Peritoneal Deposits Research Articles

039. Obstructive Ileus Caused by Colitis Tuberculosa: A Case Report

Background: Gastrointestinal TB (GTB) constituting approximately 1% to 3% of all TB globally and characterized including of any part of digestive system and its related organs. Results: A 61 years old man was admitted to emergency departement with abdominal pain and abdominal distention since 6 months and getting worse in 1 day. He also complained dispneu. On examination, the abdomen was rigid, distended, and tender and the lung has wheezing. The radiographs of abdomen revelved dilated loops of the small intestine with multiple air-fluid levels suggestive of small intestine obstruction. A chest radiograph showed active TB with opacity of the right lung. The patient was planned for exploratory laparotomy and founded anastomosis, peritoneal deposits, matted bowel, and a perforation of ileus. Intraoperative biopsy was taken from the ileus perforation and revelved tuberkulosa infected. Postoperatively, he was started antituberculous theraphy (ATT) of Rifampicin, isoniazid, and ethambutol (RHE). Conclusion: Obstructive Ileus is a complication of gastrointestinal tuberculosis in patients with a history of untreated latent tuberculosis.

Solitary Peritoneal Metastasis in Case of Osteosarcoma Detected by FDG PET/CT.

Primary osteosarcomas predominantly originate in the metaphyseal region of long bones. The introduction of 18F-FDG PET/CT imaging has revealed unusual and often rare sites of metastatic spread. Peritoneal deposits in osteosarcoma are not a commonly reported finding in the literature. The present case highlights the 18F-FDG PET/CT findings in a case of osteosarcoma of the left fibula with isolated peritoneal metastasis with no regional or distant metastases.

Unusual Scenario: Ipsilateral Pelvic Lymph Node Metastasis in High- Grade Serous Ovarian Carcinoma without Peritoneal Extension - A Case Report

Introduction:: Ovarian cancers are the third most common gynecological cancers worldwide with serous carcinomas being the most common subtype with 90% of them as high-grade carcinomas. Case Presentation:: In the present case report a 60 years postmenopausal, nulliparous woman presented with complaints of bleeding per vaginum for 1-2 months with a left-sided solid-cystic ovarian mass of size 4x5 cm and ipsilateral enlarged external iliac and obturator lymph nodes which were diagnosed on histopathological examination as high-grade serous ovarian carcinoma (HGSOCs) with ipsilateral pelvic lymph node metastasis in presence of intact ovarian capsule and no metastatic deposits over the uterus, contralateral ovary and fallopian tubes, omentum, or any other gross peritoneal deposits. There was coexisting non-atypical endometrial hyperplasia. The patient was managed successfully with staging laparotomy with modified radical hysterectomy, and bilateral pelvic lymphadenectomy followed by six cycles of adjuvant chemotherapy with Paclitaxel and Carboplatin injections. Conclusion:: Patients with HGSOCs can have varied presentations with unusual involvement of lymph nodes in the absence of peritoneal spread. Hence, the clinician must be aware of these unusual presentations for the successful management of such cases.

Mutational Features and Tumor Microenvironment Alterations in High-Grade Appendiceal Cancers Treated With Iterative Hyperthermic Intraperitoneal Chemotherapy.

High-grade appendiceal adenocarcinomas (HGAA) with peritoneal metastases (PMs) are associated with poor survival. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a novel treatment approach for unresectable HGAA-PM. However, its influence on immunogenomic profiles has not yet been fully explored. We obtained 79 samples of metastatic peritoneal tumor deposits from patients diagnosed with HGAA and performed whole-exome sequencing, RNA sequencing, and immunoprofiling before and after HIPEC. Tumor biopsies were subjected to immunogenomic profiling to detect mutational signatures and immune populations associated with oncologic outcomes. Fifteen patients with HGAA-PMs were included in the study. The median progression-free survival (PFS) was 6.7 months (2.7-25.3) and the median overall survival was 11.4 months (4.7-42). Mucin-associated genes (MUC16, MUC3A, and MUC5AC) and titin (TTN) had the highest mutation frequencies. Mutational signatures such as single-base substitution 29 and doublet-base substitution 11 were present in >50% of single-base and double-base mutations. Higher PD-L1 coexpression on CD8+ T cells demonstrated a higher PFS both intratumorally (P = .019) and at the margin (P = .025). HIPEC-associated mutational signatures were identified in HGAA-PMs. Elevated PD-L1+ cytotoxic T-cell populations after HIPEC had better PFS, offering valuable insights for prognostication in the context of HIPEC treatment.

