Involvement Of Omentum Research Articles

#331 : Bilateral Endometriomas Masquerading Synchronous Endometrial and Ovarian Cancer (SEOC) in an Infertile Female

Background and Aims: Endometriomas are diagnosed in clinical practice by imaging (mostly ultrasound) in females presenting with infertility. CA-125 level is an adjuvant investigation which may be indicative of endometriosis. A few research questions that are yet to be answered. Is ultrasound a sufficient modality to diagnose endometrioma? Is there any cut off as far as the measurement of endometrioma is concerned to step up the imaging modality to MRI? Synchronous endometrial and ovarian cancer (SEOC) is a rare phenomenon with an incidence of 1.4 - 3.8%. Mostly in SEOC, the ovarian endometroid carcinoma arises in background of endometriosis with endometrial carcinoma of lower stage and grade in premenopausal age group. Method: A 32-year-old female with Severe Dysmenorrhea and Secondary infertility had clinical evidence of bilateral endometriomas of 4-5 cm on ultrasound. She underwent hysterolaparoscopy. On hysteroscopy, endometrium was polypoidal and vascular, looking suspicious for malignancy. Hence endometrial biopsy was taken. On laparoscopy, B/L ovaries were enlarged, multiloculated, solid-cystic with granular surface and adhered in POD, decision for staging laparotomy with frozen section was taken. Frozen section was suggestive of Borderline tumor. Eventually, fertility sparing surgical staging was done (BSO + infracolic omentectomy + peritoneal biopsies). Peritoneal cytology was negative for malignant cells. Results: Histopathological examination revealed Endometriod adenocarcinoma grade 1a/1a in both endometrial and ovarian components with no involvement of omentum and peritoneum. Immunohistochemistry demonstrated P53 to be moderately positive in endometrium and strongly positive in ovary, whereas ER, PR was positive in both tumors of endometrium and ovary and WT-1 negative in ovaries. Hence diagnosed as SEOC and not metastatic tumor. Mirena was inserted in follow up and repeat biopsy is awaited. Conclusion: Suspicion of ovarian endometroid carcinoma must born in mind in cases with large bilateral endometriomas with long-standing endometriosis.

Uterine Perforation as a Complication of the Intrauterine Procedures Causing Omentum Incarceration: A Review.

Omentum involvement resulting from uterine perforation is a rare complication following intrauterine procedures that might require immediate intervention due to severe ischemic consequences. This review examines the prevalence of this complication, risk factors, the mode and timing of diagnosis, the proper management and the outcome. A systematic literature search was conducted on PubMed, PubMed Central and Scopus using uterine perforation, D&C, abortion and omentum as keywords. The exclusion criteria included the presence of the uterus or placenta's malignancy and uterine perforation following delivery or caused by an intrauterine device. The review included 11 articles from 133 screened papers. We identified 12 cases that three evaluators further analysed. We also present the case of a 32-year-old woman diagnosed with uterine perforation and omentum involvement. The patient underwent a hysteroscopic procedure with resectioning the protruding omentum into the uterine cavity, followed by intrauterine device insertion. This paper highlights the importance of a comprehensive gynaecological evaluation following a D&C procedure that includes a thorough clinical examination and a detailed ultrasound assessment. Healthcare providers should not overlook the diagnosis of omentum involvement in the presence of a history of intrauterine procedures.

Uterine Serosal Inclusion Cysts with Greater Omentum Involvement in a Cat

A 7-year-old nulliparous Chinchilla queen was admitted to a veterinary clinic for routine ovariohysterectomy. Examination of the uterus, greater omentum and varicose ovarian veins revealed multiple thin-walled cysts filled with a transparent fluid over the serosal surfaces of these organs. Histologically, the cysts were of variable size, filled with a small amount of mucinous fluid, and had thin walls that contained hypocellular collagen and a few small calibre vessels. The inner and outer epithelium of the cyst walls and the cells that lined the uterine serosa were immunopositive for cytokeratin and vimentin, suggesting a mesothelial origin. Alpha-smooth muscle actin immunolabelling was patchy or continuous in smooth muscle in the wall of many of the cysts.

