Peritoneal Washings Research Articles

Endometriosis-associated ovarian cancer is not a distinct clinical entity among young patients: A 12-year cohort study

ObjectivesTo investigate the clinicopathological features and prognostic value of endometriosis in young patients with ovarian endometrioid carcinoma (OEC) and ovarian clear cell carcinoma (OCCC). MethodsThe medical files and clinical follow-up data of patients aged 40 years or younger with OEC or OCCC between January 2006 and December 2017 who had undergone complete surgical staging followed by systemic chemotherapy were retrospectively reviewed. ResultsA total of 94 women were included in this study. Univariate analysis revealed that the progression-free survival (PFS) and overall survival (OS) rates of patients with endometriosis-associated ovarian carcinoma (EAOC) did not improve compared with those of patients without EAOC (5-year PFS: 80.0% vs. 75.9% and 5-year OS: 85.0% vs. 86.0%, respectively). Multivariate analyses confirmed that FIGO stage (II–IV), cytology-positive ascites or peritoneal washes and residual disease > 1 cm were independent predictors of PFS and that residual disease > 1 cm was the only predictor of OS. ConclusionsEndometriosis is not independently associated with the prognosis of OEC and OCCC among young patients. The intrinsic relationship between endometriosis and ovarian cancer warrants further investigation.

Prognostic indicators in pancreatic cancer patients undergoing total pancreatectomy.

To evaluate the long-term outcomes of total pancreatectomy in a modern cohort of pancreatic cancer patients and to establish whether any factors identified prior to pancreatic resection were related to poor survival. We analyzed, retrospectively, patients who underwent total pancreatectomy for pancreatic cancer between 2007 and 2016. The short- and long-term outcomes were investigated and Cox regression analysis was used to evaluate the prognostic factors identified before resection. The subjects were 49 patients with a mean age of 65years, who underwent total pancreatectomy in our hospital during the study period. Peritoneal washing cytology was performed in 48 patients, with positive results in 4 (8.3%). There was no 30-day mortality. The median overall survival was 22.5months, with a 5-year survival rate of 28.5%. Univariate analyses of the pre-resection variables revealed that overall survival was associated with tumor location, resectability classification, maximum standardized uptake value of positron emission tomography, the preoperative carbohydrate antigen 19-9 level, and peritoneal washing cytology status. Multivariate analysis revealed that positive peritoneal washing cytology status and the maximum standardized uptake value were independent predictors of poor survival. Total pancreatectomy for pancreatic cancer is appropriate for selected patients, but peritoneal washing cytology and positron emission tomography should be performed preoperatively.

260P - Malignant ovarian germ cell tumours (MOGCT): Treatment results of 149 pts

BackgroundMOGCT is rare tumors and represent 2% of all tumors of the ovary. Fertility preserving surgery is the standard of care for pts with MOGCT. Comprehensive surgical staging involves unilateral adnexectomy, omentectomy, peritoneal biopsies, washings and lymph node sampling. Visual inspection has been suggested as an alternative. Proposed surgical approach includes complete resection of the tumor-containing ovary with sparing of fallopian tube, inspection and palpation of contralateral ovary, omentum, lymph nodes, and peritoneum, biopsy of any suspicious lesions or lymph nodes, and collection of peritoneal washing or ascites. The objective of the study was to describe the clinico-pathologic features and treatment outcome of all patients diagnosed with MOGCT at the largest Russian Research Cancer Center. MethodsA total of 149 pts treated for MOGCT in our center between 1987-2018 were included into this retrospective study. All data including clinical symptoms, demographics, stage, surgery, chemotherapy, survival and fertility function were analyzed and assessed in univariate and multivariate analysis. The median age was 22 years (range, 12-49 years). 109 (73.2%) of 149 underwent fertility-sparing surgery followed by chemotherapy (ChT). Histologically 29.5% (n = 44) of cases were pure dysgerminoma. All pts received BEP/EP regimens as a first line treatment. 14 (9.4%) pts had gonadal dysgenesis. ResultsWith median follow-up of 86 mo. (range 1-337 mo.) 5-year OS was 92%. The 5-year disease free survival (DFS) was 87% (9.4% pts relapsed). The 5-year DFS in pts with dysgerminoma and non-dysgerminoma was 98% and 91% respectively (p = 0,2). The 5-year OS in pts with stage I was 100% and stages II-IV was 91%. Complete response reached in 97 (67.3%) of 144 assessed pts, marker-negative partial response registered in 34 (23.6%) pts. After first-line ChT completion 34/144 (23.6%) pts underwent surgical resection of residual masses. ConclusionsThe BEP regimen is a standard of care and provides high cure rate. Fertility-sparing surgery is standart volume of surgery even in advanced stages of disease. The BEP regimen does NOT adversely affect on fertility function of pts. Legal entity responsible for the studyThe authors. FundingHas not received any funding.All authors have declared no conflicts of interest.

