Background Peritoneal tuberculosis and primary peritoneal carcinoma can both present as an abdominal mass and ascites with elevated serum CA125. The purpose of our study was to evaluate the clinical features of perito...Background Peritoneal tuberculosis and primary peritoneal carcinoma can both present as an abdominal mass and ascites with elevated serum CA125. The purpose of our study was to evaluate the clinical features of peritoneal tuberculosis, compare them with features of primary peritoneal carcinoma, and establish definitive diagnostic procedures. Methods We conducted a retrospective study in patients with peritoneal tuberculosis from January 1995 to October 2010 at Peking Union Medical College Hospital. During this time, the data of 38 patients with primary peritoneal carcinoma were reviewed. Results The median age was 34 years （range, 19-80 years）. The most common symptoms were abdominal distension （16/30, 53.3%） and an abdominal mass （12/30, 40.0%）. The serum CA125 level was elevated in 25 patients （83.3%）. The median level of cancer antigen CA125 was 392.5 U/ml （range, 0.6-850.0 U/ml）. Abdominal ultrasound revealed a pelvic mass in 25 patients and ascites in 20 patients. Diagnostic laparoscopy was performed in 15 patients （50.0%） and exploratory laparotomy was performed in 12 patients （40.0%）, and 3 patients （10.0%） who underwent laparoscopy converted to laparotomy because of severe adhesions. The intraoperative findings were adhesions, multiple white tubercles, and ascites. Frozen tissue sections were obtained in 17 patients, and 14 of whom showed chronic granulomatous reactions. Final pathological examinations confirmed the diagnosis. Conclusions Peritoneal tuberculosis should be considered as a differential diagnosis, especially for young women with an abdominal mass, ascites, and elevated serum CA125 levels. Laparoscopy is a useful diagnostic method for peritoneal tuberculosis, and intraoperative frozen sections are recommended when the diagnosis is in doubt.展开更多
Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate wh...Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy,and the potential clinical significance in patients with epithelial ovarian carcinoma （EOC） or primary serous peritoneal carcinoma （PSPC）.Methods Samples were collected before surgery,during chemotherapy and during follow-up for enzyme-linked immunosorbent assay （ELISA）-based evaluation of serum CA-125,CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy.In total,72 patients were examined,including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy.Results In 35 de novo patients,20% （7/35） demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma （57.1%,4/7） showed resistance to chemotherapy.In the 37 recurrent patients,51.4% （19/37） had changed serum tumor markers,of whom 57.9% （11/19） presented with serous carcinoma.There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers.However,for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group.In the 17 patients with secondary recurrence,37.5% （6/17） had changed tumor marker levels.The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence.Conclusions Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence,indicating that in addition to the markers that are abnormal before surgery,those markers that are normalshould also be monitored during chemotherapy and follow-up.展开更多
Systemic chemotherapy for peritoneal disease in ovarian carcinoma is associated with a recurrence rate of more than 75%,and most of the cases are confined to the peritoneal cavity.The propensity of locoregional treatm...Systemic chemotherapy for peritoneal disease in ovarian carcinoma is associated with a recurrence rate of more than 75%,and most of the cases are confined to the peritoneal cavity.The propensity of locoregional treatment failure has paved the way for the discovery of cytoreductive surgery with intra-cavitary chemotherapy.Cytoreductive surgery(CRS)is the present-day treatment modality for a variety of peritoneal carcinomatosis including ovarian cancer,and multi-visceral resection is critical for completion of CRS.In cases of diaphragmatic infiltration by tumor deposits,partial resection leads to a diaphragmatic rent,which can be used for the perfusion of chemotherapeutic drugs into the pleural cavity.Disease transmission from the peritoneal to pleural cavity is a poor prognostic factor however.Hence,intrathoracic hyperthermic chemotherapy may be a reasonable treatment option for ovarian carcinoma with malignant pleural effusion or pleural deposits.Hyperthermic intraperitoneal chemotherapy(HIPEC)is added to the treatment plan in cases of complete CRS but this is a technically demanding procedure.Therefore,performing hyperthermic intrathoracic chemotherapy on top of CRS and HIPEC may be even more complicated for such advanced cancers.The technique of combining HIPEC and hyperthermic intrathoracic chemotherapy is also commonly known as hyperthermic thoracoabdominal chemotherapy(HITAC).The perioperative morbidity and mortality may be remarkably high in such scenarios.We describe our CRS technique with HITAC,which was performed in three FIGO stage IVA ovarian carcinoma patients with metastatic pleural effusion after complete CRS.The patients were retrospectively identified from a prospectively maintained database.All had partial diaphragmatic resection followed by HITAC as part of CRS treatment.Surgical techniques are outlined along with accompanying intra-operative images.Patient demographics,clinical and follow-up details were also described briefly.No comparative analysis with control patients was done.Adjustments in chemotherapy dose are not mandatory for HITAC.Of three patients,one had intrathoracic recurrence on followup;no mortality was recorded HITAC is a complex and potentially harmful procedure whose toxicity profile is still poorly known.Morbidity was not life-threatening and survival was acceptable.展开更多
