Lung and Intercostal Upper Abdomen Ultrasonography for Staging Patients with Ovarian Cancer: A Method Description and Feasibility Study

A detailed transabdominal and transvaginal ultrasound examination, performed by an expert examiner, could render a similar diagnostic performance to computed tomography for assessing pelvic/abdominal tumor spread disease in women with epithelial ovarian cancer (EOC). This study aimed to describe and assess the feasibility of lung and intercostal upper abdomen ultrasonography as pretreatment imaging of EOC metastases of supradiaphragmatic and subdiaphragmatic areas. A preoperative ultrasound examination of consecutive patients suspected of having EOC was prospectively performed using transvaginal, transabdominal, and intercostal lung and upper abdomen ultrasonography. A surgical-pathological examination was the reference standard to ultrasonography. Among 77 patients with histologically proven EOC, supradiaphragmatic disease was detected in 13 cases: pleural effusions on the right (n = 12) and left (n = 8) sides, nodular lesions on diaphragmatic pleura (n = 9), focal lesion in lung parenchyma (n = 1), and enlarged cardiophrenic lymph nodes (n = 1). Performance (described with area under the curve) of combined transabdominal and intercostal upper abdomen ultrasonography for subdiaphragmatic areas (n = 77) included the right and left diaphragm peritoneum (0.754 and 0.575 respectively), spleen hilum (0.924), hepatic hilum (0.701), and liver and spleen parenchyma (0.993 and 1.0 respectively). It was not possible to evaluate the performance of lung ultrasonography for supradiaphragmatic disease because only some patients had this region surgically explored. Preoperative lung and intercostal upper abdomen ultrasonography performed in patients with EOC can add valuable information for supradiaphragmatic and subdiaphragmatic regions. A reliable reference standard to test method performance is an area of future research. A multidisciplinary approach to ovarian cancer utilizing lung ultrasonography may assist in clinical decision-making.

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Clinical characterization of long term survivors (LTS) in ovarian cancer (OC): Results of a propensity score matched (PSM) analysis of the international prospective tumor bank for ovarian cancer (TOC Network).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17063 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17063-e17063

Author(s):

Elena Ioana Braicu ◽

Hannah Woopen ◽

Joanna Glajzer ◽

Oliver Hunsicker ◽

Linn Woelber ◽

...

Keyword(s):

Ovarian Cancer ◽

Nearest Neighbor ◽

Clonal Diversity ◽

Residual Tumor ◽

Figo Stage ◽

Control Group ◽

Tumor Spread ◽

Clinical Appearance ◽

Platinum Based Chemotherapy ◽

Upper Abdomen

e17063 Background: OC has the highest mortality rate amongst gynecological malignancies. Nevertheless a small fraction of OC patients will survive longer than 8 years. Aim of our study was to analyze differences in the clinical appearance and management of LTS versus “classical” OC patients. Methods: OC patients living longer than 8 years were identified within the TOC Network between 1998 and 2008, representing the LTS subgroup. PSM analysis was used to select comparable groups of LTS and OC patients who died within first 5 years (control group - CG). PSM was conducted using nearest neighbor caliper matching without replacement to match LTS and CG for age, FIGO and residual tumor mass. All calculations were performed with the R project for Statistical Computing (R-packages used: “MatchIt”). Results: A total of 347 OC patients with different histological subtypes were included in the current analysis, i.e. 173 LTS and 174 in the CG. After PSM 114 patients remained in each group. Patients had similar age, FIGO stage and residual mass (p = 0.99, p = 0.35 and p = 0.88, respectively). Tumor spread in middle and upper abdomen (p = 0.002 and 0.013, respectively) was higher and diaphragm, mesentery and peritoneum (p = 0.009, 0.037 and 0.002, respectively) were significantly more often involved in CG than in the LTS. When only considering the HGSOC patients, 95 patients remained in each group. All patients received surgery and platinum based chemotherapy. The PSM analysis showed significant higher involvement of upper abdomen (p = 0.028), higher peritoneal spread (p = 0.002), higher ascites volume (p = 0.0007) and higher bowel resection rates (p = 0.002) in the CG compared to LTS. Neoadjuvant chemotherapy rate was similar in the LTS and CG (p = 0.5). Conclusions: Based on this PSM analysis, HGSOC-LTS seem to have mainly similar clinical pattern as the control group, however with lower rates of ascites and involvement of upper abdomen. Molecular characterization including analysis of clonal diversity might help elucidate mechanisms of tumor spread and good prognosis.

