Peritoneal Serous Papillary Carcinoma Research Articles

Paraneoplastic Cerebellar Degeneration Leading to an Early Diagnosis of Peritoneal Serous Papillary Carcinoma.

A 77-year-old female with a subacute progression of ataxia and serum anti-Yo antibodies was suspected to have paraneoplastic cerebellar degeneration (PCD). An examination of an underlying cancer showed no abnormality in the gynecological organs, but the findings did show a mass in the Douglas fossa. The mass was resected and diagnosed as stage IIB peritoneal serous papillary carcinoma (PSPC), a rare gynecologic cancer that is difficult to diagnose in the early stages. PCD was treated with intravenous immunoglobulin (IVIG). For an early diagnosis and treatment, PSPC should be included in the list of malignancies that cause PCD with anti-Yo antibodies.

Interpretable attention-based deep learning ensemble for personalized ovarian cancer treatment without manual annotations.

Inhibition of pathological angiogenesis has become one of the first FDA approved targeted therapies widely tested in anti-cancer treatment, i.e. VEGF-targeting monoclonal antibody bevacizumab, in combination with chemotherapy for frontline and maintenance therapy for women with newly diagnosed ovarian cancer. Identification of the best predictive biomarkers of bevacizumab response is necessary in order to select patients most likely to benefit from this therapy. Hence, this study investigates the protein expression patterns on immunohistochemical whole slide images of three angiogenesis related proteins, including Vascular endothelial growth factor, Angiopoietin 2 and Pyruvate kinase isoform M2, and develops an interpretable and annotation-free attention based deep learning ensemble framework to predict the bevacizumab therapeutic effect on patients with epithelial ovarian cancer or peritoneal serous papillary carcinoma using tissue microarrays (TMAs). In evaluation with five-fold cross validation, the proposed ensemble model using the protein expressions of both Pyruvate kinase isoform M2 and Angiopoietin 2 achieves a notably high F-score (0.99±0.02), accuracy (0.99±0.03), precision (0.99±0.02), recall (0.99±0.02) and AUC (1.00±0). Kaplan-Meier progression free survival analysis confirms that the proposed ensemble is able to identify patients in the predictive therapeutic sensitive group with low cancer recurrence (p<0.001), and the Cox proportional hazards model analysis further confirms the above statement (p=0.012). In conclusion, the experimental results demonstrate that the proposed ensemble model using the protein expressions of both Pyruvate kinase isoform M2 and Angiopoietin 2 can assist treatment planning of bevacizumab targeted therapy for patients with ovarian cancer.

Difficult Case of Peritoneal Serous Papillary Carcinoma with an Unusual Complication

Peritoneal serous papillary carcinoma (PSPC) is a rare disease that arises in the peritoneal lining of the abdomen and pelvis, without a discriminative primary tumor site. We are presenting the case of a 72-year-old woman diagnosed with PSPC status postdebulking operation in 2017. This year, she experienced left-sided abdominal pain and had a fever for 2 days. After the series of examinations, an unusual complication of a subcutaneous abscess in the anterior abdomen and chest wall was suspected. We searched for any complications of PSPC; however, subcutaneous emphysema and abscess formation over the chest wall and abdominal wall have not been reported to date. The final diagnosis was carcinomatosis, which invaded and perforated the abdominal wall with tumor necrosis or abscess formation.

Predict the Therapeutic Effect of Bevacizumab Treatment Using a Channel Attention Convolution Neural Network

One of the malignancies with the highest mortality rates among women worldwide is ovarian cancer. Epithelial ovarian cancer (EOC) is the most common kind of ovarian cancer which takes ~90% of ovarian cancer patients. peritoneal serous surface papillary carcinoma (PSPC) is rare cancer whose incident rate is 7% in women. Bevacizumab has been used as a monotherapy along with chemotherapy to treat advanced EOC and PSPC. Bevacizumab has a significant effect on chemotherapy, however, due to the high cost and side effects of the bevacizumab, how to predict the therapeutic effect of Bevacizumab treatment is very important. In this paper, the author uses the proposed attention module, ECA, embedding to the ResNet, compose as ECA-Net, to predict the treatment effect of the bevacizumab in current tissue is effective or invalid through the histopathological image. As a result, the ECA-Net gained novel performance, scoring highly on several evaluation metrics. Specifically, the classification accuracy of the ECA-Net is 94.54% and the f1 score is 95.00%. Bevacizumab is pricey and has side effects, the classification model will forecast its therapeutic impact. In this situation, the experiment will assist the gynecologist in selecting the best course of therapy while also saving money.