PEComa-A Rare Uterine Neoplasm: A Case Report

Perivascular Epithelioid Cell Tumors (PEComas) are rare mesenchymal tumors originating from perivascular epithelioid cells. The second common affected organ is uterine. Most of PEComas are benign and patients have good prognosis. At the present time, surgery is the main treatment and adjuvant chemotherapy is used in malignant cases, although the best diagnostic and management method is yet to be discovered considering the rarity of this neoplasm. The patient was a 53 year old lady with a history of two vaginal deliveries and no previous surgery. She had severe pelvic pain and underwent MRI with the primary impression of sarcoma. In MRI, she had a 7 cm mass in lower segment of uterus. The patient underwent laparoscopic hysterectomy, bilateral oophorectomy, lymphadenectomy, and omental biopsy in Jam Hospital. Pathologic report of the patient revealed malignant PEComa without lymph node and omentum involvement. Diagnosis of PEComa before surgery is difficult and its differential diagnoses form uterine leiomyoma or leiomyosarcoma. Final diagnosis can be made after surgical biopsy and immunohistochemistry evaluation. Surgery is still the main treatment and adjuvant therapy is used in high risk patients.

Prognostic Significance of Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios in Epithelial Ovarian Cancer

Objective: This study aims to investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in epithelial ovarian cancer. Methods: This is a retrospective analysis of 116 patients who were diagnosed with epithelial ovarian tumors at the study center between January 2012 and December 2018. Results: The patients with stage 1 ovarian cancer had significantly lower NLR and PLR values than the patients with stage 2 disease (p=0.002 and p<0.0001). The patients with stage 2 ovarian cancer had significantly lower PLR values than the patients with stage 3 disease (p<0.0001). The NLR and PLR values were significantly higher in the patients with lymphovascular invasion and patients with omentum involvement (p<0.0001 for all). The patients with lymph node involvement, residual tumor and ascites had significantly higher PLR values (p=0.0004, p=0.04 and p=0.007 respectively). The patients with tumor recurrence had significantly higher NLR and PLR values (p<0.0001 for both). The patients with tumor recurrence after chemotherapy had significantly higher NLR and PLR values (p=0.02 and p=0.03 respectively). However, the patients who survived had significantly lower NLR and PLR values (p=0.04 and p=0.06 respectively). Both NLR and PLR values could be used to predict lymphovascular invasion, omentum involvement, and tumor recurrence (p<0.05 for all). Serum CA-125 levels correlated with NLR and PLR values positively and significantly (r=0.335, p<0.0001 and r=0.218, p<0.0001 respectively). Conclusions: Despite the fact that the actual prognostic cut-off values remain unspecified, NLR and PLR might act as complementary tools for other prognostic factors related to epithelial ovarian tumors. Keywords: blood platelets; lymphocytes; neutrophils; ovarian epithelial cancer; prognosis Special Issue of Health Sciences DOI: 10.7176/JSTR/6-03-13

Diagnostic performance of CT for differentiating peritoneal tuberculosis from peritoneal carcinomatosis: a systematic review and meta-analysis