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Diagnostic performance of ultrasound in assessing the extension of the disease in patients with suspicion of malignant ovarian tumor: correlation between ultrasound parameters and Fagotti’s score

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001606 ◽

2020 ◽

pp. ijgc-2020-001606

Author(s):

Maria Cristina Moruzzi ◽

Giulia Bolomini ◽

Francesca Moro ◽

Floriana Mascilini ◽

Silvia Ficarelli ◽

...

Keyword(s):

Ovarian Cancer ◽

Ultrasound Examination ◽

Performance Status ◽

Preoperative Staging ◽

Ecog Performance Status ◽

Tumor Spread ◽

Peritoneal Cancer ◽

Preoperative Ultrasound ◽

Ultrasound Evaluation ◽

Abdominal Disease

BackgroundA radical surgical approach represents the mainstay treatment for gynecological malignancy, and preoperative staging of ovarian cancer is crucial. Ultrasound evaluation is widely recognized as the gold standard technique for the characterization of ovarian masses due to a high sensitivity for malignancy. In addition, its accuracy in defining intra-abdominal ovarian cancer spread has been previously proposed.Primary objectiveTo analyze the agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intra-abdominal disease using six parameters as described by Fagotti’s score.Study hypothesisWhen performed by expert examiners, ultrasound can be an accurate technique to assess tumor spread in ovarian cancer and therefore to predict surgical resectability.Trial designThis is a single-center prospective observational study. Patients with clinical and/or radiological suspicion of advanced ovarian or peritoneal cancer will be assessed with preoperative ultrasound and assigned a score based on the six Fagotti’s laparoscopic score parameters. Each parameter will then be correlated with laparoscopic findings.Major inclusion/exclusion criteriaEligible patients include women 18–75 years of age with clinical and/or imaging suggestive of advanced ovarian or peritoneal cancer, and an ECOG performance status 0–3.Primary endpointsSensitivity and specificity of ultrasound in detecting carcinomatosis, using the parameters of Fagotti’s score as a reference standard. Agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intra-abdominal disease as described in Fagotti’s score.Sample size240 patients.Estimate dates for completing accrual and presenting resultsThe accrual started in January 2019. Enrollment should be completed approximately by October 2020 and the results will be analyzed by December 2020.Trial registrationThe study received the Ethical Committee approval on July 19 2018 (Protocol 28967/18 ID:2172).

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Abdominal wall metastasis of carcinoma breast : a case report

Bangladesh Medical Journal ◽

10.3329/bmj.v44i3.27380 ◽

2016 ◽

Vol 44 (3) ◽

pp. 172-174 ◽

Cited By ~ 1

Author(s):

Abhishak Bhattacharjee ◽

Md Rassell ◽

Md Nazmul Hasan ◽

Bidyut Chandra Debnath

Keyword(s):

Cell Carcinoma ◽

Abdominal Wall ◽

Adjuvant Treatment ◽

Duct Cell ◽

Pathological Examination ◽

Axillary Lymph ◽

Tumor Spread ◽

Abdominal Wall Metastasis ◽

The Right

Abdominal wall metastasis from breast carcinoma is an uncommon occurrence compared to local invasion into muscle from direct tumor spread. A 30 years old lady was referred to our hospital from a medical college hospital for adjuvant treatment after being done the left sided modified radical mastectomy. Pathological examination revealed poorly differentiated infiltrative duct cell carcinoma, metastatic deposits in axillary lymph node with histological grade 3. She underwent adjuvant chemotherapy and radiotherapy with regular schedule and follow up. Her adjuvant treatment and follow up period were uneventful upto 13 months. Thereafter she reported a painless lump in the right upper abdomen which was rapidly growing in size. Cytopathology report confirmed that the cells of the parietal lump were compatible with metastatic duct cell carcinoma. So, though the primary pathology was in the left side but the parietal lump was found in the right side. Skeletal muscle metastasis is uncommon and pain is the commonest symptom. But here the lump is painless and this is another rare presentation. Treatment principle is only palliation.Bangladesh Med J. 2015 Sep; 44 (3): 172-174