A Weakly Supervised Deep Learning Method for Guiding Ovarian Cancer Treatment and Identifying an Effective Biomarker.

Simple SummaryMolecular target therapy, i.e., antiangiogenesis with bevacizumab, was found to be effective in some patients of epithelial ovarian cancer. Considering the cost, potential adverse effects, including hypertension, proteinuria, bleeding, thromboembolic events, poor wound healing and gastrointestinal perforation, and no confirmed and accessible biomarkers for routine clinical use to direct patient selection for bevacizumab treatment, the identification of new predictive methods remains an urgent unmet medical need. This study identifies an effective biomarker and presents an automatic weakly supervised deep learning framework for patient selection and guiding ovarian cancer treatment.Ovarian cancer is a common malignant gynecological disease. Molecular target therapy, i.e., antiangiogenesis with bevacizumab, was found to be effective in some patients of epithelial ovarian cancer (EOC). Although careful patient selection is essential, there are currently no biomarkers available for routine therapeutic usage. To the authors’ best knowledge, this is the first automated precision oncology framework to effectively identify and select EOC and peritoneal serous papillary carcinoma (PSPC) patients with positive therapeutic effect. From March 2013 to January 2021, we have a database, containing four kinds of immunohistochemical tissue samples, including AIM2, c3, C5 and NLRP3, from patients diagnosed with EOC and PSPC and treated with bevacizumab in a hospital-based retrospective study. We developed a hybrid deep learning framework and weakly supervised deep learning models for each potential biomarker, and the experimental results show that the proposed model in combination with AIM2 achieves high accuracy 0.92, recall 0.97, F-measure 0.93 and AUC 0.97 for the first experiment (66% training and 34%testing) and high accuracy 0.86 ± 0.07, precision 0.9 ± 0.07, recall 0.85 ± 0.06, F-measure 0.87 ± 0.06 and AUC 0.91 ± 0.05 for the second experiment using five-fold cross validation, respectively. Both Kaplan-Meier PFS analysis and Cox proportional hazards model analysis further confirmed that the proposed AIM2-DL model is able to distinguish patients gaining positive therapeutic effects with low cancer recurrence from patients with disease progression after treatment (p < 0.005).

Histopathological whole slide image dataset for classification of treatment effectiveness to ovarian cancer

Ovarian cancer is the leading cause of gynecologic cancer death among women. Regardless of the development made in the past two decades in the surgery and chemotherapy of ovarian cancer, most of the advanced-stage patients are with recurrent cancer and die. The conventional treatment for ovarian cancer is to remove cancerous tissues using surgery followed by chemotherapy, however, patients with such treatment remain at great risk for tumor recurrence and progressive resistance. Nowadays, new treatment with molecular-targeted agents have become accessible. Bevacizumab as a monotherapy in combination with chemotherapy has been recently approved by FDA for the treatment of epithelial ovarian cancer (EOC). Prediction of therapeutic effects and individualization of therapeutic strategies are critical, but to the authors’ best knowledge, there are no effective biomarkers that can be used to predict patient response to bevacizumab treatment for EOC and peritoneal serous papillary carcinoma (PSPC). This dataset helps researchers to explore and develop methods to predict the therapeutic effect of patients with EOC and PSPC to bevacizumab.