To undertake a systematic review and meta-analysis of the diagnostic performance of CT for differentiating peritoneal tuberculosis (PTB) from peritoneal carcinomatosis (PC). PubMed, Embase, the Web of Science, and the Cochrane Library were searched for papers published before 23 July 2019. The methodological quality of the studies was analysed. Overlapping descriptors used in different studies to denote the same image finding were subsumed under a single CT feature. Sensitivity, specificity, and positive and negative likelihood ratios were pooled. A summary receiver operating characteristic curve (sROC) was constructed and the area under the curve (AUC) of the included studies was calculated when possible. Six studies were included and 17 CT features were analysed. The pooled sensitivity and specificity of smooth peritoneal thickening were 59% (95% CI: 52-66%) and 84% (95% CI: 79-88%), respectively. The AUC of smooth peritoneal thickening was 0.83. Omentum line/rim, lymph node necrosis or calcification, and mesenteric macro nodules had a pooled specificity ranging from 95% to 100% and a pooled sensitivity ranging from 12% to 67%. The other 12 signs had a pooled sensitivity ranging from 21% to 79% and a pooled specificity ranging from 19% to 81%. Omentum involvement (cake-like pattern) showed a threshold-effect, so only the AUC (=0.70) was calculated. Smooth peritoneal thickening shows fairly good diagnostic accuracy, while omentum rim/line, lymph nodes necrosis or calcification, mesenteric macro nodules have good specificity but limited sensitivity. The informative features summarised in this study may aid clinical practice and future studies.

Target region resection in patients undergoing cytoreductive surgery for peritoneal metastases-is it necessary in absence of visible disease?

BackgroundThe aim was to study the patterns of target region (greater omentum, lesser omentum, falciform and umbilical round ligament) involvement in patients undergoing cytoreductive surgery (CRS) from various primary tumors, factors affecting involvement and implications on surgical practice. MethodsAll patients undergoing CRS from July 2018 to December 2018 were included in this prospective study. The incidence of target region involvement in presence and absence of visible disease and the impact of primary tumor site, PCI and other variables on target region involvement was evaluated. ResultsIn 191 patients, greater omentum was involved in over 15% of patients irrespective of the primary tumor type and in 15.7% in absence of visible disease. 75% of these had PCI <20. The involvement of the other three target regions was higher than 20% in ovarian cancer, appendiceal tumors and peritoneal mesothelioma. Involvement of these 3 regions was associated with a higher PCI (p < 0.001 for all) and omental involvement (p < 0.001for all). 2.1% of colorectal cancer patients had umbilical round ligament involvement, 4.2% had falciform ligament involvement and none had lesser omentum involvement. ConclusionsTarget region involvement varies according to primary tumour site and disease extent. Resection of the greater omentum should be performed during CRS for PM arising from all primary sites. Resection of other target organs may be performed for selected patients with ovarian cancer, peritoneal mesothelioma and mucinous appendiceal tumors in absence of visible disease. For other patients, it should be done only in presence of visible disease.

The non-coding RNA OTUB1-isoform2 promotes ovarian tumour progression and predicts poor prognosis.

Ovarian cancer is the leading malignancy of the female reproductive system and is associated with inconspicuous early invasion and metastasis. We have previously reported that the oncogene OTUB1 plays a crucial role in ovarian cancer progression, but the role of its isoform, the non‐coding RNA OTUB1‐isoform2, in ovarian cancer is still elusive. Here, we reported that OTUB1‐isoform2 expression in ovarian cancer tissues was significantly higher than that in the paired paratumorous tissues (P < .01). The patients with high expression of OTUB1‐isoform2 had larger tumours than those with low expression (P < .05). The high expression of OTUB1‐isoform2 was correlated with the involvement of bilateral ovaries (P < .05), lymph node metastasis (P < .05), vascular invasion (P < .05), greater omentum involvement (P < .01), fallopian tube involvement (P < .05), advanced FIGO stages (P < .01) and recurrence (P < .01). Moreover, OTUB1‐isoform2 served as an independent negative prognostic predictor for disease‐free survival (DFS) and disease‐specific survival (DSS). Overexpression of OTUB1‐isoform2 in the ovarian cancer cells stimulated cell proliferation, migration and invasion both in vitro and in vivo. In summary, our study suggested that OTUB1‐isoform2 is a novel prognostic biomarker with independent oncogenic functions for ovarian cancer.

Gall Bladder Cancer - Is the Stage Set? Yet!

