Background: Primary broad ligament epithelial malignancies are rare occurrence. Hence, the treatment options are uncertain. Therefore, an accurate diagnosis is warranted to manage this condition. Case report: We present a 61-year-old female with abdominal distension associated with significant weight loss for six months. A computed tomography (CT) scan of the abdomen and pelvis revealed a pelvic mass measuring 10.7 × 14.6 × 13.5 cm with omental caking. Result: An exploratory laparotomy and tumour debulking was performed. Histological examination revealed moderately differentiated endometrioid carcinoma of the broad ligament stage IC and an endometrioid carcinoma of endometrium, stage 1A. She received external beam radiotherapy; brachytherapy followed by adjuvant chemotherapy with a 6 monthly surveillance. Currently, she is healthy with no recurrence at 24 months postoperatively. Conclusion: The rarity of primary broad ligament endometrioid carcinoma may incline clinicians to suspect more common malignancies such as ovarian. However, with an accurate diagnosis, the treatment will allow a better prognosis to the patient.

Clinical and ultrasound features of pseudomyxoma peritonei and its histopathological subtypes among women seen at a Philippine tertiary hospital: A 10-year review

OBJECTIVES: Pseudomyxoma peritonei (PMP) in women arises from an appendiceal or ovarian pathology and presents either of two histological subtypes of differing prognosis, disseminated peritoneal adenomucinosis (DPAM), or peritoneal mucinous carcinomatosis (PMCA). This study aimed to evaluate the demographic, clinical, and sonographic features among affected women and the differences between the two histological subtypes. METHODS: A retrospective study was conducted involving 36 women with histopathological diagnosis of PMP who had preoperative ultrasound and underwent surgery at the department of obstetrics and gynecology in a tertiary hospital. Demographic and clinical data, ultrasound images and reports, and final histopathology were reviewed. To compare the subtypes, one-way analysis of variance for continuous data and Chi-square/Fisher exact test for categorical data were used, with P < 0.05 indicating statistical significance. RESULTS: Patients were mostly >50 years of age, multigravid, and presented with abdominal distention. Ultrasound examinations consistently showed amorphous, mixed echo or echogenic ascites, peritoneal thickening, and omental caking. Adnexal/ovarian masses were detected in 66.7% of cases. Omental caking was significantly more prevalent in PMCA (83.3%; P = 0.0002), whereas larger ovarian tumors (>20 cm) and papillarities were more common in DPAM (both 92.9%; P = 0.0005). Most patients underwent gynecologic surgery (n = 31; 86.1%), and 14 (38.9%) required readmission due to recurrence. The final histopathology revealed largest tumor involvement of the appendix (n = 13; 36.1%), the ovaries (n = 11; 30.5%), or undetermined (n = 12; 33.3%). CONCLUSIONS: Preoperative diagnosis of PMP is possible based on its clinical and ultrasound features. Although the subtypes are similar in most of these features, certain ultrasound findings may aid in distinguishing them.

DIPG-51. ABDOMINAL METASTASES OF DIFFUSE MIDLINE GLIOMA, H3K27-ALTERED WITH A VENTRICULOPERITONEAL SHUNT

Abstract Extraneural metastases are extremely rare in diffuse midline glioma (DMG), H3K27-altered, despite a tendency toward aggressive local growth and potential neuroaxis dissemination at progression. Ventriculoperitoneal shunt (VPS) placement for cerebrospinal fluid diversion is commonly performed in patients with thalamic tumors and increasingly considered in brainstem disease with developing hydrocephalus. Herein, we present a case of DMG seeding the abdomen presumably via the VPS. This patient was diagnosed at 22 years of age with a bithalamic tumor with extension into the brainstem and cerebellum as well as non-contiguous periventricular spread to the bilateral frontal lobes, with associated hydrocephalus. The patient underwent VPS insertion and biopsy, with pathology consistent with DMG, H3K27-altered. Whole exome sequencing revealed H3-3A and TP53 alterations as well as PDGFRA amplification. Treatment consisted of upfront craniospinal photon irradiation, with subsequent reduction in thalamic disease burden. Adjuvant therapy with an oral PDGFRA inhibitor (avapritinib) was initiated, though discontinued after two weeks due to worsening neurocognitive deficits. The patient presented three months post-completion of radiation, five months from diagnosis, and six weeks following VPS revision with rapidly progressive abdominal distension and altered mental status, with imaging demonstrating omental caking and significant malignant ascites, resulting in shunt malfunction and increased intracranial pressure. With limited therapeutic options, the family decided not to pursue further intervention and the patient died five days later. Autopsy confirmed metastatic disease throughout omentum, in addition to diffuse leptomeningeal dissemination. Comprehensive molecular profiling of diagnostic and post-mortem thalamic and omental tissue is in process to assess temporal as well as spatial genomic heterogeneity, including of metastasis-mediated pathways. In summary, abdominal dissemination of DMG, H3K27-altered is uncommon, but possible, especially in the presence of a VPS. Further research is necessary to determine biologic mechanisms and predictors of extraneural metastases in this disease.