The outcome of patients with serous papillary peritoneal cancer, fallopian tube cancer, and epithelial ovarian cancer by treatment eras: 27 years data from the SEER registry

AimTo determine the differential effect of the treatment periods on the survival of patients with stage IV serous papillary peritoneal carcinoma (SPPC), fallopian tube cancers, and epithelial ovarian cancers (EOC). MethodsThis was an exploratory, population-based observational study of all patients with stage IV SPPC, fallopian tube cancers, and EOC collected from the SEER Research Data 1973–2017. The study period was divided into three time-periods: platinum combinations before the taxane era (1990–1995), platinum plus taxane chemotherapy era (1996–2013), and bevacizumab era (2014–2017). ResultsA total of 9828 patients were eligible for analyses: SPPC (3898 patients; 39.7%), fallopian tube cancers (1290 patients; 13.1%) and EOC (4640 patients, 47.2%). In the 1990–1995 era, the 3-year cause-specific survival was 40% for SPPC, 53% for fallopian tube cancers, and 40% for POC. In the following era 1993–2013, the 3-year cause-specific survival increased to 55% for SPPC, 74% for fallopian tube cancers, and 45% for POC. The last era 2014–2017 showed a 3-year cause-specific survival of 64%, 67%, and 45% for patients with SPPC, fallopian tube cancers, and POC, respectively. The differences in cause-specific survival were statistically significant for patients with SPPC (p=0.004). Multivariable analysis showed that the treatment eras and age at diagnosis were associated with cause-specific survival. ConclusionThe results of this study are hypothesis-generating and cannot be considered conclusive given the inherent limitations of registry analysis. Subgroup analyses of the phase III randomized controlled trials, by tumor subset (EOC, fallopian tube cancer, and SPPC) would shed more light on the differential effects of novel therapies.

AIM2 Inflammasome in Tumor Cells as a Biomarker for Predicting the Treatment Response to Antiangiogenic Therapy in Epithelial Ovarian Cancer Patients.

Antiangiogenic therapy, such as bevacizumab (BEV), has improved progression-free survival (PFS) and overall survival (OS) in high-risk patients with epithelial ovarian cancer (EOC) according to several clinical trials. Clinically, no reliable molecular biomarker is available to predict the treatment response to antiangiogenic therapy. Immune-related proteins can indirectly contribute to angiogenesis by regulating stromal cells in the tumor microenvironment. This study was performed to search biomarkers for prediction of the BEV treatment response in EOC patients. We conducted a hospital-based retrospective study from March 2013 to May 2020. Tissues from 78 Taiwanese patients who were newly diagnosed with EOC and peritoneal serous papillary carcinoma (PSPC) and received BEV therapy were collected. We used immunohistochemistry (IHC) staining and analyzed the expression of these putative biomarkers (complement component 3 (C3), complement component 5 (C5), and absent in melanoma 2 (AIM2)) based on the staining area and intensity of the color reaction to predict BEV efficacy in EOC patients. The immunostaining scores of AIM2 were significantly higher in the BEV-resistant group (RG) than in the BEV-sensitive group (SG) (355.5 vs. 297.1, p < 0.001). A high level of AIM2 (mean value > 310) conferred worse PFS after treatment with BEV than a low level of AIM2 (13.58 vs. 19.36 months, adjusted hazard ratio (HR) = 4.44, 95% confidence interval (CI) = 2.01–9.80, p < 0.001). There were no significant differences in C3 (p = 0.077) or C5 (p = 0.326) regarding BEV efficacy. AIM2 inflammasome expression can be a histopathological biomarker to predict the antiangiogenic therapy benefit in EOC patients. The molecular mechanism requires further investigation.

Primary peritoneal serous papillary carcinoma: a case series.

To present the clinical and laboratory characteristics, as well as the management, of patients with primary peritoneal serous papillary carcinoma (PPSPC). This is a retrospective study of 19 patients with PPSPC who underwent debulking surgery followed by first line chemotherapy and were managed in Metaxa Memorial Cancer Hospital between January 2002 and December 2017. The median age of the patients was found to be 66years (range 44-76years). Clinical presentation of PPSPC included abdominal distention and pain, constipation, as well as loss of appetite and weight gain. Two of the patients did not mention any symptomatology and the disease was suspected by an abnormal cervical smear and elevated CA125 levels respectively. Biomarkers measurement during the initial management of the patients revealed abnormal values of CA125 for all the participants (median value 565 U/ml). Human epididymis secretory protein 4 (HE4) and ratios of blood count were also measured. Perioperative Peritoneal Cancer Index ranged from 6 to 20. Optimal debulking was achieved in 5 cases. All patients were staged as IIIC and IVA PPSPC and received standard chemotherapy with paclitaxel and carboplatin, whereas bevacizumab was added in the 5 most recent cases. Median overall survival was 29months. PPSPC is a rare malignancy, the management of which should take place in tertiary oncology centers.