The current TNM staging of gall bladder cancer (GBC) has some shortcomings. We propose some changes in the current TNM staging of GBC. We propose that involvement of muscularis propria should be classified as T2 (instead of current T1b) and stage grouped as II (instead of current I). T4 in GBC should be subdivided into T4a (perforation of serosa, involvement of omentum, CBD, stomach/duodenum and colon) and T4b (involvement of pancreas, hepatic artery and portal vein). Hepato-duodenal ligament lymph nodes alone should be classified as N1; periduodenal, peripancreatic and common hepatic artery lymph nodes should be classified as N2 and stage grouped as IVA; non-regional (distant) lymph nodes should be classified as M1a and distant (non-nodal) metastases should be classified as M1b. We also propose changes in the TNM stage grouping of GBC – stage I (T1 N0 M0), II (T2 N0 M0), III (T3 N0 M0, T1-3 N1 M0) and IV (T4 Any N M0, Any T N2 M0, Any T Any N M1). Tumors at GB neck are difficult to resect and have poorer prognosis even after resection. Surgical obstructive jaundice (SOJ) in GBC makes resection difficult and is associated with poorer prognosis even after resection. We also propose inclusion of non TNM factors viz. site of tumor (fundus/body or neck) and SOJ in staging of GBC.

Preoperative Monocyte Count as a Mirror of Tumor Characteristics and Likelihood of Recurrence in Endometrial Carcinoma Cases

Background:Recently preoperative hematologic parameters have attracted attention for their capacity to predict tumor characteristics and recurrence. Considering the established role of tumor-associated macrophages (TAM) in the tumor microenvironment, we evaluated the role of the preoperative monocyte count as a surrogate for TAM.Methods:We retrospectively reviewed 166 patients with histopathologically proven endometrial cancers from January 2011 to March 2015 and assessed any association of preoperative monocyte count with tumor characteristics and recurrence.Results:The majority of patients had tumors with the following characteristics: endometrioid histology (83.1%), low grade (grade I-II, 71.7%) and stage I disease (68.1%). The mean ± SD monocyte, neutrophil and platelet counts were 8.23 x 109/L ± 3.56 x 109/L, 64.0 x 109/L ± 11.3 x 109/L and 261.6 x 109/L ± 74.6 x 109. Statistically significant associations were noted with between preoperative monocyte count and tumor stage (p value=0.044), recurrence (p value<0.001) and omentum involvement (p value< 0.001) but not with tumor grade (p value=0.897), depth of myometrium involvement (p value=0.479), lymphovascular space invasion (p value=0.269) and lymph node involvement (p value=0.377).Conclusion:An elevated preoperative monocyte count is related to more aggressive tumors and a higher recurrence rate in patients with endometrial cancer.

CT differentiation of malignant peritoneal mesothelioma and tuberculous peritonitis.

The aim of this study was to determine which computed tomography (CT) findings were useful in differentiating malignant peritoneal mesothelioma (MPM) and tuberculous peritonitis (TBP). CT scans performed in 53 patients with MPM and 27 patients with TBP confirmed by pathology were retrospectively reviewed. The CT findings were evaluated for the morphologic appearance of ascites, peritoneum, mesenterium and omentum involvement, enlarged lymph nodes, solid abdominal viscera infiltration and metastases, and thoracic changes. The Pearson χ (2) test was used to compare differences between groups. Patients in both groups displayed a high proportion of peritoneum and mesenterium thickening. However, there were no obvious differences observed for ascites or swollen lymph nodes. There were significant differences in the following aspects between the two groups: (1) smooth peritoneal thickening was more frequent in patients with TBP, while irregular thickening was more frequently observed in patients with MPM; (2) caked omentum stratification was more common in patients with MPM; (3) mesentery involvement was less commonly observed in patients with TBP; (4) abdominal viscera infiltration and pleural plaques were more common in patients with MPM (46/53 and 48/53, respectively) than in those with TBP (0/27 and 0/27); and (5) more patients in the TBP group (14/27) displayed pleural effusion, and extraperitoneal tuberculosis was more common in patients with TBP (20/27). Although most CT findings analyzed are observed in both diseases, each disease has its own several unique characteristics. Therefore, using a combination of CT findings may increase our ability to distinguish TBP from MPM.