文摘Background Peritoneal tuberculosis and primary peritoneal carcinoma can both present as an abdominal mass and ascites with elevated serum CA125. The purpose of our study was to evaluate the clinical features of peritoneal tuberculosis, compare them with features of primary peritoneal carcinoma, and establish definitive diagnostic procedures. Methods We conducted a retrospective study in patients with peritoneal tuberculosis from January 1995 to October 2010 at Peking Union Medical College Hospital. During this time, the data of 38 patients with primary peritoneal carcinoma were reviewed. Results The median age was 34 years （range, 19-80 years）. The most common symptoms were abdominal distension （16/30, 53.3%） and an abdominal mass （12/30, 40.0%）. The serum CA125 level was elevated in 25 patients （83.3%）. The median level of cancer antigen CA125 was 392.5 U/ml （range, 0.6-850.0 U/ml）. Abdominal ultrasound revealed a pelvic mass in 25 patients and ascites in 20 patients. Diagnostic laparoscopy was performed in 15 patients （50.0%） and exploratory laparotomy was performed in 12 patients （40.0%）, and 3 patients （10.0%） who underwent laparoscopy converted to laparotomy because of severe adhesions. The intraoperative findings were adhesions, multiple white tubercles, and ascites. Frozen tissue sections were obtained in 17 patients, and 14 of whom showed chronic granulomatous reactions. Final pathological examinations confirmed the diagnosis. Conclusions Peritoneal tuberculosis should be considered as a differential diagnosis, especially for young women with an abdominal mass, ascites, and elevated serum CA125 levels. Laparoscopy is a useful diagnostic method for peritoneal tuberculosis, and intraoperative frozen sections are recommended when the diagnosis is in doubt.
文摘Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy,and the potential clinical significance in patients with epithelial ovarian carcinoma （EOC） or primary serous peritoneal carcinoma （PSPC）.Methods Samples were collected before surgery,during chemotherapy and during follow-up for enzyme-linked immunosorbent assay （ELISA）-based evaluation of serum CA-125,CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy.In total,72 patients were examined,including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy.Results In 35 de novo patients,20% （7/35） demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma （57.1%,4/7） showed resistance to chemotherapy.In the 37 recurrent patients,51.4% （19/37） had changed serum tumor markers,of whom 57.9% （11/19） presented with serous carcinoma.There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers.However,for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group.In the 17 patients with secondary recurrence,37.5% （6/17） had changed tumor marker levels.The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence.Conclusions Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence,indicating that in addition to the markers that are abnormal before surgery,those markers that are normalshould also be monitored during chemotherapy and follow-up.
文摘Systemic chemotherapy for peritoneal disease in ovarian carcinoma is associated with a recurrence rate of more than 75%,and most of the cases are confined to the peritoneal cavity.The propensity of locoregional treatment failure has paved the way for the discovery of cytoreductive surgery with intra-cavitary chemotherapy.Cytoreductive surgery(CRS)is the present-day treatment modality for a variety of peritoneal carcinomatosis including ovarian cancer,and multi-visceral resection is critical for completion of CRS.In cases of diaphragmatic infiltration by tumor deposits,partial resection leads to a diaphragmatic rent,which can be used for the perfusion of chemotherapeutic drugs into the pleural cavity.Disease transmission from the peritoneal to pleural cavity is a poor prognostic factor however.Hence,intrathoracic hyperthermic chemotherapy may be a reasonable treatment option for ovarian carcinoma with malignant pleural effusion or pleural deposits.Hyperthermic intraperitoneal chemotherapy(HIPEC)is added to the treatment plan in cases of complete CRS but this is a technically demanding procedure.Therefore,performing hyperthermic intrathoracic chemotherapy on top of CRS and HIPEC may be even more complicated for such advanced cancers.The technique of combining HIPEC and hyperthermic intrathoracic chemotherapy is also commonly known as hyperthermic thoracoabdominal chemotherapy(HITAC).The perioperative morbidity and mortality may be remarkably high in such scenarios.We describe our CRS technique with HITAC,which was performed in three FIGO stage IVA ovarian carcinoma patients with metastatic pleural effusion after complete CRS.The patients were retrospectively identified from a prospectively maintained database.All had partial diaphragmatic resection followed by HITAC as part of CRS treatment.Surgical techniques are outlined along with accompanying intra-operative images.Patient demographics,clinical and follow-up details were also described briefly.No comparative analysis with control patients was done.Adjustments in chemotherapy dose are not mandatory for HITAC.Of three patients,one had intrathoracic recurrence on followup;no mortality was recorded HITAC is a complex and potentially harmful procedure whose toxicity profile is still poorly known.Morbidity was not life-threatening and survival was acceptable.