Clinico-pathological outcomes after total parietal peritonectomy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in advanced serous papillary peritoneal carcinoma submitted to neoadjuvant systemic chemotherapy- largest single institute experience

IntroductionSerous papillary peritoneal carcinoma (SPPC) is a rare clinical entity. Based on the understanding of the pattern of spread, its multifocality, polyclonality and the high frequency of diffuse, widespread peritoneal metastasis, a robust rationale for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for SPPC exists. Herein we report the clinical outcomes of SPPC patients treated with neoadjuvant systemic chemotherapy (NACT) followed by CRS including total parietal peritonectomy and HIPEC. MethodsClinico-pathological data of 22 patients of serous papillary peritoneal carcinoma (SPPC) was retrospectively analyzed from a prospectively maintained database from June 2000 to July 2017. Patients were treated with CRS, total parietal peritonectomy and HIPEC with cisplatin (42 mg/L of perfusate) and doxorubicin (15 mg/L of perfusate) after NACT. Survival curves were calculated from the date of surgery. Results22 patients underwent CRS, total parietal peritonectomy and HIPEC. The median age was 62 years (Range 47–72). On histological evaluation, 18/30 (60%) parietal peritonectomy specimens showed microscopic disease, when no disease was evident macroscopically at surgical exploration. Grade III-IV surgical complications were recorded in 4/22 (18%) patients. There was no postoperative mortality. At a median follow up of 12 months, the five-year overall survival (OS) was 64.9%. The median OS was not reached. Median progression-free survival was 32.9 months and progression-free survival at 5 years was 33.2%. ConclusionCRS with total peritonectomy + HIPEC after NACT, presents as a promising treatment modality for SPPC, and could be associated with good survival results in patients with SPPC.

A rare cause of jejunal wall thickening: Primary peritoneal serous papillary carcinoma

Primer seröz papiller peritoneal karsinoma, peritonun nadir görülen bir adenokarsinomudur ve histolojik özellikleri overin seröz papiller karsinomu ile benzerdir. Ancak primer seröz papiller peritoneal karsinomada tipik olarak overler normaldir. Sıklıkla postmenapozal kadınlarda (ortalama yaş 55-65) görülür. En sık görülen bulgular asit ve karsinoembriyonik antijen-125 yüksekliğidir. Abdominal bilgisayarlı tomografi ve manyetik rezonans görüntülemelerde asit, peritoneal kalınlaşma, omental kek ve intraabdominal kitle görülen bulgulardır. Bu yazımızda jejunoileal duvar kalınlaşması ve asit ile başvuran ve primer seröz papiller peritoneal karsinoma tanısı alan olgu sunuldu. Literatürde jejunaileal tutulum ile prezente olan ilk vakadır.

Long-term survival of high-grade primary peritoneal papillary serous adenocarcinoma: a case report and literature review

BackgroundPrimary peritoneal papillary serous carcinoma (PPPSC) is an uncommon disease which has a high malignancy and a poor prognosis.Case presentationWe report here a long-term survival case of PPPSC with postoperative lung metastasis. A 62-year-old female patient with PPPSC was administered two cycles of neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and six cycles of platinum-based (docetaxel + carboplatin) intraperitoneal chemotherapy postoperatively. The patient reached a complete remission at the completion of primary treatment. Malignant thoracic effusion and lung metastasis developed 5 months after the treatment. The patient underwent video-assisted thoracoscopic surgery plus hyperthermic intrapleural chemotherapy.ConclusionsUp to present, the patient has been survived with tumor for over 86 months with a good performance status, with only encapsulated effusion found at the latest follow-up. As a relatively new regime, the application of CRS + HIPEC in our patient has been proved example for MPE management, although more large-scale studies are needed to substantiate its efficiency and safety.