COMPARISON OF COMPUTERIZED TOMOGRAPHIC AND ULTRASONOGRAPHIC FINDINGS IN ABDOMINAL TUBERCULOSIS

Abstract Introduction: Abdominal TB is very common in third world countries with poor socioeconomic status like Pakistan. Majority of patients end up in intestinal obstruction and other complications and finally under-go surgery. Abdominal tuberculosis may be, enteric, peritoneal, nodal and solid visceral TB or in any com-bination of these four varieties. In some cases, res-ponse to therapeutic trials of anti-tuberculous drugs is the basis of diagnosis that may cause a delay in the diagnosis of other diseases which mimic abdominal tuberculosis. Therefore, diagnosis of abdominal tuberculosis is an ongoing challenge to the physicians, espe-cially with limited resources. Ultrasound and CT are good diagnostic helping tools in diagnosis of abdomi-nal tuberculosis. Objectives: To compare the diagnostic accuracy of Computerized Tomographic and Ultrasonographic findings in Abdominal Tuberculosis considering His-topathology as gold standard. Study Design: Comparative cross sectional. Setting: Department of Diagnostic Radiology, Mayo Hospital Lahore. Duration of Study: Twelve months after the approval of synopsis, from June 2007 to May 2008. Subjects and Methods: 50 patients with clinically suspected abdominal tuberculosis who were candidate for elective surgery were selected. History, examinat-ion and relative investigation were recorded and analy-zed with SPSS version 10. Results: CT is a better modality in finding ileocecal involvement, omentum involvement and para-aortic lymphadenopathy than USG and USG is slightly better in finding mesenteric lymphadenopathy than CT in abdominal tuberculosis. Conclusion: Although none is 100% accurate but there is difference in diagnostic accuracy of compu-terized tomographic and ultrasonographic findings in abdominal tuberculosis. In short combined together, these two modalities can be of great help in pre-opera-tive diagnosis of ATB and in decreasing the mortality and morbidity of the disease. Key words: Abdomen, Tuberculosis, Ultrasono-graphy, Computerized Tomography.

Lack of Relation of Survivin Gene Expression with Survival and Surgical Prognostic Factors in Endometrial Carcinoma Patients

The relation of survivin gene expression to survival and surgical prognostic factors in the patients with endometrial carcinoma is unclear. In this study, 62 cases who were operated due to endometrial carcinoma were investigated between 2003 and 2011 in the the gynecological oncology clinic of Female Disease Training and Investigation Hospital of Etlik Zubeyde, Hanim, Turkey. Clinical and surgical prognostic factors were investigated by screening the records of these cases. With the standard streptavidin-biotin immune peroxidase method, cytoplasmic and nuclear expression of survivin was investigated in sections with specific antibodies (1:100, diagnostic Bio Systems, USA) primer. The aim was to elucidate any relation between survivin expression and defined prognostic factors and survival. There was no statistically significant relationship between cytoplasmic and nuclear indexes identified for survivin and age, body mass index, the levels of preoperative hemoglobin, platelet and Ca 125, stage, grade, lymph node meastasis, the number of metastatical lymph nodes (total, paraaortic and pelvic), myometrial invasion, serosal invasion, adnexal involvement, the presence of acid in the first diagnosis, the involvement of omentum, the adjuvant treatment application of the cases, the presence of recurrence and rate of mortality (p>0.05). Statistical significance was noted for the presence of advanced stage lymph node metastasis (pelvic, paraaortic, pelvic and paraaortic), serosal involvement, positive cytology, lymph vascular space invasion, intra abdominal metastasis, and omentum involvement. When investigated the relation between cytoplasmic and nuclear survivin indexes and total survival, the result was not statistically significant (p>0.05). In our study, there was no statistically significant relationship between the rates of cytoplasmic and nuclear survivin expression with identified prognostic factors and total or non-disease survival.