MIRRORS ICG: Perfusion Assessment Using Indocyanine Green (ICG) Peritoneal Angiography during Robotic Interval Cytoreductive Surgery for Advanced Ovarian Cancer.

Indocyanine green (ICG) is a fluorescent dye used for sentinel lymph node assessment and the assessment of perfusion in skin flaps and bowel anastomoses. ICG binds serum proteins and behaves as a macromolecule in the circulation. Tumour tissue has increased vascular permeability and reduced drainage, causing macromolecules to accumulate within it. MIRRORS ICG is designed to determine whether indocyanine green (ICG) helped identify metastatic deposits in women undergoing robotic interval cytoreductive surgery for advanced-stage (3c+) ovarian cancer. Peritoneal surfaces of the abdominal and pelvic cavity were inspected under white light and near-infrared light (da Vinci Si and Xi Firefly Fluorescence imaging, Intuitive Surgical Inc.) following intravenous injection of 20 mg ICG in sterile water. Visibly abnormal areas were excised and sent to histopathology, noting IGC positivity. In total, 102 biopsies were assessed using ICG. Intravenous ICG assessment following neoadjuvant chemotherapy had a sensitivity of 91.1% (95% CI [82.6-96.4%]), a specificity of 13.0% (95% CI [2.8-33.6%]), a positive predictive value of 78.3% (95% CI [68.4-86.2%]), and a negative predictive value of 30.0% (95% CI [6.7-65.2%]) False-positive samples were seen in 9/20 patients. Psammoma bodies were noted in the histopathology reports of seven of nine of these patients with false-positive results, indicating that a tumour had been present (chemotherapy-treated disease). This study demonstrates the appearance of metastatic peritoneal deposits during robotic cytoreductive surgery following the intravenous administration of ICG in women who have undergone neoadjuvant chemotherapy for stage 3c+ advanced ovarian cancer. A perfusion assessment using indocyanine green (ICG) peritoneal angiography during robotic interval cytoreductive surgery for advanced ovarian cancer did not clinically improve metastatic disease identification in patients with high-volume disease. The use of ICG in patients with excellent response to chemotherapy where few tumour deposits remained shows some promise. The potential of molecular imaging to enhance precision surgery and improve disease identification using the robotic platform is a novel avenue for future research.

Tc-99m-MDP Uptake in Extraosseous Metastases from Ovarian Papillary Serous Adenocarcinoma.

The uptake of Tc-99m-uptake of Tc-99m-methylene diphosphonate (MDP) on bone scintigraphy can be seen at sites other than bone in a varying number of benign and malignant conditions. Extraosseous metastatic calcifications can occur in ovarian papillary serous adenocarcinoma (PSAC). These extraosseous calcifications show Tc-99m-MDP uptake. We report a case of a female in her sixties who had a previous history of PSAC of the ovary. The patient had undergone neoadjuvant chemotherapy (NACT) followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. She also received adjuvant chemotherapy. Tc-99m-MDP bone scan was performed post chemotherapy because the patient complained of lower backache. The scan showed increased uptake in the lower thoracic and lumbar vertebral regions. However, single-photon emission computed tomography/computed tomography (CT) localizes the uptake to metastatic calcified peritoneal deposits. Further 18F-fluorodeoxyglucose positron emission tomography/CT confirmed widespread peritoneal and omental metastatic disease with increased uptake.

The Added Value of (18) F-FDG Positron Emission Tomography/ Computed Tomography Compared to Contrast Enhanced Computed Tomography in the Detection and Assessment of Peritoneal Deposits of Colorectal Origin.

The Added Value of (18) F-FDG Positron Emission Tomography/ Computed Tomography Compared to Contrast Enhanced Computed Tomography in the Detection and Assessment of Peritoneal Deposits of Colorectal Origin.