The clinical value of pleural effusion by liquid-based cytology combined with cell block and immunohistochemical to prompt the origin of tumor cells

Objective To investigate application values of Liquid-based cytology(TCT), cell block and immunohistochemical on estimating sources of malignant tumor cells in hydrothorax. Methods Collect 113 cases of Pleural effusion by Liquid-based cytology that are tentatively diagnosed as malignant tumor or suspected malignancies from January 2013 to June 2016 in Yuncheng Central Hospital. Through centrifuging to collect sediment cells and make paraffin block, 99 cases are selected for immunohistochemical examinations, through the CK7,CK20 and villin immunohistochemical staining determine the direction of the source of tumor, then targeted choose the TTF-1,NapsinA,CK5/6,p63,CR,Syn,CgA,CA125,GCDFP- 15,ER,PR and CDX-2 antibody to immunohistochemical staining. Results Among 94 cases of adenocarcinomas by TCT, 92 cases are still diagnosed as adenocarcinomas by immunohistochemistry. In addition, tumours sources of 92 cases are as following: 70 cases are from lung, 2 cases are from breast, 6 cases are from ovary, 8 cases are from alimentary canal, 1 case is from peritoneal serouspapillary carcinoma, and 5 cases are unknown sources. The other 2 cases are definitely diagnosed as reactive mesothelial cells and tumors of mesothelium respectively. The same diagnostic results of squamous-cell carcinoma and small cell carcinoma by TCT, cell block and Immunohistochemistry are 2 cases and 3 case respectively. The sensitivity and idiosyncrasy of Immunohistochemistry on determining the direction of tumours sources are 94.6% and 100% respectively, which are better than histological examination. Conclusions Making hydrothorax into cell blocks for immunohistochemical examination not only save tumor cells in hydrothorax, but also gathering and collecting tumor cells by centrifuge improves positive detection rate of cellular pathology and contributes to differential diagnosis of tumour cell, analysis of tissues sources, gene mutations detection and molecular targeted therapy. Therefore, it is significant to prolong patients'lives, lessen their pain, improve living quality and clinical values. Key words: Liquid-based cytology; Cell block; Immunohistochemica; Tumor cell origin

Genetic landscape of a case of extraovarian peritoneal serous papillary carcinoma.

The present report aimed to study genetic alterations underlying extraovarian peritoneal serous papillary carcinoma (EPSPC), which have not previously been systematically investigated. A case of EPSPC was identified, and its genetic alterations were assessed by combining comparative genomic hybridization and whole-exome sequencing technologies to investigate the genomic landscape, including copy number variations and mutations in EPSPC. It was found that a large number of germline mutations were present, which may have predisposed the patient to the occurrence of this disease. Copy number gains were found in a range of chromosomes, including 4q, 5q, 8q, 10q, 15q, 16p, 18q, 20p, 20q and Xq. Large-scale copy number loss occurred in chromosomes 2p, 13q, 16q, 17p and 17q. Through use of whole-exome sequencing, germline mutations were widely found that were associated with cancer development, including mutations in the BRCA1, DNA repair associated (BRCA1), BRCA2, tumor protein 53, erb-b2 receptor tyrosine kinase 2, matrix metalloproteinases and ADAM metallopeptidase domain-containing genes. In addition, 165 somatic mutations, including 52 missense mutations and 7 short insertions or deletions, were also identified. In summary, the EPSPC was undergoing profound genomic rearrangement and somatic mutation, which may have led to its initiation and development, and the present study discussed the genetic basis of this highly malignant cancer.

A case report of primary psammomatous serous adenocarcinoma of the peritoneum

Extraovarian peritoneal serous papillary carcinoma is an uncommon malignant tumour characterised by peritoneal involvement with ascites, which is similar to ovarian serous papillary carcinoma histologically. Our case involved only the surface and superficial cortex of the ovaries, with peritoneal involvement, as described in the literature.