Von Hippel–Lindau Syndrome and Steroid Cell Tumour of the Ovary: A Rare Association

Steroid cell tumours of the ovary account for approximately 0.1% of all ovarian tumours. Association of these tumours with Von Hippel–Lindau syndrome is an extremely rare phenomenon. A 24-year-old female, diagnosed with Von Hippel–Lindau syndrome, with previous surgeries for cervical haemangioblastomas and pheochromocytoma was evaluated in the Reproductive Medicine Unit for secondary infertility and abnormal uterine bleeding. She was referred to the Gynaecologic Oncology Department with the sonological diagnosis of a left-sided complex adnexal mass. After evaluation, patient underwent laparoscopy proceed, peritoneal washings, chromopertubation, left salpingo-oophorectomy and omental biopsy. Histopathology was reported as a pure stromal tumour consistent with a benign steroid cell tumour (alpha inhibin positive), not otherwise specified. At the last visit, the patient was asymptomatic. Von Hippel–Lindau syndrome, an autosomal dominant inherited disorder, is characterized by the formation of tumours (haemangioblastomas in brain, spinal cord and retina), pheochromocytoma and cysts in many different parts of the body (kidneys, pancreas and genital tract). In women, broad ligament cystadenomas are commonly reported.Steroid cell tumours of the ovary are extremely rare. About 20% are malignant and nearly 95% unilateral. They can manifest at any age but majority occur in third or fourth decade. There are very few reported cases of steroid cell tumours in association with Von Hippel–Lindau syndrome. We present a case of an ovarian steroid cell tumour in a young patient of VHL syndrome. This focuses on the rarity of their association.

Intraperitoneal cancer-immune microenvironment promotes peritoneal dissemination of gastric cancer

ABSTRACTA solid tumor consists of cancer and stromal cells, which comprise the tumor microenvironment (TME). Tumor-associated macrophages (TAMs) are usually abundant in the TME, contributing to tumor progression. In cases of peritoneal dissemination of gastric cancer (GC), the contribution of intraperitoneal TAMs remains unclear. Macrophages from peritoneal washings of GC patients were analyzed, and the link between intraperitoneal TAMs and GC cells was investigated to clarify the interaction between them in peritoneal dissemination. Macrophages were predominant among leukocytes constituting the microenvironment of the peritoneal cavity. The proportion of CD163-positive TAMs was significantly higher in stage IV than in stage I GC. Co-culture with TAMs potentiated migration and invasion of GC. IL-6 was the most increased in the medium of in vitro co-culture of macrophages and GC, and IL-6 elevation was also observed in the peritoneal washes with peritoneal dissemination. An elevated concentration of intraperitoneal IL-6 was correlated with a poor prognosis in clinical cases. In conclusion, intraperitoneal TAMs are involved in promoting peritoneal dissemination of GC via secreted IL-6. TAM-derived IL-6 could be a potential therapeutic target for peritoneal dissemination of GC.

