Volume 6, Number 26;  September 13, 2006

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Unique Identifier [PMID]: 2502058

Authors: Strnad CM. Grosh WW. Baxter J. Burnett LS. Jones HW 3rd. Greco FA. Hainsworth JD.

Institution: Vanderbilt University Medical Center, Nashville, Tennessee.

Title: Peritoneal carcinomatosis of unknown primary site in women. A distinctive subset of adenocarcinoma.

Source: Annals of Internal Medicine. 111(3):213-7, 1989 Aug 1.

Abstract: STUDY OBJECTIVE: To define the clinical features and results of systemic treatment in women with adenocarcinoma of unknown primary site involving predominantly the peritoneal surfaces. DESIGN: Retrospective analysis of 18 patients treated at a single institution between 1978 and 1984. PATIENTS: All 18 women had abdominal carcinomatosis and had no primary site identified at laparotomy. Nine patients had limited residual tumor (maximal tumor diameter, 3 cm OR less) after initial cytoreductive surgery, and 9 patients had extensive residual disease. INTERVENTIONS: In general, patients were treated according to standard guidelines for treatment of advanced ovarian carcinoma. All patients had initial laparotomy with attempted cytoreduction; of these 18 patients, 16 subsequently received cisplatin-based chemotherapy. Patients were restaged either clinically (10 patients) OR with second-look surgery (8 patients). RESULTS: The median survival for all patients was 23 months. Five patients had complete response to chemotherapy, and three patients remain disease-free 41, 59, and 77 months after diagnosis. Patients with limited residual disease had longer median survival than did those with extensive residual disease (31 months compared with 11 months). CONCLUSIONS: Women with adenocarcinoma of unknown primary site involving predominantly the peritoneal surface should be distinguished from other patients with adenocarcinoma of unknown primary site because they have a more indolent disease course, a higher response rate to systemic therapy, and a chance for long-term, disease-free survival after therapy. Although optimal treatment is undefined, we recommend that these patients be treated using the guidelines established for therapy of advanced ovarian carcinoma, including initial surgical cytoreduction followed by cisplatin-based combination chemotherapy.

Publication Type: Journal Article.

Link Directly to Fulltext Article at Science Direct

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Unique Identifier [PMID]: 11748996

Authors: Mahdavi A. Malviya VK. Herschman BR.

Institution: Department of Obstetrics and Gynecology, Providence Hospital and Medical Centers, 16001 West Nine Mile Road, Southfield, Michigan 48075, USA. amahdavi@prodigy.net

Title: Peritoneal tuberculosis disguised as ovarian cancer: an emerging clinical challenge.

Source: Gynecologic Oncology. 84(1):167-70, 2002 Jan.

Abstract: BACKGROUND: The incidence of peritoneal tuberculosis in the western world has increased over the past decade. The diagnosis is often made at laparotomy for suspected peritoneal carcinomatosis. CASE: A 56-year-old Filipino female underwent exploratory laparotomy for suspected ovarian cancer. Frozen-section analysis of her ovaries revealed noncaseating granuloma and the initial acid-fast stains were negative, consistent with non-tuberculous granulomatous disease. Later, all specimen cultures grew Mycobacterium tuberculosis. CONCLUSION: The diagnosis of peritoneal tuberculosis can be difficult and elusive. It mimics ovarian cancer and non-tuberculous granulomatous diseases by its vague symptoms and nonspecific radiographic, pathologic, and laboratory findings. In patients at high risk for peritoneal tuberculosis, we emphasize the importance of clinical suspicion in addition to frozen-section analysis to avoid unnecessary extensive surgery and delay in anti-tuberculous treatment.

Publication Type: Case Reports. Journal Article.

Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 11568336

Authors: Spencer JA. Swift SE. Wilkinson N. Boon AP. Lane G. Perren TJ.

Institution: Department of Clinical Radiology, St James's University Hospital, Beckett St, Leeds LS9 7TF, England. wilsonspencer@compuserve.com

Title: Peritoneal carcinomatosis: image-guided peritoneal core biopsy for tumor type and patient care.[see comment].

Source: Radiology. 221(1):173-7, 2001 Oct.