Primary peritoneal serous papillary carcinoma that metastasized to an axillary lymph node in a woman with a history of breast cancer: A case report and diagnostic pitfalls

Herein, we will report on a patient with primary peritoneal serous papillary carcinoma that metastasized to an axillary lymph node and who had previously undergone a mastectomy and chemotherapy for carcinoma of the right breast. A 40-year-old Japanese woman underwent partial resection of her left lung for metastatic breast cancer at our hospital. Thirteen years later, she developed a left axillary lymph node swelling, and a biopsy was performed. Histological findings were compatible with metastatic breast carcinoma. Positron emission tomography–computed tomography revealed systemic lymphadenopathy, peritoneal nodules, and a liver mass. The patient was diagnosed with recurrent breast cancer and underwent additional chemotherapy. Six months later, she developed ascites. She was diagnosed with serous adenocarcinoma using conventional and immunocytological examinations of the ascites. She underwent suboptimal debulking surgery, consisting of a total hysterectomy, bilateral oophorectomy, and partial omentectomy. The final pathological diagnosis was primary peritoneal serous papillary carcinoma.The diagnosis and pitfalls of this case will be presented.

912P - Salvage Chemotherapy in Recurrent Ovarian Cancer: a Combination of Gemcitabine and Treosulfan is Equally Active in Platinum-Resistant and Platinum-Sensitive Disease

ABSTRACT Aim: The prognosis of heavily pretreated patients (pts) with epithelial ovarian carcinoma (EOC) and related malignancies having failed multiple chemotherapy (CTx) regimens is poor, irrespectively of the individual platinum-resistance status. In preceding studies, the combination of treosulfan and prolonged low-dose gemcitabine (GeT) has shown promising activity in platinum-resistant EOC. This non-interventional study has been set up in order to obtain more detailed informations regarding the clinical value of GeT given under routine conditions. Methods: 59 pts with recurrent EOC (n = 54), fallopian tube cancer (FTC; n = 2), peritoneal papillary-serous carcinoma (PPSC; n = 2), and type II endometrial carcinoma (EC-II; n = 1) who did not qualify for recruitment into a controlled clinical trial were included in this study. Pts had failed a median of 3 (range 1-11) prior Ctx, 37 were platinum-resistant (group R) and 22 were sensitive (group S). GeT was administered for 1-11 q2w cycles with treosulfan at 1 g/m2 PO on days 1-4 and gemcitabine at 450 mg/m2 IV (3 h infusion) on day 1. Adverse effects were scored according to CTCAE 4.0, responses were classified according to the integrated GCIG criteria. PFS and OS were calculated from the start of GeT until progression or death from any reason or loss to follow up. Results: GeT was generally well tolerated. Hematological side-effects were frequent but manageable with G3-4 neutropenia seen in 6, G3-4 anemia in 8, G3 fever in 3 and G3 infection in 1 pt. Non-hematological side effects exceeded G2 in only 4 pts. In 1 pt, GeT was prematurely stopped due to toxicity (allergic exanthema). A total of 8 CR and 19 PR accounted for an ORR of 45.8%. Adding 16 pts with SD, the clinical benefit rate (CBR) was 72.9%. PFS was 17.3 weeks (wks) and OS was 67.6 wks. No significant differences between groups R and S were found in regard to ORR (40.5% vs 54.5%), CBR (70.3% vs 77.3%), PFS (17.0 vs 18.4 wks), and OS (63.0 vs 72.6 wks). Moreover, prior Ctx with one of the single agents did not lower the likelihood to benefit from GeT. Conclusions: GeT given under routine conditions is well-tolerated and efficacious in heavily pretreated pts with recurrent EOC, FTC, PPSC, and EC-II by exhibiting chemomodulatory properties. Its particularly promising activity in platinum-resistant disease should be further explored in large-scaled prospective clinical trials. Disclosure: All authors have declared no conflicts of interest.

Clinical value of 18 F-FDG PET/CT in the diagnosis of primary peritoneal papillary serous carcinoma

Objective To explore the diagnostic value of 18F-FDG PET/CT in primary peritoneal papillary serous carcinoma (PPPSC).Methods Ten postmenopausal female cases of pathologically diagnosed PPPSC from March 2009 to October 2011 were retrospectively reviewed (age range:61-81 years,mean:(69.4±6.2) years).All cases underwent 18F-FDG PET/CT.The CT characteristics and SUVmax of lesions on PET images were analyzed.Serum CA125 levels were measured before or after PET/CT within one week.The patterns of PPPSC on PET/CT were compared with histopathological results.Linear correlation analysis was used to evaluate the correlation between the CA125 and the maximum SUVmax of lesions presented in parietal peritoneum,greater omentum or mesentery.Results The PET/CT uptake pattern of the 10 PPPSC cases was described as floccus,multi-nodular or cake-like in greater omentum (SUVmax =6.32±2.87),and as diffuse or localized nodules,or non-uniform strip-like thickening in 9 parietal peritoneum and 8 mesentery cases (SUVmax =5.96±2.14 and 5.70± 1.69,respectively).The most commonly involved sites were pelvic wall of peritoneum and mesentery of small intestine.All 10 cases had different degrees of ascites,mainly intrapelvic and perihepatic.Hypermetabolic ovarian enlargement (all ＜5 cm) was bilateral in 2 patients and right-sided in 1 patient.Four patients had retroperitoneal lymph node metastasis and others were found with punctate calcifications in metastatic lymph nodes,small pleural effusions,liver metastasis,as well as portal node metastasis.CA125 concentration was elevated in all cases ((51.25±26.40) ×104 U/L),but there was no significant correlation between CA125 and the maximum SUVmax of lesions found in parietal peritoneum,greater omentum or mesentery (r=0.05,P＞0.05).Conclusion 18F-FDG PET/CT could show the positions and metabolic status of PPPSC lesions.It may be an effective imaging modality in the diagnosis and assessment of PPPSC. Key words: Peritoneal neoplasms ; Tomography, emission-computed ; Tomography,X-ray computed ; Deoxyglucose

Bevacizumab-based therapy in patients with heavily pretreated ovarian and other Mullerian tract cancers.

e16533 Background: Bevacizumab (Bev) is approved for the therapy (Tx) of primary and platinum-sensitive recurrent Mullerian tract cancers (MTC) such as ovarian (OC), fallopian tube (FTC), type II endometrial (EC-II), and peritoneal papillary-serous carcinomas (PPSC). However, the role of Bev in the ≥ 3rd line Tx of MTCs is still unclear.This retrospective study summarizes our long-term experiences with Bev in patients (pts) with heavily pretreated MTC who did not qualify for recruitment into a controlled clinical trial. Methods: A total of 74 intensively pretreated MTC pts (OC, n = 65; FTC, n = 2; EC-II, n = 4; PPSC, n = 3) were included in this study with 43 (58.1%) being platinum-resistant. Pts had failed a median of 4 (range 1-10) prior chemotherapies (CTx ). Tx included Bev monotherapy (group A, n = 17), Bev + metronomic CTx (group B, n = 37), and Bev + conventionally dosed CTx (Group C, n=20). Bev was administered at either 10 mg/kg BW q2w or 15 mg/kg BW q3w. Adverse effects were classified according to CTCAE Vs 4.03. TTP was calculated from the start of Bev until progression, OS was calculated from the start of Bev until death or loss to follow up. Results: Most common Tx related toxicities were hypertension, proteinuria, headache, inflammation/infection, epistaxis, and subileus. Hypertension which often required adequate treatment was limiting in only one case as also were renal toxicity and infection. Median TTP was 27.8 wks and median OS was 53.6 wks with no significant difference between platinum-resistant and –sensitive pts. In regard to both TTP and OS, there was a non-significant trend favoring groups A (33.4/63.0 wks) and B (29.9/61.6 wks) vs group C (19.2/35.4 wks). Conclusions: Bev based Tx was active and generally well tolerated in this hard-to-treat population of pts with recurrent MTC. Both TTP and OS were equal or even superior to any conventional CTx used in this setting. Moreover, clinical platinum-resistance did not predict a worse clinical outcome. Although this is not a randomized trial, our results argue in favor that Bev should be preferably given either as single agent or combined with metronomic CTx in pts with heavily pretreated MTCs. Further clinical trials of Bev in recurrent MTCs may prove useful.

Primary peritoneal serous papillary carcinoma (PSPC) involving ovary and colon: Management and Treatment

Primary peritoneal serous papillary carcinoma (PSPC) involving ovary and colon: Management and Treatment