Primary tumor types and origins in positive abdominopelvic washing cytology, a single institution experience

Abdominopelvic washing cytology is a common specimen evaluated for ovarian, fallopian tubal, and peritoneal cancer staging or other nongynecologic malignancies presented as metastases. We reviewed our experience in diagnosing abdominopelvic washing specimens and assessing the primary tumor types and origins of the positive abdominopelvic washings. A pathology archive database search was performed for abdominopelvic washing specimens from 2007 to 2018. The corresponding cytologic diagnoses, results of ancillary studies, clinical histories, and surgical follow-up were reviewed. The primary sites were determined based on the synoptic reports, when available. A total of 5.8% (350 of 6023) of cases were positive for malignancy or neoplasm. Additionally, 1.3% (78 of 6023) were diagnosed as atypical cells. Of the 350 positive cases, 93.4% were müllerian tumors. The frequency of primary sites for müllerian tumors in descending order were: ovary, uterus, fallopian tube, peritoneum, and uncertain müllerian sites. The common ovarian tumors identified in pelvic washing in descending order were: high-grade serous carcinoma, serous borderline tumor, clear cell carcinoma, low-grade serous carcinoma, and endometrioid carcinoma. Gastrointestinal, breast, bladder, and lymphoma primaries were the 23 nongynecologic tumors identified in pelvic washings. Positive findings in abdominopelvic washing cytology is rare. The majority of the positive cases were from müllerian origins, with ovary and uterus as the most common sites. Endometrial adenocarcinoma, endometrioid type and ovarian high-grade serous carcinoma were the most common tumor types. Knowing prior history of malignancy, morphologic comparison with concurrent surgical cases, and performing ancillary studies are keys to improve diagnostic accuracy of abdominopelvic washings.

1235 Myometrial Cells in Pelvic Washings at time of Benign Hysterectomy

Study Objective To evaluate if smooth muscle cells can be detected in pelvic washings at time of intact hysterectomy. Design A multi-centered pilot cohort study. Setting Two academically affiliated tertiary referral centers. Patients or Participants Patients undergoing total hysterectomy for benign indications without morcellation by minimally invasive gynecologic surgeons were enrolled from January 2018 to July 2018. Interventions Pelvic washings were collected at 2 times during surgery: after abdominal entry and after vaginal cuff closure. Cell blocks were generated, slides were stained using hematoxylin and eosin (HE three subjects were excluded due to unplanned morcellation. Smooth muscle uterine cells were detected in 1 pre-wash specimen and 2 post-wash cases. The group with positive washings was noted to have longer procedure time (136 minutes versus 114 minutes), lower blood loss (25 mL versus 86 mL) and higher uterine weight compared to negative washings group (242 grams versus 234 grams). Conclusion Tissue dissemination of uterine cells may be possible at time of hysterectomy. Larger prospective studies are needed in order to better describe the incidence of and risk factors for tissue dissemination.

Yield of peritoneal cytology in staging patients with gastric and gastroesophageal cancer.

Guidelines for gastric and gastroesophageal (GE) cancer recommend staging laparoscopy (SL) with peritoneal cytology (PC). However, the reliability of PC is unknown. The primary purpose of this study was to determine the sensitivity of PC. We analyzed a prospectively maintained database of patients who underwent SL and PC for gastric and GE cancer. Test sensitivity of PC for detecting peritoneal disease was assessed. Survival analyses were used to examine the implication of PC. There were 1186 patients that underwent SL and PC; 282 (24%) were found with carcinomatosis. PC was analyzed in 214 (76%) of these patients and 77 (36%) were found to have no malignant cells. In this setting, PC had a sensitivity of 64% for confirming peritoneal disease. Those with peritoneal disease had a poorer 5-year overall survival (5.8% vs 37.7%; P < .001). Those with positive PC without carcinomatosis had a similar survival to those with gross disease with and without cytological confirmation (both P > .05). PC has limited sensitivity for detecting peritoneal disease. Positive PC alone carries a similar poor survival as in patients with gross carcinomatosis. Improvements in the identification of microscopic disease in peritoneal washings are needed.