Case report: diagnostic approach to malignancy ascites patient who misdiagnosed with abdominal tuberculosis

Introduction: Ascites is an accumulation of free fluid with an abnormal amount in the peritoneal cavity. The causes of ascites are hepatic cirrhosis, malignant ascites, and mixed ascites, which can be caused by tuberculosis infection. Malignant ascites is a pathological condition caused by primary abdominal and extra-abdominal malignancies. This study aims to report malignant ascites that was misdiagnosed with abdominal tuberculosis. Case Presentation: Forty-one years old man came with an enlarged stomach, pain in the abdomen, fever, and decreased appetite accompanied by >20 kg weight loss with a change in bowel habits in the last 3 months. At first, the patient was diagnosed with abdominal tuberculosis and took a tuberculosis drug regimen for almost 2 months. However, the patient did not feel any improvement in the symptoms he was experiencing. The patient then went to Soetomo General Hospital and underwent several examinations. In colonoscopy examination, we found a mass in the transverse colon that almost covered the lumen with hard consistency and was not easy to bleed. Pushing outside the recto-sigmoid lumen causes narrowing of the lumen, and from CT scan showed a solid mass in the pelvic cavity; visible lesions penetrate the serosa to form a picture of "fat stranding," attached to the rectum posteriorly and bluntly to the anterior; multiple nodules in the left mesentery with peritumoral lymphadenopathy can be a feature of malignant soft tissue mass. Ascites accompanied by multiple nodular peritoneal thickening and thickening of the omentum that forms an omental cake can represent peritoneal carcinomatosis. The results of the open biopsy obtained histopathological results in the adverse colon suggesting adenocarcinoma, signet ring cell carcinoma. All the examination results led to the diagnosis of colorectal cancer. Conclusion: A 41 years old man, who was misdiagnosed with abdominal tuberculosis and had been taking the drug for tuberculosis for 2 months, has no improvement in his symptoms. Then he went to Soetomo General Hospital and underwent several examinations, which led to the diagnosis of colorectal cancer. This instance demonstrates that some doctors still struggle to diagnose colorectal cancer, even if patient outcomes improve with earlier treatment.

The Omental Cake Sign in Pediatric Tuberculosis.

Ultrasound and computed tomography (CT) images showing ascites and omental infiltration (omental cake sign) in a 12-year-old girl with abdominal pain and fever for two weeks. The presence of abdominal and mediastinal lymphadenopathy as well as of a pulmonary consolidation at CT suggested a diagnosis of tuberculosis which was then clinically confirmed. After treatment with ethambutol, rifampicin and isoniazid, pyrazinamide, and vitamin B6 (i.e., intensive treatment for two months followed by a continuation phase with two drugs regimen for four months) the patient fully recovered. Abdominal involvement is rare in children with tuberculosis but the presence of omental involvement together with ascites and enlarged lymph nodes at imaging may suggest this diagnosis and guide the clinicians to proper testing.

S2917 Acute Alcoholic Hepatitis With Portal Hypertension Complicated by Tuberculous Peritonitis and Ascites