Challenges in Distinguishing Rectal Leiomyosarcoma from Ovarian Malignancy: A Diagnostic Conundrum

Introduction: Rectal leiomyosarcoma is a rare malignant mesenchymal tumor accounting for <0.1% of all malignant colorectal neoplasms and carries a grave prognosis. Case Presentation: A 50-year-old postmenopausal, P3L3 woman presented with complaints of abdominal pain for two months, dark-colored loose stools, 10-15 episodes per day for 2-3 months, and gradual weight loss for 4-5 months. On ultrasonography and MRI of the pelvis, a large irregular lobulated ill-defined solid lesion was seen arising from the right side of the pelvis measuring 14x8x14cm. The right ovary was not observed to be separate from the mass. There was omental thickening and peritoneal deposits with ascites. The final impression suggested a right-sided malignant ovarian mass with peritoneal dissemination (ORADS-5) with a differential leiomyosarcoma. Her tumor markers (CA- 125; CA19-9, and CEA) were raised. Given the strong dilemma between ovarian malignancy and leiomyosarcoma and the advanced stage of the disease, the patient was planned for an ultrasound-guided biopsy of the lesion. The histopathological report revealed atypical spindle cell proliferation with myoid features with the presence of multiple mitotic figures. The diagnosis of rectal leiomyosarcoma was further confirmed with immunohistochemical tests, which were positive for actin and desmin and negative for CD 117 and S100. The patient was referred to oncosurgeon for further management and was planned for surgical resection followed by chemotherapy with intravenous doxorubicin. Conclusion: Rectal leiomyosarcoma is commonly misdiagnosed as ovarian malignancy because of its exophytic growth and similar clinical features at the time of the presentation. Hence, clinicians must be aware of these differentials for the successful management of cases.

Two years recurrence rate of ovarian and endometrial malignancies following Surgical versus clinical staging

Background and objectives: Gynecological cancers represent a big burden on national health institutes. Recurrences of these cancers are documented frequently that needed more efforts to prevent or reduce them. The aim of the study was to know the difference between Standard Surgical Staging and Non-Standard Surgical Staging in gynecological cancers in terms of recurrence rate. Methods: This study was a retrospective cross-sectional study conducted at the Maternity Teaching Hospital and Hiwa Hospital in Sulaymaniyah city-Kurdistan region/Iraq over two years from June 2020 to June 2022, on sample of 86 women with gynecological cancer divided into two study groups (42 women underwent standard surgical staging and 44 women underwent non-standard surgical staging). Standard surgical staging for endometrial and ovarian cancers included midline laparotomy, peritoneal washout, samples from the right and left sub-diaphragmatic surfaces, infracoloic Omentectomy, total abdominal hysterectomy & bilateral salpingo-oophorectomy, any peritoneal deposits and pelvic and para-aortic Lymphadenectomy in maternity hospital Results: The recurrence rate in women with non-standard surgical staging were 25% (p=0.009), while in women with standard surgical staging were 4.8%. 11 women with non-standard surgical staging had advanced cancer stages at recurrence compared to 2 cases with standard surgical staging. Although no significant difference in death outcome between both study groups (p=0.09), no woman who underwent standard surgical staging with recurrence died, while the death rate of women underwent non-standard surgical staging with recurrence was (63.6%) Conclusions: The standard surgical staging in women with gynecological cancer is important in the recurrence rate of these cancers.

Intestinal and peritoneal lymphoma complicating Chron’s disease

BackgroundCrohn’s disease is an inflammatory bowel disease which mostly affects the small intestine. It has a variable clinical course, with alternating attacks of exacerbation and remission. In the last decades, the incidence of Crohn’s disease has been increasing, so imaging of those cases has become more important.Case presentationWe report a case of a male patient who was treated for Chron’s disease in the past three years and presented with abdominal pain. Post-contrast CT abdomen and pelvis was done revealing soft tissue thickening of intestinal walls in a skip fashion with multiple peritoneal deposits. The case was pathologically proven to be anaplastic large cell lymphoma on top of Chron’s disease.ConclusionsThe cause of the association between Crohn's disease and lymphoma is still elucidated. Radiologists should be aware that Chron’s disease can be complicated by intestinal and peritoneal lymphoma and should suspect the presence of lymphoma on top of Chron’s disease if there is wall thickening of soft tissue attenuation affecting the small bowels in a skipping manner following the areas previously affected by Chron’s disease.