Effects of the Storage Solution Type and Prolonged Storage on the Immunoreactivity of Cells

Introduction: In effusion cytology, immunocytochemistry is a useful staining approach to provide important information for diagnosis. Effusion cytology is performed not only for pleural effusions and ascites but also for peritoneal and needle washing from fine needle aspirations or instruments. Although various solutions are used for washing cytology, the effect of the solution type on immunocytochemical reactivity is not fully understood. In this study, we examined the immunocytochemical reactivity of cytological samples after storage in various solutions. Methods: Cell block specimens were obtained from ascites of patients with peritoneal cancer and pleural effusions of patients with diffuse malignant mesothelioma. Various solutions, including physiological saline (PS), Ringer solution, a low-molecular-weight dextran L injection, Voluven 6% solution, Mixid L injection, RPMI-1640 medium, and horse serum were added to the sediment layers of aliquots. All samples were kept at 4°C, and aliquots were subsequently processed at specific time points (0, 1, 2, 4, 7, and 14 days). Formalin-fixed, paraffin-embedded, cell block samples were prepared for immunocytochemical staining. Immunocytochemical results were analyzed for differences in the percentages of positive cells, using the effusion sample stored for 1 h as standard (100%). Results: For all solutions other than PS, the median and central 50% of values were <100% (with respect to the effusion sample as a standard) after 1 h of storage. Immunoreactivity decreased for most solutions as time progressed. Conclusion: Of note, immunocytochemistry results obtained using a washing solution are different from those using an effusion sample. For cytology, when a washing solution was used or when a sample was stored for a long time, the accuracy of the immunocytochemical results was low.

Cytological diagnostics of intraoperative peritoneal washes in gastric cancer.

Diagnosis of peritoneal microcanceromatosis is the most important task allowing to determine treatment strategy for patients with stomach cancer. Laparoscopy combined with peritoneal flushing and subsequent cytological examination should be performed to detect the peritoneal microcanceromatosis at the preoperative stage. The objective of this work was to improve cytological diagnostics of peritoneal washings using immunocytochemical techniques and the cell block method. The work was carried out on the basis of 276 surgical peritoneal washings in patients with stomach cancer who were on treatment in the department of high-tech surgery of the Moscow Clinical Scientific Centre of the State Budgetary Healthcare Institution named after Loginov A.S. from June 2016 to June 2018. As a result, the optimal panel of monoclonal antibodies (Ber-EP4, CEA, CK20) was chosen, which increased the sensitivity from 52% to 96% and the specificity of cytological diagnosis from 80% to 98%, and the overall accuracy of the method from 67% to 98%.

CYTOLOGICAL DIAGNOSTICS OF INTRAOPERATIVE PERITONEAL WASHES IN GASTRIC CANCER

Diagnosis of peritoneal microcanceromatosis is the most important task allowing to determine treatment strategy for patients with stomach cancer. Laparoscopy combined with peritoneal flushing and subsequent cytological examination should be performed to detect the peritoneal microcanceromatosis at the preoperative stage. The objective of this work was to improve cytological diagnostics of peritoneal washings using immunocytochemical techniques and the cell block method. The work was carried out on the basis of 276 surgical peritoneal washings in patients with stomach cancer who were on treatment in the department of high-tech surgery of the Moscow Clinical Scientific Centre of the State Budgetary Healthcare Institution named after Loginov A.S. from June 2016 to June 2018. As a result, the optimal panel of monoclonal antibodies (Ber-EP4, CEA, CK20) was chosen, which increased the sensitivity from 52% to 96% and the specificity of cytological diagnosis from 80% to 98%, and the overall accuracy of the method from 67% to 98%.