Introduction: Peritonitis related to tuberculosis (TB) infection is rare in the US and normally associated with immunocompromised states. We present a patient found to have TB peritonitis during evaluation of alcoholic hepatitis without evident lung disease. Case Description/Methods: The patient is a 39 yo male born in Mexico with no medical history who presented with three days of abdominal distention, jaundice, and fevers in the setting of alcohol use disorder. He had no other historic risk factors for TB or cough. Exam was remarkable for a distended abdomen. Laboratory results showed leukocytosis, total bilirubin 3.5 (mg/dL), alkaline phosphatase 295 (U/L), AST 147 (U/L), ALT 62 (U/L), and positive quantiferon gold. Chest x-ray had no pulmonary lesions. Ascites fluid studies were significant for high white count (2214 k/uL) with lymphocytic predominance (91%). The serum ascites albumin gradient was consistent with portal hypertension, and ascites total protein was elevated (3.6 g/dL). Fluid ADA was positive. Cross sectional imaging of the abdomen showed omental caking, peritoneal lining nodularity, and hepatosplenomegaly. Fine needle aspiration of the peritoneum showed necrotizing and non-necrotizing granulomas. Sputum gram stain was negative for acid fast bacilli although sputum and ascites cultures ultimately grew TB (Figure). The patient was started on rifampin, isoniazid, pyrazinamide and ethambutol for TB and abstained from further alcohol use. Three months after discharge, jaundice and ascites had resolved and his liver tests had significantly improved. Discussion: TB peritonitis makes up 4-10% of extrapulmonary TB infections. Though rare in the US, it has a high mortality rate (50-60%). Diagnosis can be complicated by difficulty isolating the organism and culture results can take weeks. TB peritonitis can be supported by ascites fluid studies with elevated lymphocyte count, total protein, and positive ADA; although for more definitive diagnosis peritoneal biopsy should be considered. This patient represents a unique confluence of portal hypertension related ascites, induced by acute alcoholic hepatitis, along with TB peritonitis. It is possible that transient immunosuppression from alcoholic hepatitis served as a risk factor in reactivation and dissemination of latent TB. An index of suspicion for TB infection, based on his foreign birth, along with his abnormal ascites fluid studies, led to the peritoneal biopsy and ultimate culture diagnosis of his infection that might otherwise have been overlooked.Figure 1.: Nodularity of the peritoneal lining.

S1741 Gelatinous Ascites and a Double Duct Sign: A Case of Pancreatic Adenocarcinoma

Introduction: Pseudomyxoma peritonei (PMP) is a rare disorder characterized by the accumulation of gelatinous material within the abdomen and pelvis. While usually appendiceal in origin, it can be seen with mucinous tumors arising from the ovary, GI tract, urachus, and pancreas. We describe a case of pancreatic adenocarcinoma diagnosed due to the clinical syndrome precipitated by pseudomyxoma peritonei. Case Description/Methods: A 59-year-old Hispanic male presented to the hospital for evaluation due to a 2 month history of poor oral intake and worsening abdominal fullness, distension, discomfort, and intermittent pain. The patient reported one prior hospitalization for pancreatitis of unclear etiology, 3 years ago. A CT abdomen & pelvis was obtained; findings reported include multiple hepatic subcapsular cystic liver lesions, abdominal omental caking, ascites, and extrahepatic biliary and pancreatic ductal dilatation without definitive evidence of a mass. CEA and CA 19-9 were found to be elevated at 49.4 and 416 respectively. CT chest revealed a left-sided pleural effusion. Upper endoscopy and colonoscopy were negative. Paracentesis yielded gelatinous ascites. Clinical suspicion for appendiceal malignancy was raised which required surgical exploration and biopsy to confirm. An MRI of the abdomen was obtained to assess for pancreatic mass given presence of double duct sign. MRI revealed 2.2 x 2.7 x 5 cm lesion in the body of the pancreas, pseudomyxoma peritonei with scalloping of the liver and extension into the right posterior mediastinum via the esophageal hiatus, metastatic deposits in the porta hepatis and peritoneal carcinomatosis. No apparent abnormality in the appendix was observed. EUS FNA was performed; splenic vessel invasion by the mass was noted. Cytopathology supported a diagnosis of pancreatic adenocarcinoma. The patient was initiated on palliative chemotherapy with gemcitabine and nab-paclitaxel which led to a significant reduction in ascites and pleural effusion and improvement in symptoms. Discussion: This case highlights the potential of malignancies such as pancreatic adenocarcinoma to cause pseudomyxoma peritonei despite it more commonly being associated with appendiceal origin. Knowledge of this can help guide diagnostic and therapeutic plans.

Is MDCT an accurate tool to differentiate between benign and malignant etiology in diffuse peritoneal disease?