The yield of diagnostic laparoscopy with peritoneal lavage in gastric adenocarcinoma: A retrospective cohort study

IntroductionDiagnostic laparoscopy (DL) with peritoneal lavage has been adopted as a standard staging procedure for patients with gastric cancer (GC). Evaluation of the value of DL is important given ongoing improvements in diagnostic imaging and treatment. As contemporary data from European centres are sparse, this retrospective cohort study aimed to assess the yield of DL in patients with potentially curable gastric cancer, and to identify predictive factors for peritoneal metastases. MethodsPatients with adenocarcinoma of the stomach, treated between January 2016 and December 2018, were identified from institutional databases of two high volume European Upper-GI centres. Patients who underwent a DL with peritoneal lavage for potentially curable disease after clinical staging with imaging (cT1-4N0-3M0) were included. The primary outcome was the proportion of patients with a positive DL, defined as macroscopic metastatic disease, positive peritoneal cytology washings (PC+) or locally irresectable disease. ResultsSome 80 of 327 included patients (24.5%) had a positive DL, excluding these patients from neoadjuvant treatment (66 of 327; 20.2%) and/or surgical resection (76 of 327; 23.2%). In 34 of 327 patients (10.3%), macroscopic metastatic disease was seen, with peritoneal deposits in 30 of these patients. Only 16 of 30 patients with peritoneal disease had positive cytology. Some 41 of 327 patients (12.5%) that underwent DL had PC+ in the absence of macroscopic metastases and five patients (1.5%) had an irresectable primary tumour. Diffuse type carcinoma had the highest risk of peritoneal dissemination, irrespective of cT and cN categories. ConclusionThe diagnostic yield of staging laparoscopy is high, changing the management in approximately one quarter of patients. DL should be considered in patients with diffuse type carcinoma irrespective of cT and cN categories.

ThTP2.3 Value of staging laparoscopy in patients with oesophageal and junctional cancers – Single centre retrospective observational study

Abstract Introduction The role of staging laparoscopy in oesophageal and junctional cancer remains controversial due to lack of robust evidence leading to heterogenous practice nationally and globally. The purpose of this study was to identify the value of staging laparoscopy in patients with oesophageal and junctional cancer. Methods A retrospective review of all consecutive patients who underwent staging laparoscopy for oesophageal and junctional cancer over 7-year period at Royal Derby Hospital, Derby was conducted using hospital database. Patient demographics, histology, staging, location, and findings of staging laparoscopy were analysed. Results A total of 278 of patients underwent staging laparoscopy from July 2015 to September 2022 were included. All patients with gastric cancer histology were excluded. Majority of the patients were having adenocarcinoma histology (N=248, 89.2%) and 236 (84.8%) cancers were involving lower oesophagus/ GOJ. Additionally, nearly three-quarters of patients (N=203, 73%) were having T3 staging before the procedure. Overall, staging laparoscopy had changed the management in 22 patients (7.9%) due to positive cytology (N=12, 4.3%) and other findings (N=10, 3.5%) such as cirrhosis liver, large bulky tumour, and peritoneal deposits. Out of patients who were having positive cytology, all had adenocarcinoma histology, located in the lower oesophagus, and had T3 or above pre-operative staging. Conclusion This study identified the value of staging laparoscopy in patients with certain risk factors who are at risk of having peritoneal disease. Therefore, selective approach would be more appropriate when selecting patients for staging laparoscopy in oesophageal and junctional cancer.