Abstract: PURPOSE: To assess image-guided peritoneal core biopsy for the diagnosis of tumor type and treatment of patients with peritoneal carcinomatosis. MATERIALS AND METHODS: Thirty-five women (age range, 47-85 years; mean age, 69 years) prospectively identified in a gynecologic oncology center underwent 18-gauge core biopsy in omental cake (n = 25), peritoneal (n = 7), OR adnexal (n = 3) sites. No complications of biopsy occurred. Standard hematoxylin-eosin analysis of the biopsy cores was supplemented by immunohistochemical markers to CA-125, carcinoembryonic antigen, cytokeratin 7, and cytokeratin 20. Diagnoses were validated with further multidisciplinary review, subsequent surgery, and response to specific chemotherapy. RESULTS: In 27 (77%) of the 35 women, a confident primary site diagnosis was obtained with standard hematoxylin-eosin analysis of core biopsy material from the following sites: ovary (n = 22), breast (n = 2), colon (n = 2), and lymphoma (n = 1). The finding at hematoxylin-eosin analysis in another seven (20%) women was poorly differentiated adenocarcinoma with no definite primary site but with an immunohistochemical profile suggesting ovarian cancer (CA-125 positive, carcinoembryonic antigen negative, cytokeratin 7 positive, cytokeratin 20 negative). There was one false-negative biopsy result. CONCLUSION: Image-guided peritoneal core biopsy with hematoxylin-eosin analysis supplemented with immunohistochemical analysis is a simple, safe, and accurate technique for providing site-specific diagnoses in women with undiagnosed peritoneal carcinomatosis.

Publication Type: Journal Article.

Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 12740470

Authors: Pannu HK. Bristow RE. Montz FJ. Fishman EK.

Institution: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287, USA. hpannu@jhmi.edu

Title: Multidetector CT of peritoneal carcinomatosis from ovarian cancer. [Review] [40 refs]

Source: Radiographics. 23(3):687-701, 2003 May-Jun.

Abstract: Ovarian cancer is usually in an advanced stage at diagnosis due to the presence of peritoneal carcinomatosis, which develops as a result of peritoneal fluid circulation. Tumor implants of varying size can occur anywhere from the diaphragm through the pelvis. Computed tomography (CT) can be used to detect these metastatic lesions, which can be miliary OR large and appear as soft-tissue OR low-attenuation masses. Recent advances in CT technology have increased the flexibility of image acquisition, thereby allowing the use of thin sections and multiplanar reformatting. With multidetector CT, thin-section images of the abdomen and pelvis can be obtained to assess for subcentimeter implants and to create three-dimensional images with reduced artifact. Multiplanar reformatting can be used to confirm the presence of implants. Structures such as the diaphragm, paracolic gutters, bowel, and cul-de-sac can be evaluated in multiple planes for surface nodularity and small implants. Interactive multiplanar review of the abdomen and pelvis has the potential to improve detection of peritoneal metastases at CT. [References: 40]

Publication Type: Journal Article. Review.

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Unique Identifier [PMID]: 10861608

Authors: Cavaliere F. Perri P. Di Filippo F. Giannarelli D. Botti C. Cosimelli M. Tedesco M. Principi F. Laurenzi L. Cavaliere R.

Institution: First Department of Surgical Oncology, Regina Elena National Cancer Institute, Rome, Italy. cavaliere@crs.ifo.it

Title: Treatment of peritoneal carcinomatosis with intent to cure.

Source: Journal of Surgical Oncology. 74(1):41-4, 2000 May.

Abstract: BACKGROUND AND OBJECTIVES: Low-grade malignant tumors arise in the abdomen, do not infiltrate, and "redistribute" on the peritoneum with no extraregional spreading. In these cases, aggressive surgery combined with localized chemotherapy may provide cure. METHODS: After removing the tumor with the regional peritoneum en bloc, intraabdominal hyperthermic chemoperfusion was performed throughout the abdominopelvic cavity. Alternatively, early intraabdominal chemotherapy, starting on the first postoperative day, was administered for 5 days. RESULTS: Forty patients affected with extensive peritoneal carcinomatosis underwent peritonectomy, with no residual macroscopic disease except in four cases. Seventy-five percent of the patients underwent locoregional chemotherapy. Major complications were observed in 40% of the patients and led to death in five; there was a direct correlation to the duration of surgery (P = 0.03). At a mean follow-up of 20 months, the overall 2-year survival was 61.4%, with a median survival of 30 months. CONCLUSIONS: After a learning curve of 18 months, the feasibility of the integrated treatment increased to greater than 90%, and mortality dramatically decreased. The combined treatment resulted in a high survival rate in patients with extensive carcinomatosis who were no longer responsive to traditional therapies. Copyright 2000 Wiley-Liss, Inc.

Publication Type: Journal Article.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth