Hidatidosis multiorgánica con compromiso peritoneal: reporte de un caso y revisión de la literatura / Multi-organ hydatidosis with peritoneal involvement: a case report and literature review

La hidatidosis es una parasitosis cuyo agente etiológico es el céstodo del género Echinococcus, siendo las especies más frecuentemente involucradas la E. granulosus y E. multilocularis. Puede afectar a cualquier órgano, aunque con mayor frecuencia se asocia a compromiso hepático y pulmonar. Los hallazgos imagenológicos clásicos en órganos habitualmente comprometidos están ampliamente descritos, no así en localizaciones poco comunes. Presentamos un caso de hidatidosis multiorgánica con compromiso peritoneal y pericárdico, estudiado con ultrasonido y tomografía computada, con revisión de la literatura actualmente disponible al respecto.

Abstract. Hydatidosis is a parasitic disease whose etiologic agent is the tapeworm of the genus Echinococ-cus, the species most frequently involved being E. granulosus and E. multilocularis. It can affect any organ, but most often is associated with liver and lung involvement. The classic imaging findings in organs that are usually involved are fully described, but not so for those in unusual locations. We report a case of multi-organ hydatidosis with peritoneal and pericardial commitment, studied with ultrasound and computed tomography, with a review of the currently available literature regarding this.

A Case of Ovarian Malignant Melanoma showing Peritoneal Dissemination with Unknown Primary Origin / 대한산부인과학회지

Malignant melanoma is a neoplasm of the skin and mucous membrane which very rarely occurs in the ovary. Malignant melanomas occurring in the ovary must be differentiated from primary and metastatic malignant melanoma. Primary malignant melanoma of the ovary is extremely rare and is thought to originate from a cystic teratoma. Malignant melanoma of ovary without evidence of residual teratoma must be considered metastatic even in the absence of a previously cutaneous or mucocutaneous lesion. Opinions about its histogenesis, diagnostic criteria and elective treatment are controversial because of rare manifestations, and the prognosis remains poor in spite of the variety of therapeutic measures. After thoroughly surveying the specific literature, we report case of malignant melanoma with multiple metastases located in the stomach, the omentum and both ovaries with unknown site of primary origin.

Surgical approaches for gynecologic malignancies causing peritoneal dissemination / 대한산부인과학회지

OBJECTIVE: The aims of this study were to compare the efficacy and morbidity of optimal debulking operation with those of suboptimal operation for patients with advanced gynecologic malignancies and to establish the precluding factors for performing the optimal cytoreductive surgery. METHODS: From January 1998 to December 2003, debulking operation for advanced gynecologic malignancy was performed in thirty-nine patients with ovarian cancer (32), tubal cancer (4), and primary peritoneal carcinoma (3) at the department of obstetrics and gynecology, Ghil Medical Center. Of them, 38 patients had FIGO Stage IIIC disease and only one patient had FIGO Stage IV disease. Most informations were obtained by hospital records and were analyzed retrospectively. RESULTS: The mean follow-up was 23 months (range, 1-62 months). The optimal debulking operation could be performed in 25 patients (64.1%). In multivariate analysis, the largest diameter of residual tumor was the most important prognostic factor. Two-year overall survival rate of optimally debulked patients was 86.5% and that of suboptimally debulked patients was 41.3% (p=0.015). Two-year disease free survival rates were 75.9% and 7.1%, respectively (p=0.0003). Complication rates associated with surgery were 40% in optimally debulked patients and 35.7% in suboptimally debulked patients (p=0.083). Major causes of suboptimal surgery were old age (>69 yrs), poor medical condition (cardiac problem, intraoperative unstable vital sign, bronchiectasis), no submission of permission, and involvement of the base of mesentery and small bowel. CONCLUSION: Optimal debulking operation is possible if there were no significant clinical problem and involvement of base of mesentery and small bowel. It appears acceptable surgical morbidity and better prognosis. Therefore, the surgeon should use every technique aimed at removing the tumor as much as possible.

Lymph node metastasis versus peritoneal dissemination in patients with gastric cancer: analysis of the correlated factors and prognosis / 中国普通外科杂志

Objective To investigate the correlated factors of peritoneal dissemination and lympah node metastasis from gastric cancer, the prognosis of patients with peritoneal dissemination and N_2 lymph node metastasis, and the impact of palliative surgery on the prognosis. Methods Based on our database built from 1994, the clinicopathologic data and the outcomes of the follow-up were analyzed respectively. Results The clinicopathologic factors correlated with peritoneal dissemination included T_4, hepatic metastasis, the primary tumor involving the whole stomach, undifferentiated carcinoma, female sex and lymph node metastasis, while those correlated with lymph node metastasis included the primary tumor involving the whole stomach, Borrmann III, T_2, T_3 and T_4, hepatic metastasis and peritoneal dissemination (P

Final Results of Surgery Plus Intraperitoneal Hyperthermo-Chemo-Perfusion (IHCP) for the Prevention and the Treatment of Peritoneal Recurrence in Advanced Gastric Carcinomas

PURPOSE: Despite recent advances in the treatment for serosa invasive gastric carcinomas, no satisfactory outcomes are available because of early peritoneal recurrence caused by micrometastases and free floating cancer cells already existing in the peritoneal cavity. METHODS: We analyzed 103 serosa invasive gastric carcinoma patients who had recieved a surgical resection with or without IHCP from 1990 to 1995. All the patients were pathologically staged according to the UICC classification (1997): Stage II in 17 patients, IIIA in 24, IIIB in 24 and IV in 38. Under hypothermic general anesthesia (32.4- 34oC), IHCP was performed for 2 hours using 1.5% peritoneal dialysis solution mixed with l0 microgram/ml of mitomycin-C warmed at an inflow temperature over 43.5oC in 52 patients. RESULTS: 69 patients died during follow up period. The overall 5-YSR (year survival rate) was 32.8% in the IHCP group, 27.1% in the control group but this difference was not statistically significant. However, in 65 patients, except for those in stage IV, the 5-YSR was 58.6% in the IHCP group and 44.4% in the control group, this difference was statistically significant (p=0.0379). Especially in stage IIIB, the 5-YSR was significantly higher in the IHCP group than in the control group, 41.7% and 25% respectively (p=0.0417). The median survival in the IHCP group (36 mon.) was longer than the control group (22.9 mon.) due to differences in the recurrence patterns. The most common recurrence pattern in the control group was early peritoneal recurrence, but it was late local recurrence in the IHCP group. The types and the rates of complications between the two groups were not different, except for 3 patients with pancytopenia and renal insufficiency in the IHCP group. CONCLUSION: Complete cytoreductive surgery plus IHCP was a safe and effective method to prevent peritoneal recurrence and should lead to long term survival in serosa invasive gastric carcinoma patients, except for those in stage IV with distant metastases.

A Case of Advanced Gastric Cancer Showing Colon Metastasis with Peritoneal Seeding / 대한소화기내시경학회지

The extension of infiltrating gastric cancer through the gastrocolic ligament into the transverse colon appears to be relatively common, but metastases from the ileocecal valve to the sigmoid colon are rare conditions and have been reported in only a few cases. Although direct invasion of tumor cells into the transverse colon and peritoneal dis-semination through the entire colon was a main cause of colon metastasis of gastric cancer, variable other causes were divided, by method of invasion to other organ. There are a few description for endoscopic finding of metastatic colon cancer. A 45-year-old man was admitted to our hospital because of epigastric discomfort and pain for 3 months ago. He was confirmed to have diffuse infiltrating adenocarcinoma (Borrman type IV) by gastro-duodenoscopy, endoscopic ultrasonography, and diagnosed as the colonic invasion by the colonoscopy and biopsy. We report a case of advanced gastric cancer with colon metastasis and review its pathogenetics and endoscopic characteristics from relevant literature.

Significance of Carcinoembryonic Antigen Levels in Peritoneal Washings for Gastric Cancer Patients

Carcinoembryonic antigen (CEA) levels were determined in peritoneal washings from 42 patients who recieved explo-laparatomies from Jan. to Dec. 1995, and these were compared with blood CEA and peritoneal cytology. The patients consisted of 9 patients with benign diseases, 11 with gastric cancer without serosal invasion, 15 with gastric cancer with serosal invasion, and 7 with gastric cancer with visible peritoneal dissemination. Positive values (> 100 ng/g of protein) of peritoneal CEA were observed in 15 cases (45.5%) among 33 gastric cancer patients: 6 (85.7%) of the 7 patients with gastric cancer with visible dissemination, 7 (46.7%) of the 15 patients with serosal invasion without peritoneal dissemination, and 2 of the 11 patients with no serosal invasion, however, no elevation was observed in the 9 patients with benign diseases. The blood CEA and the peritoneal cytology were positive in 8 (24.2%) and 3 (10%) out of the 33 gastric cancer patients, respectively. The sensitivity for peritoneal dissemination was better in peritoneal CEA than in blood CEA and peritoneal cytology. The 1-year survival rates for the patients with and without elevations of the CEA levels were 46.7% and 94.4%, respectively (p < 0.001). The cause of death in 7 (87.5%) of the 8 patients with elevated CEA level in their peritoneal washings could be a sensitive detector of peritoneal dissemination as well as a new predictor for the postoperative prognosis of gastric cancer and an indication for intraperitoneal chemotherapy of hyperthermia.