There is often considerable overlap of imaging findings in benign and malignant peritoneal diseases. We evaluated patients with diffuse peritoneal disease, to assess the diagnostic value of MDCT in predicting benign or malignant etiology in patients with unknown etiology, by analyzing the various patterns of involvement, particularly tuberculosis (TB) vs malignancy. One hundred and thirty-six patients with diffuse peritoneal disease who had abdominal CT and subsequently underwent omental biopsies were included in the study. Peritoneal, mesenteric and omental involvement by disease was evaluated on CT using specific parameters. The presence of lymphadenopathy, ascites, scalloping of organs, involvement of liver and spleen, were also compared between benign and malignant conditions using histopathology as the gold standard. In 136 patients, 72 benign and 64 malignant pathologies were classified as per histopathology. Higher age (p < 0.001), increasing omental thickness (mean 25.2mm, p = 0.004), omental caking (p < 0.001), > 10mm mesenteric/peritoneal nodules (p < 0.03), visceral scalloping (p = 0.001), free ascites (p = 0.003), serosal involvement (p = 0.004) and bilateral pleural effusion (p = 0.02) were associated with malignant etiology. Mesenteric thickening/stranding (p = 0.02), mesenteric adenopathy (p < 0.001), necrotic nodes (p = 0.02), splenomegaly (p = < 0.001) and higher attenuation (> 20HU) of ascitic fluid (p < 0.001) were associated with benign etiology. The presence of mesenteric thickening or stranding (p = 0.01), splenomegaly (p = 0.02), higher ascitic fluid attenuation > 20HU (p = < 0.01), mesenteric adenopathy (p < 0.01), necrotic nodes (p = 0.03) favored tuberculosis. CT had diagnostic accuracy (79.3, 86.7%), sensitivity (79.2, 74.6%) and specificity (79.4, 97%) for observers 1 and 2, respectively (Kappa 0.713). Contrast-enhanced MDCT has good sensitivity, specificity and accuracy in differentiating benign and malignant etiologies of diffuse peritoneal disease. Multiple common parameters can be used to differentiate between tuberculous peritonitis and peritoneal carcinomatosis.

EP-138 Pseudomyxoma peritoni induced by appendiceal mucinous adenocarcinoma- a case report

Abstract Introduction Appendiceal tumours are rare and mucinous tumours account for 58% of the malignant tumours of appendix according to SEER data base, with remaining being carcinoid tumors. Mucinous tumours of appendix have a potential of peritoneal spread in the form of gelatinous material, resulting in pseudomyxoma peritoni (PMP). We report a case of mucinous adenocarcinoma of appendix inducing pseudomyxoma peritoni in a 37 year old male. Case summary A 37 year old male presented with generalised abdominal pain for 2 months and gradually increasing abdominal distension over a period of one month. On examination, abdomen was tense, distended and mildly tender. Rest of systemic examination was unremarkable. Biochemical investigations revealed normal blood complete picture. AST was mildly raised. ALP was 330 (normal upto 130 U/L. Bilirubin, total proteins and renal function tests were within normal limits. CECT abdomen and pelvis showed omental caking and moderate ascites with no overt bowel mass lesion. Diagnostic laparoscopy was done which showed extensive mucinous deposits over peritoneum. Biopsy was taken which revealed metastatic mucinous adenocarcinoma with appendix as primary organ of origin on immunohistochemistry (CK 7 -/CK 20 +, CDX 2 positive). CEA levels were done which were 220 ng/ml (normal upto 10 ng/ml). Patient was referred to oncology centre for further management. Discussion PMP occurs in 7th decade of life and more common in females with a M: F ratio of 1:4 and is almost always of appendiceal in origin. Conclusion PMP is rare tumour with negligible incidence in younger population.

Robotic assisted primary cytoreductive surgery for treatment of advanced stage ovarian cancer: A pilot study (553)

Robotic assisted primary cytoreductive surgery for treatment of advanced stage ovarian cancer: A pilot study (553)

Highly Aggressive Surgery Benefits in Patients With Advanced Ovarian Cancer.

We investigated whether highly aggressive surgery has survival and perioperative complication benefit in patients with advanced ovarian cancer. This retrospective study included 209 patients with stage III/IV ovarian cancer who underwent aggressive surgery [surgical complexity score (SCS) ≥8] between January 2008 and December 2018. Patients were categorized into the SCS 8-12 (less aggressive surgery, 83 patients) and SCS ≥13 (highly aggressive surgery, 126 patients) groups. Survival outcomes and perioperative complications between the groups were compared. Patient suitability for primary debulking surgery or neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) was based on the evaluation of performance status, tumor load, and ascites. If patients were suitable for NACT/IDS, the residual tumor margins were marked at the initial laparotomy. The previously marked lesions were removed during IDS, even in patients with macroscopic tumor resolution. Prevalence rates of stage IV disease, poor performance status, presence of omental cake, peritoneal cancer index ≥15, and IDS performed were significantly higher in the highly aggressive surgery group than in the less aggressive surgery group. The median progression-free survival (PFS) and overall survival (OS) were not significantly different between the groups (PFS, 32 and 31 months, respectively; p=0.622; OS, 99 and 75 months, respectively; p=0.390). The incidence of severe perioperative complications was not significantly different between the less aggressive group (4.8%) and the highly aggressive surgery group (6.4%) (p=0.767). Highly aggressive surgery with appropriate selection regardless of the timing of cytoreduction benefits patients with advanced ovarian cancer.