Unravelling Peritoneal Carcinomatosis Using Cross-Sectional Imaging Modalities

Peritoneal carcinomatosis (PC) refers to malignant epithelial cells that spread to the peritoneum, principally from abdominal malignancies. Until recently, PC prognosis has been considered ill-fated, with palliative therapies serving as the only treatment option. New locoregional treatments are changing the outcome of PC, and imaging modalities have a critical role in early diagnosis and disease staging, determining treatment decision making strategies. The aim of this review is to provide a practical approach for detecting and characterizing peritoneal deposits in cross-sectional imaging modalities, taking into account their appearances, including the secondary complications, the anatomical characteristics of the peritoneal cavity, together with the differential diagnosis with other benign and malignant peritoneal conditions. Among the cross-sectional imaging modalities, computed tomography (CT) is widely available and fast; however, magnetic resonance (MR) performs better in terms of sensitivity (92% vs. 68%), due to its higher contrast resolution. The appearance of peritoneal deposits on CT and MR mainly depends on the primary tumour histology; in case of unknown primary tumour (3–5% of cases), their behaviour at imaging may provide insights into the tumour origin. The timepoint of tumour evolution, previous or ongoing treatments, and the peritoneal spaces in which they occur also play an important role in determining the appearance of peritoneal deposits. Thus, knowledge of peritoneal anatomy and fluid circulation is essential in the detection and characterisation of peritoneal deposits. Several benign and malignant conditions show similar imaging features that overlap those of PC, making differential diagnosis challenging. Knowledge of peritoneal anatomy and primary tumour histology is crucial, but one must also consider clinical history, laboratory findings, and previous imaging examinations to achieve a correct diagnosis. In conclusion, to correctly diagnose PC in cross-sectional imaging modalities, knowledge of peritoneal anatomy and peritoneal fluid flow characteristics are mandatory. Peritoneal deposit features reflect the primary tumour characteristics, and this specificity may be helpful in its identification when it is unknown. Moreover, several benign and malignant peritoneal conditions may mimic PC, which need to be considered even in oncologic patients.

Germline BRCA 1 Positive Breast Ovarian Cancer Syndrome

Background: BRCA1 (Beast Cancer gene 1) and BRCA2 (Breast Cancer gene 2) are genes that produce proteins that help repair damaged DNA. Mutations in these genes predispose the person to a substantiable risk of developing breast and ovarian cancers among others. Approximately 10 to 15% of all cases of epithelial ovarian cancer and les than 10 % of Breast cancers are caused by a mutation in the BRCA1 or BRCA2 genes, which when occurs together results in hereditary breast ovarian cancer syndrome. Case Presentation: This case report presents the clinical course of a 57-year-old female patient who presented with a mass in her right breast in June 2022. The patient’s past medical history is significant with a diagnosis of triple-negative non-metastatic left breast cancer that was treated with surgery followed by adjuvant chemotherapy containing Doxorubicin and Taxanes with loco-regional radiotherapy in May 2009. On June 2022 (later after 13 years) patient noticed a Rt breast mass and was evaluated further. A mammography showed an ill-defined micro lobulated lesion 4 cm from the nipple, measuring 43 x 27 mm with a few microcalcifications. Later, an ultrasound right breast confirmed the presence of an ill-defined lesion in her right breast with no significant axillary nodes, True-cut biopsy performed on October 26th, 2022 revealed invasive triple negative ductal carcinoma. Staging work up with Positron Emission tomography and computerized tomography scan showed in addition to the right breast mass, an ovarian mass with peritoneal deposits. This prompted a peritoneal biopsy which confirmed a high grade primary serous carcinoma of ovary. Additionally, BRCA1/2 germline testing showed a positive BRCA1 germline mutation. Following this, the patient was started on neoadjuvant keynote 522 protocol specifically with Epirubicin, Cyclophosphamide, Paclitaxel carboplatin with pembrolizumab. As of the date of reporting she has completed CARBOPLATIN-TAXOL and is now on the third ........

Inter observer reliability for peritoneal carcinomatosis at computed tomography.

To determine whether there is inter-observer reliability between radiologists for reporting peritoneal carcinomatosis and computed tomography peritoneal carcinomatosis index estimation. The retrospective, cross-sectional study was conducted at Dow Institute of Radiology, Dow University of Health Sciences (DUHS), Ojha campus and comprised computed tomography scans done between December 1, 2019, to May 31, 2020, that were extracted from the institutional database searched using key words 'peritoneal carcinomatosis' and/or 'serosal deposits'. The first readers had 1-4 years of post-fellowship experience, while the 2nd readers were senior radiologists. Inter-observer reliability was assessed quantitatively and qualitatively for 15 peritoneal sites using, among other tolls, the Sugarbaker computed tomography peritoneal carcinomatosis index. Data was analysed using SPSS 21. Out of 236 subjects with mean age 53.6±13.6 years, there were 173(73.3%) females and 63(26.7%) males. The most common primary cancer was ovarian 145(61.4%), followed by colon 26(11%). The size of peritoneal deposit was not reported in 75(31.8%) cases. Of the 15 sites analysed, good agreement was not found in 7(46.7%). There was an excellent intra-class correlation for measuring computed tomography peritoneal carcinomatosis index scores among the radiologists irrespective of the grade of the faculty (>0.90). The inter-observer reliability was low, but good agreement for computed tomography peritoneal carcinomatosis index would encourage radiologists to use it in peritoneal cancer reporting.