A rare omental tumor presenting as pelvic mass – A case report

Abstracts Benign multicystic mesothelioma (BMCM) of omentum and peritonium is a rare intra-abdominal lesion of unknown etiology. Incidence is more common in females of child-bearing age group. Rarity of this tumor and non-specific symptoms causes preoperative diagnostic dilemma. Precise diagnosis requires immunohistochemistry study. Despite of high recurrence rate, aggressive surgical excision is the treatment of choice. Our case report of BMCM is a rare as it was detected in a young male patient and there was involvement of omentum only.

Systemic Granulomatous Disease and Sialometaplasia in a Dog withBartonellaInfection

Systemic granulomatous disease involving the spleen, heart, lymph nodes, omentum, liver, kidney, lung, mediastinum, and salivary glands developed in an 8-year-old Rottweiler. The dog also had sialometaplasia of both submandibular salivary glands. Bartonella henselae and B. vinsonii subsp. berkhoffii DNA was amplified from the salivary gland by polymerase chain reaction analysis. Bartonellae may be the cause of this systemic disease, but to the authors' knowledge, involvement of omentum, mediastinum, and salivary glands has not previously been reported in association with Bartonella infection. Bartonellae should be considered potential causes of sialometaplasia.

Peritoneal lymphomatosis: CT findings.

Diffuse peritoneal tumor infiltration is well recognized on computed tomography (CT) and is usually associated with carcinomatosis. The purpose of this investigation was to analyze the CT findings of peritoneal spread from primary gastrointestinal lymphomas. Abdominal CT scans in eight patients with peritoneal lymphomatosis were retrospectively reviewed. Patients were 12-75 years old (mean = 48 years); with six patients were male and two were female. Pathologic evidence of primary lymphoma was available by colonoscopic biopsy of the terminal ileum in seven cases and by gastroscopic biopsy of the stomach in one case. All patients had non-Hodgkin's lymphoma. We analyzed CT findings in view of presence or loculation of ascites, abnormal patterns of mesentery and omentum, presence of peritoneal enhancement, presence of low attenuation and location of lymph nodes, and primary gastrointestinal lymphoma. Although ascites was present in all patients, there was no loculation. The involvement of mesentery was present in seven patients, and the stellate pattern was the common type (4/7). The involvement of omentum was present in seven patients, and the common type was omental cake (3/7). Peritoneal enhancement was present in six patients. Enlarged lymph nodes were present in six patients, mainly at the retroperitoneum and mesentery, and showed centrally low attenuation in half the patients. Patterns of tumor involvement of mesentery, omentum, and peritoneum seen in peritoneal lymphomatosis are indistinguishable from those seen in peritoneal carcinomatosis or tuberculous peritonitis. However, ascites without any loculation or septation and diffuse distribution of enlarged lymph nodes were helpful signs of peritoneal lymphomatosis.

On echinococcal disease. G. N. Ter-Nersesov (D. Ztschr. f. Chir., Bd. 206)

G. N. Ter-Nersesov reports in detail about 90 cases of echinococcus in the last 15 years. In the Caucasus, echinococcus accounts for 1.2% of all cases. Recognition is mostly provided by intradermal reaction according to Iturrat-Cazoni and x-rays. Of the 210 patients, 74.4% had liver involvement, 6.17% had spleen involvement, 5.7% had muscle involvement, 3.32% had chest involvement, 1.9% had omentum involvement, 1.43% had bowel involvement, 0.95% had abdomen involvement in multiple sites, 0, 95% - liver and spleen together, 0.48% - bronchial glands, prostate, kidneys, chest-abdominal barrier, uterus, brain, thyroid, gallbladder, spinal cord, omentum, bones.