3230 Metastatic Signet Ring Cell Carcinoma to the Pelvis in a Young Female

INTRODUCTION: Gastric Cancer is the fifth most frequently diagnosed cancer in the world. While the incidence of gastric cancer has been decreasing, the incidence of signet-ring cell carcinoma (SRCC) continues to increase; with data from 2014 SEER analysis showing incidence of 0.4 per 100,000 cases [1-3]. The incidence of SRCC has increased ten-fold between 1970 and 2000 [3]. SRCC tends to occur in younger patients with a mean age ranging from 55 to 61 years [4]. Here we present a case of SRCC in a 23-year-old female with metastasis to the pelvis. CASE DESCRIPTION/METHODS: 23-year-old female w/medical history of iron deficiency anemia presents with 6 months of abdominal pain, nausea, vomiting and 20-pound weight loss. CT scan showed a 4 cm mass of the right pelvic side wall contiguous with the uterus and ascites. Recent endoscopy showed a 4 cm ulcerated mass in the body of the stomach, pathology was positive for poorly differentiated adenocarcinoma with signet ring cell features invading the lamina propria positive for CK20, CK7, AE1/3, EMA. Patient underwent laparoscopy, pelvic washing and peritoneal biopsy, which was positive for malignant cells. The immunostains were positive for CK7, Ber-EP4, MOC31; consistent with gastric adenocarcinoma. Further imaging did not show any distant metastasis and she was referred to oncology after discharge for further treatment. DISCUSSION: SRCC carries a poor prognosis and therapeutic strategy remains unclear; overall prognosis depends on the stage of the cancer [3]. Some studies have shown that prognosis of early stage SRCC cancer might be equivalent to other gastric adenocarcinomas. On the other hand, prognosis of advanced SRCC is very poor with a 5-year survival rate as low as 9% [3]. SRCC differs significantly from non-SRCC oncogenic pathway, as it involves loss of cell-cell adhesion and collection of mucin in large vacuoles. It has been shown that e-cadherin deficiency might initiate carcinogenesis in SRCC at an earlier stage than other cancers [3]. Furthermore, as compared to non-SRCC cancers, gastric SRC patients has reduced sensitivity to chemotherapy [5]. Young patients with SRCC tend to present with more advanced disease; however, they have improved survival as compared to older patients [6]. This is consistent with our young female patient, who presented with metastatic disease. Further studies need to be done concerning treatment strategies and prognostic factors in young patients who present with advanced SRCC.

785P - Observational study of the peritoneal washing cytology positive gastric cancer without gross peritoneal metastasis underwent radical D2 gastrectomy

BackgroundClinical features and therapeutic strategies for peritoneal washing cytology- positive (CY+) gastric cancer without gross peritoneal metastasis have not yet been defined. The aim of the study was to evaluate the clinical prognostic impacts of postoperative chemotherapy for treating gastric cancer patients with CY+ without peritoneal metastasis. MethodsIntraoperative peritoneal washing cytology was performed in 285 patients who underwent curative D2 gastrectomy between April 2004 and May 2016. Of them, 88 patients with CY+ without peritoneal metastasis were included in the study. 64 patients received postoperative chemotherapy, whereas 24 patients underwent surgery only. We combined CY+64 patients who received postoperative chemotherapy with another cohort of stage II/III gastric cancer patients (n=819) who received adjuvant chemotherapy, for survival comparison. ResultsThe Disease-free survival (DFS) and overall survival (OS) curves were well separated according to stage and CY+ in combined cohort (both, P<0.001). CY+ gastric cancer patients demonstrated the worst DFS and OS in combined cohort. CY+ gastric cancer patients showed poorer DFS and OS than CY- gastric cancer patients (CY+ vs. CY-, median DFS 10.270 months vs. not reached, P<0.001; median OS 19.730 vs. 59.400 months, P<0.001). Postoperative chemotherapy improved DFS and OS compared to surgery only in CY+ patients group (median DFS 11.630 vs. 6.980 months, P<0.001; median OS 25.500 vs. 12.110 months, P<0.001). In multivariate analyses in the CY+ patients group, no chemotherapy was the strongest clinical factor for poorer DFS (HR 3.761, P<0.001) and OS (HR 4.366, P<0.001). ConclusionsThe prognosis of gastric cancer with CY+ without gross peritoneal metastasis is somewhat different from gastric cancer with overt peritoneal metastasis, and postoperative chemotherapy improves survival outcome in this patient group. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