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Severe bone disease caused by primary hyperparathyroidism: a case report and review of the literature

Journal of International Medical Research ◽

10.1177/0300060520966484 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096648

Author(s):

Yu Wang ◽

Jie Liu

Keyword(s):

Case Report ◽

Primary Hyperparathyroidism ◽

Bone Disease ◽

Distal Humerus ◽

Left Lobe ◽

Pathological Examination ◽

Hypoechoic Mass ◽

Brown Tumors ◽

Restricted Mobility ◽

The Right

Bone disease is an important complication of hyperparathyroidism. We herein report a rare case of severe bone disease caused by primary hyperparathyroidism. A 33-year-old man presented with pain and restricted mobility in his right upper limb and right hip due to a fall 3 days previously. X-ray examination showed a fracture of the proximal and distal humerus. Computed tomography examination showed a supracondylar fracture of the right humerus, a fracture of the right femoral neck, a fracture of the right sciatic branch, and multiple brown tumors. Ultrasonography showed a 3.5- × 1.6-cm hypoechoic mass below the left lobe of the thyroid. The patient was diagnosed with primary hyperparathyroidism based on increased serum calcium and parathormone concentrations, pathological fractures, and multiple brown tumors. He therefore underwent bilateral lower parathyroidectomy. Pathological examination revealed a parathyroid adenoma. The patient recovered well after surgery and was followed up for 6 months with no symptoms of hyperparathyroidism. This case report suggests that clinicians should be aware of the possibility of severe bone disease secondary to primary hyperparathyroidism. Active and early diagnosis and surgical treatment are important in such cases.

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Laparoscopic Resection of Renal Capsular Endometriosis in a Woman with Menstrual-Related Flank Pain: Case Report

African Journal of Urology ◽

10.1186/s12301-021-00186-2 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Abbas Basiri ◽

Iman Ghanaat ◽

Hamidreza Akbari Gilani

Keyword(s):

Flank Pain ◽

Pathological Examination ◽

Histologic Evaluation ◽

Normal Renal Parenchyma ◽

Perinephric Space ◽

Superior Portion ◽

The Right ◽

First Time ◽

Laparoscopic Removal

Abstract Background Although involvement of the urinary system is not uncommon, endometriosis in the kidneys is rare. To date, laparoscopic partial nephrectomy has been the preferred approach for managing renal endometriosis. Here, we report for the first time the results of laparoscopic removal of a renal capsular endometriosis in a malrotated kidney in an attempt to save the whole kidney parenchyma, in terms of feasibility and safety. Case presentation A 37-year-old female presented with periodic right flank pain associated with her menstrual cycle. On imaging, a malrotated right kidney and a hypodense irregular-shaped lesion measuring 30 * 20 * 15 mm were seen in the superior portion of the right perinephric space. Histologic evaluation of the ultrasound-guided biopsy was consistent with renal capsular endometriosis. The patient underwent laparoscopic surgery to remove the capsular mass while preserving the normal renal parenchyma. Pathological examination of the biopsy obtained during surgery was in favor of renal endometriosis. At 6-month follow-up, the patient’s pain had completely disappeared and no complications had occurred. In addition, imaging did not show any remarkable recurrence. Conclusion Renal endometriosis should be strongly considered as a differential diagnosis in female patients with a renal capsular mass and exacerbation of flank pain during menstruation. Based on our experience, with preoperative needle biopsy and clearing the pathology, laparoscopic removal of the mass in spite of renal anatomic abnormality is feasible and safe and thus could be considered as a possible treatment option.

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Coincidence of Intra-Abdominal Splenosis in a Patient with Advanced Ovarian Cancer: Case Report and Review of the Literature

The Surgery Journal ◽

10.1055/s-0041-1731426 ◽

2021 ◽

Vol 07 (02) ◽

pp. e116-e120

Author(s):

Tatjana Braun ◽

Amelie De Gregorio ◽

Lisa Baumann ◽

Jochen Steinacker ◽

Wolfgang Janni ◽

...