Omental cake invading the urinary bladder – a case report and literature review

Omental cake represents a common finding in advanced stage ovarian cancer and is characterized by the complete omental transformation. Most often it is associated with subjacent invasion of the enteral segments and needs multiple resections in order to achieve radical cytoreductive surgery. Meanwhile, in other cases different visceral invasions are encountered necessitating other visceral resections. The aim of the current paper is to report the case of a 55 year old patient diagnosed with stage IIIC ovarian cancer in whom intraoperatively omental cake transformation invading the urinary bladder was encountered.

Spiderweb omentum – A previously unknown surgical finding in ovarian cancer

Carcinoma ovary is the most lethal gynecological malignancy and thereby, leading cause of death worldwide. Most common histopathology of ovarian cancer is high-grade serous carcinoma. More than 75% patients present at advanced stages, FIGO stage III onwards. The response of chemotherapy in patients is variable and the surgical finding of the state of omentum following chemotherapy has not been described specifically in literature. Here we presented a case of carcinoma ovary whose omental caking totally dissolved after chemotherapy leaving behind only the vasculature resembling a spiderweb. Though the treatment policy was the same. Keywords: Carcinoma ovary; Neoadjuvant Chemotherapy; Omental caking; Spiderweb omentum.

Ascites of Unexplained Origin: A Case Report

Ascites is defined as a massive collection of fluid in the peritoneal cavity, and it is most commonly caused by portal hypertension due to liver cirrhosis, acute liver failure, and heart failure. We report a case of ascites in a 39-year-old male who presented to the ED complaining of abdominal distention, sporadic pain on the epigastric area, unintentional weight loss over the past two months, night sweats, and blood-mixed stool. We conducted several imaging investigations and laboratory studies and none of them revealed any significant findings except for the abdominal CT with contrast, which showed large ascites along with submucosal fat deposition in the long segment of the transverse colon, suggestive of chronic inflammation [probably inflammatory bowel disease (IBD)], omental caking, and thickening. Peritoneal malignancy was highly suspected.A diagnostic/therapeutic paracentesis was performed, through which 8 L of fluid was drained. Cytology was also performed and this showed mostly reactive mesothelial cells, negative acid-fast bacilli (AFB) culture, and negative polymerase chain reaction (PCR). We also discuss the other investigations performed, none of which helped in establishing a diagnosis.

Radiomics analysis based on CT\u2019s greater omental caking for predicting pathological grading of pseudomyxoma peritonei

The objective of this study was to predict the preoperative pathological grading and survival period of Pseudomyxoma peritonei (PMP) by establishing models, including a radiomics model with greater omental caking as the imaging observation index, a clinical model including clinical indexes, and a combined model of these two. A total of 88 PMP patients were selected. Clinical data of patients, including age, sex, preoperative serum tumor markers [CEA, CA125, and CA199], survival time, and preoperative computed tomography (CT) images were analyzed. Three models (clinical model, radiomics model and combined model) were used to predict PMP pathological grading. The models’ diagnostic efficiency was compared and analyzed by building the receiver operating characteristic (ROC) curve. Simultaneously, the impact of PMP’s different pathological grades was evaluated. The results showed that the radiomics model based on the CT’s greater omental caking, an area under the ROC curve ([AUC] = 0.878), and the combined model (AUC = 0.899) had diagnostic power for determining PMP pathological grading. The imaging radiomics model based on CT greater omental caking can be used to predict PMP pathological grading, which is important in the treatment selection method and prognosis assessment.