PERITONITIS DUE TO AN INTRAUTERINE CONTRACEPTIVE DEVICE

Objectives: Reporting peritonitis as a complication to a patient holding copper IUD for 9 years, this ended in hysterectomy. Method: Reporting the case of a patient who was hospitalized and operated in gynecology at “Queen Geraldine” Hospital, Tirana. Results: Patient with high temperature of 39.5˚C, pain at the end of the abdomen with moderate intensity, with no accompanying illnesses. After ambulatory treatment with antipyretics, the complaints persisted. In this situation she was addressed to the gynecological service, “Queen Geraldine” Hospital, Tirana. In the history of the patient, she has had around 9 years since she has placed copper IUD and repeated unrecognized vaginal infections. The ultrasound examination showed: uterus with size 86 x 53 x 56mm. The IUD was found in the cavity in a normal position, an admixed mass with a size of 66 x 55 mm of dishomogeneous content. At the Douglas level, stretching to the right adjective, a hypoecogeneous piriform mass is found in favor of a pyosalpingitis. In the hemogram obtained a leukocytosis of 22.37 x 10 * 9/L, granulocytes 20.68 x 10 * 9/L, HGB 9.4 g/dl. In the vaginal examination, the uterus was included with a massive conglomerate occupying the whole of Douglas and tamponized by intestines, dolent, with fluctuation. Affiliates included in this conglomerate. Parameters sore, infiltrated. The patient underwent antibiotic therapy for 7 days, improving the situation of complaints and preparing for intervention. Conclusions: The patient underwent supravaginalhysterectomy and bilateralsalpingooophorectomy, a peritoneal wash, after the peritoneal generalization was found. Postoperative deafness of the patient, with early placement of peristalsis and significant improvement of the clinical staff. Antibiotic prophylaxis at the time of IUD placement, patient explanation for its complications, and correct tracking over the years are important in preventing these severe situations. It is also worth emphasizing the importance of accurate diagnosis and timely intervention in chronic SIP or generalized peritonitis. Recommendations: Proper timely screening and treatment of vaginal infections in IUDcarriers prevents pelvic inflammatory disease and consequently severe peritoneal complications.

Proceedings of the American Society of Cytopathology Companion Session at the 2019 United States and Canadian Academy of Pathology Meeting Part 1: towards an International System for Reporting Serous Fluid Cytopathology

The International System for the Reporting of Serous Fluid Cytopathology was initiated to provide a common language for cytopathology reports on body fluids. The International Academy of Cytology and the American Society of Cytopathology collaborated to provide evidence-based and expert-driven terminology for reporting serous fluids. Lead editors were selected and expert authors invited to form working groups for the diagnostic categories and special sections. Preliminary results of the collaboration include the 6 diagnostic terminology categories: non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, malignant-primary, and malignant-metastatic. Four special sections on ancillary testing, peritoneal washings, cytotechnical aspects, and quality assurance will appear in the final text. Initial results of an international survey indicate strong support for a uniform terminology for reporting serous fluids. This article outlines the initial findings of the collaboration as presented to the United States and Canadian Academy of Pathology at the 2019 annual meeting at the National Harbor, MD.

MiR-194-5p in Pancreatic Ductal Adenocarcinoma Peritoneal Washings is Associated with Peritoneal Recurrence and Overall Survival in Peritoneal Cytology-Negative Patients.

Peritoneal dissemination is one of the major recurrence patterns in patients with pancreatic ductal adenocarcinoma (PDAC) and is associated with poor prognosis. Here, we assessed the diagnostic potential of microRNA (miRNA) profiles in peritoneal washings for prediction of peritoneal dissemination in PDAC. From January 2016 to July 2017, peritoneal washings were obtained prospectively from 59 patients with PDAC undergoing surgery the Yokohama City University Hospital. MiRNA expression was evaluated by Agilent human miRNA microarray and quantitative reverse-transcription polymerase chain reaction. Microarray analysis identified upregulated and downregulated miRNAs in peritoneal washings of patients with peritoneal dissemination. We validated four miRNAs (miR-141-3p, miR-194-3p, miR-194-5p, and miR-200c-3p) with high expression in peritoneal washings. The cumulative incidence rate of peritoneal recurrence in peritoneal cytology-negative patients in the miR-194-5p high group was significantly higher than that in the miR-194-5p low group (p = 0.002). Univariate and multivariate analyses revealed that high miR-194-5p was associated with overall survival (OS). High expression of miR-194-5p in peritoneal washings is associated with peritoneal recurrence and poor OS in patients with peritoneal cytology-negative PDAC.