Keyword(s):

Ovarian Cancer ◽

Case Report ◽

Diagnostic Imaging ◽

Medical History ◽

Rare Disease ◽

Metastatic Cancer ◽

Abdominal Cavity ◽

Advanced Ovarian Cancer ◽

Splenic Tissue ◽

Tumor Spread

AbstractSplenosis is a rare disease, which is often discovered incidentally years after surgical procedures on the spleen or traumatic splenic lesions. Through injury of the splenic capsule, splenic cells are able to spread and autoimplant in a fashion similar to the process of metastatic cancer. Here we present the case of a 62-year-old female patient with a palpable tumor of the lower abdomen. Her medical history was unremarkable, except for splenectomy after traumatic splenic lesion in her childhood. Clinical examination and diagnostic imaging raised the suspicion of advanced ovarian cancer, which was further substantiated by the typical presentation of adnexal masses and disseminated peritoneal metastases during the following staging laparotomy. Surprisingly, we also found peritoneal implants macroscopically similar to splenic tissue. Microscopic examination of tissue specimens by intrasurgical frozen section confirmed the diagnosis of intra-abdominal splenosis. The patient then underwent cytoreductive surgery with complete resection of all cancer manifestations, sparing the remaining foci of splenosis to avoid further morbidity. This case demonstrates the rare coincidence of intra-abdominal carcinoma and splenosis, which could lead to intraoperative difficulties by misinterpreting benign splenic tissue. Therefore, splenosis should be considered in patients with medical history of splenic lesions and further diagnostic imaging like Tc-99m-tagged heat-damaged RBC scan could be used for presurgical distinguishing between tumor spread in the abdominal cavity and disseminated splenosis. The presented case report should not only raise awareness for the rare disease splenosis, but also emphasize the need to consider the possibility of simultaneous incidence of benign and malignant intra-abdominal lesions, as to our knowledge this is the first published case of simultaneous peritoneal carcinomatosis and splenosis.

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RONC-26. A CASE OF RADIATION NECROSIS OF THE CEREBELLUM 16 YEARS AFTER CHEMORADIOTHERAPY FOR MEDULLOBLASTOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.795 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii460-iii460

Author(s):

Mayuko Miyata ◽

Masahiro Nonaka ◽

Akio Asai

Keyword(s):

Radiation Necrosis ◽

Tumor Resection ◽

Pathological Examination ◽

Secondary Cancer ◽

Brain Necrosis ◽

Cerebellar Medulloblastoma ◽

Cerebellar Peduncle ◽

The Right ◽

The Brain

Abstract BACKGROUND If new lesions are observed during follow-up of the malignant tumor after treatment, it is difficult to distinguish whether the tumor is a recurrent lesion, secondary cancer, or radiation necrosis of the brain. We have encountered a patient with symptomatic radiation necrosis of the cerebellum 16 years after treatment of medulloblastoma. CASE PRESENTATION: A 24-year-old man who had received a tumor resection and chemoradiotherapy for cerebellar medulloblastoma at the age of 8 presented with dizziness. For the past 16 years, there was no recurrence of the tumor. He subsequently underwent MRI scan, and T1-Gd image showed enhanced lesion in the right cerebellar peduncle. Cerebrospinal fluid cytology analysis was negative for tumor. We suspected tumor reccurence or secondary cancer, and performed lesion biopsy. The result of the pathological examination was radiation necrosis of the cerebellum. DISCUSSION: The interval of radiation necrosis of the brain and radiotherapy can vary from months to more than 10 years. So, whenever a new lesion is identified, radiation brain necrosis must be envisioned. According to guidelines in Japan, there is no absolute examination for discriminating tumor recurrence from radiation brain necrosis and diagnosis by biopsy may be required. CONCLUSION We experienced a case of symptomatic radiation necrosis of the cerebellum 16 years after treatment. In patients showing new lesion after long periods of time, the possibility of radiation necrosis to be considered.

