Mucinous neoplasm of the appendix:A case report and review of literature

BACKGROUND Appendiceal mucinous neoplasms(AMNs),although not classified as rare,are relatively uncommon tumors most often discovered incidentally during colorectal surgery.Accurate identification of AMNs is difficult due to non-specific sym-ptoms,overlapping tumor markers with other conditions,and the potential for misdiagnosis.This underscores the urgent need for precision in diagnosis to pre-vent severe complications.CASE SUMMARY This case report describes the unexpected discovery and treatment of a low-grade AMN(LAMN)in a 74-year-old man undergoing laparoscopic hemicolectomy for transverse colon adenocarcinoma(AC).Preoperatively,non-specific gastroin-testinal symptoms and elevated tumor markers masked the presence of AMN.The tumor,presumed to be an AMN peritoneal cyst intraoperatively,was con-firmed as LAMN through histopathological examination.The neoplasm exhibited mucin accumulation and a distinct immunohistochemical profile:Positive for Ho-meobox protein CDX-2,Cytokeratin 20,special AT-rich sequence-binding protein 2,and Mucin 2 but negative for cytokeratin 7 and Paired box gene 8.This profile aids in distinguishing appendiceal and ovarian mucinous tumors.Postoperative recovery was uncomplicated,and the patient initiated adjuvant chemotherapy for the colon AC.CONCLUSION This case highlights the diagnostic complexity of AMNs,emphasizing the need for vigilant identification to avert potential complications,such as pseudomyxoma peritonei.

Primary malignant peritoneal mesothelioma mimicking tuberculous peritonitis:A case report

BACKGROUND Malignant peritoneal mesothelioma(MPM)is a rare malignancy arising in mesothelial cells in the peritoneum.It can be mistaken for many other diseases,such as peritoneal carcinomatosis and tuberculous peritonitis(TBP),because its clinical manifestations are often nonspecific.Therefore,the diagnosis of MPM is often challenging and delayed.CASE SUMMARY A 42-year-old man was referred to our hospital with lower abdominal pain for 1 wk and ascites observed under abdominal sonography.His laboratory findings revealed an isolated elevated tumor marker of carcinoma antigen 125(167.4 U/m L;normal,<35 U/m L),and contrast enhanced computed tomography showed peritoneal thickening.Thus,differential diagnoses of TBP,carcinomatosis of an unknown nature,and primary peritoneal malignancy were considered.After both esophagogastroduodenoscopy and colonoscopy produced negative findings,laparoscopic intervention was performed.The histopathological results revealed mesothelioma invasion into soft tissue composed of a papillary,tubular,single-cell arrangement of epithelioid cells.In addition,immunohistochemical staining was positive for mesothelioma markers and negative for adenocarcinoma markers.Based on the above findings,TBP was excluded,and the patient was diagnosed with MPM.CONCLUSION It is important to distinguish MPM from TBP because they have similar symptoms and blood test findings.

Postoperative complications and critical care management after cytoreduction surgery and hyperthermic intraperitoneal chemotherapy: A systematic review of the literature

BACKGROUND Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)is a comprehensive treatment option performed for peritoneal surface malignancies.Postoperatively almost all patients are transferred to the intensive care unit electively.AIM To describe the common and rare postoperative complications,postoperative mortality and their critical care management after CRS-HIPEC.METHODS The authors assessed 54 articles for eligibility.Full text assessment identified 14 original articles regarding postoperative complications and critical care management for inclusion into the final review article.RESULTS There is an exaggerated metabolic and inflammatory response after surgery which may be termed as physiological in view of the nature of surgery combined with the use of heated intraperitoneal chemotherapy with/out early postoperative intravenous chemotherapy.The expected postoperative course is further discussed.CRS-HIPEC is a complex procedure with some life-threatening complications in the immediate postoperative period,reported morbidity rates between 12%-60%and a mortality rate of 0.9%-5.8%.Over the years,since its inception in the 1980s,postoperative morbidity and survival have significantly improved.The commonest postoperative surgical complications and systemic toxicity due to chemotherapy as reported in the last decade are discussed.CONCLUSION CRS-HIPEC is associated with a varying rate of postoperative complications including postoperative deaths and needs early suspicion and intensive care monitoring.

Can HIPEC be used against platinum-resistance and for inducing sensitivity to PARP inhibitors in ovarian cancer?

Hyperthermic intraperitoneal chemotherapy(HIPEC)has emerged as a main comprehensive treatment of epithelial ovarian cancer(EOC).Despite much criticism to this approach,HIPEC has shown cost-effective benefits in both progression-free survival and overall survival for high tumor burden with no important impairment on patient-reported quality of life.On the other hand,the landscape of EOC treatment is changing rapidly and poly(ADP-ribose)polymerase inhibitors(PARPi)currently play an important role in the management of EOC based on recent trials.At this point,an important question to be scrutinized is what to expect from up-front HIPEC in the era of amazing benefits by the PARPi.Herein,we discuss the promising role of combining PARPi and HIPEC in the management of advanced EOC.