Development and Validation of Nomograms to Predict Survival in Patients Undergoing Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin

Pseudomyxoma peritoni, a rare condition characterized by mucinous ascites and peritoneal deposits, mainly originates from a ruptured mucinous appendix tumor and is considered an indolent disease but can progress and become fatal. Optimal treatment to improve cure and survival rates involves complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Accurate predictive models are useful in supporting and informing treatment strategies and stratifying patient follow-up. To evaluate the prognostic significance of clinically important variables and generate validated nomograms to predict overall (OS) and disease-free survival (DFS) following CCRS and hyperthermic intraperitoneal HIPEC for pseudomyxoma peritonei (PMP) of appendiceal origin. This retrospective study used prospectively collected data on patients who had cytoreductive surgery (CRS) and HIPEC in a single institution between 1994 and 2018. The cohort was randomly allocated into development (70%) and validation (30%) sets. Univariate and multivariate analyses were performed with Cox proportional hazards regression. A prediction model was developed with significant prognostic factors identified by multivariate analysis. The model's prognostic performance was evaluated with the concordance index (C index). The nomogram was calibrated by comparing the predicted and observed probabilities. Of 2637 CRS and HIPEC operations, 1102 patients (female, 64.4%; median age [IQR], 57.0 [48.0-66.0] years) (41.8%) had CCRS for PMP of appendiceal origin. Elevated tumor markers, peritoneal carcinomatosis index, gastrectomy, and tumor grade were independent predictive factors for DFS. Gender, age, elevated tumor makers, peritoneal carcinomatosis index, and tumor grade influenced OS. The nomograms were generated with respective prognostic factors. The nomograms showed good performance in predicting survival. Median OS of the cohort was 16.5 years (95% CI, 13.7-19.2) with a 5-year probability of survival of 80.2%. The median DFS was 10.3 years (95% CI, 7.2- 13.3) and the 5-year probability of recurrence-free survival was 60.5%. Clinically important independent predictors for survival and recurrence were selected to develop the nomograms for OS and DFS. These 2 nomograms are user friendly and useful tools for patient management with clinical trial design applications.

Prognostic significance of acellular mucin in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for appendiceal neoplasms

Appendiceal neoplasms have a propensity for peritoneal dissemination. The standard of care for select individuals is CRS/HIPEC. In the current 8th AJCC Staging system, a finding of only intraperitoneal acellular mucin (M1a) is classified as Stage IVa. There is concern that the current AJCC system may over-stage patients. This was a single-institution retrospective review of 164 cases of mucinous appendiceal neoplasm. Patients undergoing CRS/HIPEC with M1a disease were compared to patients with peritoneal deposits containing tumor cells (well-differentiated adenocarcinoma; low-grade mucinous carcinoma peritonei-M1b,G1). Overall and recurrence-free survival were assessed. Median age was 51years, 70% were female, and 75% White. Sixty-four patients had M1a disease and 100 M1b,G1 disease. M1a disease had a lower median PCI score (11 vs. 20, p = .0001) and a higher rate of complete CRS (62% vs. 50%, p = .021). Median follow-up was 7.6years (IQR 5.6-10.5years). For M1a disease, there were no recurrences and only one patient died during the study interval. In comparison, for M1b disease, 66/100 (66%) recurred with a 5-year RFS of 40.5% (HR 8.0, 95% CI 4.9-15.1, p < .0001), and 31/100 (31%) died with a 5-year OS of 84.8% (HR 4.5, 95% CI 2.2-9.2, p < .0001). Acellular mucin (M1a disease) after CRS/HIPEC for appendiceal neoplasm is associated with longer OS and RFS compared to M1b, G1 disease. Current AJCC staging does not accurately reflect the differing outcomes of these two patient populations. The presence of acellular mucin in the peritoneal cavity should not be perceived as a metastatic equivalent.