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What comprises the plate-like structure between the pancreatic head and the celiac trunk and superior mesenteric artery? A proposal for the term “P–A ligament” based on anatomical findings

Anatomical Science International ◽

10.1007/s12565-020-00597-1 ◽

2021 ◽

Author(s):

Satoru Muro ◽

Wachirawit Sirirat ◽

Daisuke Ban ◽

Yuichi Nagakawa ◽

Keiichi Akita

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Pancreatic Head ◽

Celiac Trunk ◽

Dorsal Side ◽

Uncinate Process ◽

Anatomical Basis ◽

The Right ◽

Upper Abdomen ◽

Macroscopic Examination

AbstractA plate-like structure is located posterior to the portal vein system, between the pancreatic head and roots and/or branches of two major arteries of the aorta: the celiac trunk and superior mesenteric artery. We aimed to clarify the distribution and components of this plate-like structure. Macroscopic examination of the upper abdomen and histological examination of the plate-like structure were performed on 26 cadavers. The plate-like structure is connected to major arteries (aorta, celiac trunk, superior mesenteric artery) and the pancreatic head; it contains abundant fibrous bundles comprising nerves, vessels, collagen fibers, and adipose tissue. Furthermore, it consists of three partly overlapping fibrous components: rich fibrous bundles (superior mesenteric artery plexus) fused to the uncinate process of the pancreas; fibrous bundles arising from the right celiac ganglion and celiac trunk that spread radially to the dorsal side of the pancreatic head and superior mesenteric artery plexus; and fibrous bundles, accompanied by the inferior pancreaticoduodenal artery, entering the pancreatic head. The plate-like structure is the pancreas–major arteries (aorta, celiac trunk, superior mesenteric artery) ligament (P–A ligament). The term “P–A ligament” may be clinically useful and can facilitate comprehensive understanding of the anatomy surrounding the pancreatic head and provide an anatomical basis for further pancreatic surgery studies.

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Neutrophil Extracellular Trap Formation Correlates with Favorable Overall Survival in High Grade Ovarian Cancer

Cancers ◽

10.3390/cancers12020505 ◽

2020 ◽

Vol 12 (2) ◽

pp. 505 ◽

Cited By ~ 3

Author(s):

Besnik Muqaku ◽

Dietmar Pils ◽

Johanna C. Mader ◽

Stefanie Aust ◽

Andreas Mangold ◽

...

Keyword(s):

Patient Outcome ◽

Ovarian Cancer ◽

Abundance Ratio ◽

Neutrophil Extracellular Trap ◽

High Grade ◽

Serous Ovarian Cancer ◽

Association Network ◽

Tumor Spread ◽

Peritoneal Tumor ◽

Extracellular Trap

It is still a question of debate whether neutrophils, often found in the tumor microenvironment, mediate tumor-promoting or rather tumor-inhibiting activities. The present study focuses on the involvement of neutrophils in high grade serous ovarian cancer (HGSOC). Macroscopic features classify two types of peritoneal tumor spread in HGSOC. Widespread and millet sized lesions characterize the miliary type, while non-miliary metastases are larger and associated with better prognosis. Multi-omics and FACS data were generated from ascites samples. Integrated data analysis demonstrates a significant increase of neutrophil extracellular trap (NET)-associated molecules in non-miliary ascites samples. A co-association network analysis performed with the ascites data further revealed a striking correlation between NETosis-associated metabolites and several eicosanoids. The congruence of data generated from primary neutrophils with ascites analyses indicates the predominance of NADPH oxidase 2 (NOX)-independent NETosis. NETosis is associated with protein S100A8/A9 release. An increase of the S100A8/CRP abundance ratio was found to correlate with favorable survival of HGSOC patients. The analysis of additional five independent proteome studies with regard to S100A8/CRP ratios confirmed this observation. In conclusion, NET formation seems to relate with better cancer patient outcome.

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Ovarian abscessation and oophoritis in a first lactation dairy cow: a case report

Livestock ◽

10.12968/live.2021.26.5.228 ◽

2021 ◽

Vol 26 (5) ◽

pp. 228-232

Author(s):

David Charles ◽

Victoria Wyse ◽

Katie Waine ◽

Mark Wessels

Keyword(s):

Case Report ◽

Dairy Cow ◽

Transrectal Ultrasound ◽

Rare Condition ◽

Pathological Examination ◽

The Right

A 28-month-old first lactation dairy cow presented as ‘oestrus not observed’ and transrectal ultrasound showed a hyperechoic mass on the right ovary. The mass continued to grow despite treatment, and 8 weeks later a right-sided ovariectomy was performed. A single, large, cavitated mass was found on gross pathological examination with histopathology confirming ovarian abscessation and oophoritis, a rare condition in cattle.

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