Atypia of Undermined Significance on Pelvic Washings and Ascites: Practical Approach to Minimize its Use

Atypia of Undermined Significance on Pelvic Washings and Ascites: Practical Approach to Minimize its Use

Primary Tumor Types and Origins in Positive Pelvic Washing Cytology, A-Single Institution Experience

Primary Tumor Types and Origins in Positive Pelvic Washing Cytology, A-Single Institution Experience

Prognostic importance of peritoneal washing cytology in patients with otherwise resectable pancreatic ductal adenocarcinoma who underwent pancreatectomy: A nationwide, cancer registry–based study from the Japan Pancreas Society

BackgroundThe importance of peritoneal washing cytology status both as a sign of irresectability and as a prognostic factor for pancreatic ductal adenocarcinoma remains controversial. The purpose of this nationwide, cancer registry–based study was to clarify the clinical implications of operative resection in patients who had positive cytology status. MethodsClinical data from 1,970 patients who underwent tumor resection were collected from the Pancreatic Cancer Registry in Japan. Clinicopathologic factors and overall survival curves were analyzed, and multivariate Cox proportional hazard models were evaluated. ResultsAmong the 1,970 patients analyzed, positive cytology status was found in 106 patients and negative cytology status was found in 1,864 patients. The positive cytology status group had a greater frequency of pancreatic body and tail cancer and greater preoperative serum carbohydrate antigen 19-9 levels than the negative cytology status group (P < .001 each). The ratio of peritoneal recurrence tended to be greater in the positive cytology status group (14% vs 43%; P < .001). Overall median survival times were less in the positive cytology status group (17.5 months vs 29.4 months; P < .001). The 5-year survival rates were 13.7% and 31.1% in the positive cytology status and negative cytology status groups, respectively. Multivariate analysis of positive cytology status patients revealed that adjuvant chemotherapy was an independent prognostic factor. ConclusionPositive cytology status was an adverse prognostic factor in patients who underwent resection for pancreatic ductal adenocarcinoma but did not preclude attempted curative resection. Curative resection followed by adjuvant chemotherapy may contribute to long-term prognosis in patients with positive cytology status.

The Morphological Analysis of Cells in the Peritoneal Washing Fluids of Patients with Gastric Cancer

The cytology of peritoneal washing fluids for gastric cancer is the most basic method for judging peritoneal micrometastasis. However, the clinical value of this method is not clear at present. A retrospective analysis was performed on 277 patients with pathologically proven and surgically treated gastric cancer. The peritoneal washing fluids were collected after opening the abdomen and before the operation, and were sent to the cytology laboratory for screening of occult cancer cells in the collected washing fluids. The number of cases diagnosed as cancer cells, reactive mesothelial cells, serosal balls, and traumatic mesothelial cells were 42, 18, 27, and 190, respectively. Typical adenocarcinoma cell nests were found in eight of 10 T4b samples, whereas 34 cases of cancer cells in T3 and T4a showed that these cell nests usually contained mesothelial cells, and the three-dimensional stereoscopic sense of the nests was not obvious. In the specific subcellular morphological changes of both reactive mesothelial cells and serosal balls, the changes of both the contour of nuclear membrane and the polarity of cell alignment were present only in stage T3 and T4a. The presence or absence of mesothelial cells in the nests of cancer cells and the changes of the contour of nuclear membrane and of the polarity of cell alignment in reactive mesothelial cells or serosal balls may help us to predict the depth of invasion of cancer cells.