Predictors of peritoneal metastasis of gastric origin

BackgroundGastric adenocarcinoma is one of the most aggressive forms of cancer. Despite marked advancements in radiological techniques, peritoneal deposits are still only discovered during laparotomies in a significant number of cases. The role of surgery in the management of metastatic gastric cancer is very limited, reducing the value of conducting laparotomies. In addition, conducting laparoscopies for the purposes of properly staging every case of gastric cancer is difficult, especially in healthcare systems with limited resources. It is thus crucial to investigate all possible predictors of peritoneal metastasis of gastric cancer, with the aim of reserving the use of laparoscopies to cases known to have high incidences of peritoneal metastasis despite negative radiological results.Patients and methodsThis is a case control study that included all cases of gastric adenocarcinoma that had presented to the National Cancer Institute–Cairo University between January 2018 and December 2019. The ‘cases’ group encompassed all gastric adenocarcinoma patients who were found to have peritoneal metastasis, whilst the ‘control’ group included those patients who were apparently metastasis-free. Comparisons were made between the two groups in terms of demographics, tumor characteristics, and results of laboratory tumor marker investigations.ResultsPatients with peritoneal metastasis were statistically significantly younger than those who had no apparent metastasis (mean ± SD 51.4 ± 12.5 and 56.2 ± 12.6 respectively; P = 0.020). Significant associations were found between a finding of peritoneal metastasis and (i) a middle tumor site (P = 0.002); (ii) tumor thickening morphology (P < 0.001); (iii) undifferentiated histopathology (P = 0.040); (iv) tumor grade III (P < 0.001); (v) lower lymphocyte counts of < 1.9/ml (P = 0.030); and (vi) high levels of CA 19-9 of > 37 units/ml (P = 0.032).ConclusionTumor pathological criteria, including tumor site, degree of differentiation, shape, and grading, as well as laboratory findings of low lymphocytic counts and high levels of CA 19-9 appear to be reliable predictors of the presence of peritoneal metastasis from a gastric adenocarcinoma.

Prognostic Outcome of Mesenchymal Transition Biomarkers in Correlation with EGFR Expression in Epithelial Ovarian Carcinoma Patients

CD44 is an epithelial-mesenchymal transition (EMT) surface receptor that regulates the interactivity between the cells and the extracellular matrix, thereby promoting cell migration. The epidermal growth factor receptor (EGFR) family is a trans-membrane kinase-related protein. It regulates cell adhesion proteins, which may promote cell proliferation and invasiveness. Mesenchymal epithelial transition (MET) is another EMT receptor that stimulates cell proliferation, invasion, survival, and angiogenesis. This study aimed to evaluate the prognostic impact of CD44, EGFR expressions, and MET gene amplification in epithelial ovarian cancer (EOC). This is a retrospective cohort study, including 85 cases of EOC. CD44 and EGFR expressions were evaluated in both epithelial and stromal cells by immunohistochemistry. Tumor cells also underwent a cytogenetic analysis using fluorescent in situ hybridization (FISH) to detect MET gene amplification. High CD44 expression in tumors was significantly associated with serous subtypes (P=0.001), peritoneal deposits (P=0.002), and advanced stage (P=0.002). EGFR high tumor expression demonstrated a significant association with lymph node metastasis (P=0.038) and the advanced stage of EOC (P=0.016). Increased copy number of the MET gene was significantly associated with partial therapy response (P=0.030). CD44 and EGFR tumor high expression was associated with poor overall survival (OS). In addition, MET gene gain in tumors was associated with a shorter OS (P=0.000). EMT biomarkers (CD44 and MET) and EGFR expression in EOC are independent prognostic factors for OS. MET gene increase copy number was detected in cases of serous neoplasm and associated with poor survival and minimal therapy response.

Efficacy of MRI for detection of frozen pelvis

A 26- year old female presented to us with severe pelvic pain. She was adviced follicular study and MRI pelvis. There was a large, multilobulated cyst in her pelvic region appearing hyperintense on both T1 and T2 fat sat sequences. There was also presence of multiple, hypointense peritoneal deposits seen on both T1 and T2 fat sat sequences. The findings concluded the diagnosis of frozen pelvis.