Ct Patterns of Omental Pathology and to Determine the Validity of Omental Caking in Diagnosis of Ovarian Cancer

Objective: To depict and characterize CT patterns of omental pathology and to determine the validity of omental caking in diagnosis of ovarian cancer. Methodology: A cross-sectional study was conducted in a tertiary care center between January 2020 to February 2021. In this study, 64 consecutive female patients with omental pathology, scheduled for biopsy, surgery and follow up were included. All CT scans were reviewed and findings were discussed with the consultant radiologists. The results were compared and confirmed on histopathology by either open surgical biopsy or per-cutaneous needle biopsy. Result: A total of 64 patients were enrolled in the study. Omental caking on computed tomography was identified in 44 (68.8%) patients. Presence of Omental caking was significantly associated with ovarian cancer (p&lt;0.001). The positive and negative predictive values were 86.4% and 75%, respectively. The sensitivity and specificity of omental caking as diagnostic criteria for ovarian cancer were 88.4% and 71.4%. Conclusion: CT scan is the modality of choice to detect omental pathology. In addition it depicts all other related or unrelated abnormalities as well as causative factors like ovarian carcinoma. Keywords: Omental Caking, Ovarian Carcinoma, Multi Detector Computed Tomography, Patterns, Tuberculosis.

A Case of Erdheim-Chester Disease with Omental Caking Initially Mistaken for a Malignancy

Introduction: Erdheim-Chester disease (ECD) is an uncommon non-Langerhans cell histiocytosis. Bilateral symmetric sclerosis of the long bones and possible multiorgan involvement are the main presentations of this disease. Histologically, lipid-laden foamy histiocytes are positive immunochemically for CD68 (occasionally for PS100) and negative for S100 and CD1a in ECD. Case Presentation: We describe the case of a 35-year-old man diagnosed with ECD with peritoneal and retroperitoneal infiltrations and bone involvement. The diagnosis of ECD was only confirmed after two years of non-specific abdominal pain, nausea, and weight loss. Primarily, the patient’s clinical symptoms and abdominal computed tomography (CT) findings, which indicated omental caking, peritoneal thickening, and perinephric soft tissue density, suggested an intra-abdominal malignancy. Finally, a peritoneal biopsy was carried out, which demonstrated xanthogranulomatous infiltrations from ECD. Further radiographic skeletal survey based on histopathological results showed symmetric osteosclerosis of the long bones. Conclusion: Although ECD, associated with peritoneal and retroperitoneal infiltrations, is an uncommon finding, it should be included in the differential diagnosis of patients with non-specific gastrointestinal manifestations, along with multiorgan involvement and typical radiological findings.

Preoperative Predictors of Optimal Tumor Resectability in Patients With Epithelial Ovarian Cancer.

BackgroundSeveral studies have shown that whether complete tumor resection can be achieved during debulking surgery depends on various patient-related factors. However, none of these studies was conducted among patients with epithelial ovarian cancer (EOC) in sub-Saharan Africa. In this study, we aimed to determine the preoperative predictors of optimal tumor resectability (OTR) during primary debulking surgery (PDS) in patients with EOC.MethodologyIn this study, we reviewed all patients with histologically diagnosed EOC who underwent PDS between January 2011 and December 2020. We included 83 patients with complete clinical records for subsequent data analysis. Descriptive statistics were computed for patients’ data, and binary logistic regression analysis was used to assess the strength of associations between patients’ preoperative characteristics and OTR.ResultsThe overall rate of OTR was 53.0%, while the rate in advanced EOC patients was 36.1%. In the univariate analyses, pleural effusion, ascites, tumor bilaterality, size of the largest tumor, retroperitoneal lymph nodes, omental caking, peritoneal thickening, significant extrapelvic tumor, serum cancer antigen-125 (CA-125) levels, and hemoglobin levels were recorded as the predictors of OTR. However, after adjusting for covariates in the final multivariate models, we found that the absence of moderate-to-large pleural effusion (odds ratio (OR) = 5.60; 95% confidence interval (CI) = 1.32, 23.71) and having serum CA-125 levels of ≤370 U/mL (OR = 6.80; 95% CI = 1.19, 38.79) were the overall independent predictors of OTR while not having any preexisting comorbidity (OR = 18.21; 95% CI = 2.40, 38.10), and the absence of pleural effusions (OR = 13.75; 95% CI = 1.80, 24.85) or enlarged retroperitoneal lymph nodes (OR = 11.95; 95% CI = 1.35, 16.07) were predictors of OTR in advanced EOC patients.ConclusionsWe demonstrated that the radiological absence of pleural effusions and enlarged retroperitoneal lymph nodes and having no preexisting medical morbidity and serum CA-125 levels of ≤370 U/mL were the independent predictors of OTR during PDS. The preliminary data generated from this study can be used to develop variables for a prediction model in a future validation study.

Nomogram to predict feasibility of minimally invasive interval debulking surgery in advanced ovarian cancer

ObjectiveCurrently, there is no clear guidance defining the ideal candidate for minimally invasive interval debulking surgery. This study aimed to identify predictive factors for a minimally invasive approach in patients...