Incidence and effect on survival of abdominal wall metastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer

The aim of this retrospective study was to examine the incidence and prognostic significance of abdominal wall metastases in patients with ovarian cancer present at the primary debulking at the entry sites of previous laparoscopy or paracentesis. The clinical records of 219 patients were studied. In 7 of 43 patients (16%) who had undergone laparoscopy and 3 of 30 patients (10%) who had undergone paracentesis previous to the primary debulking, an abdominal wall metastasis had developed at the entry sites. All metastases occurred in patients with FIGO stage IIIC-IV including ascites. Survival analysis using the Cox proportional hazards model showed that after adjustment for age, FIGO stage, histology, grade, ascites, and residual disease after primary debulking, the presence of abdominal wall metastases in the entry sites of previous laparoscopy or paracentesis was negatively, although not statistical significantly, correlated with survival (P = 0.14).

Solitary splenic metastasis of an adenocarcinoma of the ovaries

Metastatic involvement of the spleen by carcinoma occurs in a setting of widespread malignant disease. Solitary splenic metastasis in the absence of disseminated disease is rare. We report a case of a 55-year-old woman in whom the sole clinical manifestation of recurrent papillary serous cystadenocarcinoma of the ovary was an elevated serum CA125 level due to a solitary splenic metastasis.

Ovarian cancer: staging with CT and MR imaging

PURPOSE

To evaluate ovarian cancer staging and tumor resectability with computed tomography (CT) or magnetic resonance (MR) imaging.

MATERIALS AND METHODS

Eighty-two women underwent CT (n = 43) or MR imaging (n = 50); eleven of these 82 underwent both. Imaging was performed within 4 weeks of surgical staging. Radiologic, surgical, and histopathologic findings were compared.

RESULTS

Overall staging accuracy was similar for CT and MR imaging (77% [33 of 43] vs 78% [39 of 50]). Evaluation of pelvic cancer extent was better with MR imaging than with CT. There was no difference in detection of abdominal disease. Most mesenteric and small-bowel implants were not detected with either CT or MR imaging. For CT, the positive predictive value for cancer nonresectability was 100% (three of three patients); the negative predictive value was 92% (37 of 40 patients). The positive and negative predictive values for MR imaging were 91% (10 of 11 patients) and 97% (38 of 39 patients).

CONCLUSION

While the staging accuracy of both CT and MR imaging is only moderate, prediction of tumor resectability is excellent.

[Intraarterial chemoembolization therapy for unresectable liver cancer using plachitin particles]

Plachitin formed of both poly-N-acetyl-D-glucosamine (chitin) and cis-diamminedichloroplatinum (CDDP), was used as an arterial chemoembolization therapy against unresectable liver cancer. One gram of Plachitin contained 300 mg of CDDP. The Plachitin particle was 50-100 microns in diameter. Plachitin particles (50-100 mg) were injected via hepatic artery once or twice every week, and the total amount of 300 mg was considered one course of this therapy. The size and number of tumors were measured by computer tomography (CT). Pharmacokinetics of this drug was also assessed by serum and urine platinum (Pt) concentration. Three patients underwent the chemoembolization therapy using plachitin particles. Case 1 had multiple hepatocellular carcinomas. The tumor regression rate was 39% after two courses of this therapy. Serum alpha-fetoprotein (AFP) level decreased from 1,182 ng/ml to 300 ng/ml. Case 2 suffered from bile duct cystadenocarcinoma. After three courses of the therapy, the tumor regression rate was 84.4%. Serum carbohydrate antigen 19-9 (CA19-9) decreased from 731 U/ml to 75 U/ml. Case 3 had synchronous multiple liver metastases from sigmoid colon cancer. The tumor regression rate was 77% after one course of the therapy. Carcinoembryonic antigen (CEA) and CA19-9 decreased from 406 ng/ml to 65 ng/ml and from 4,800 U/ml to 790 ng/ml, respectively. The response rate of the 3 cases was 66.7%. The peak levels of the serum Pt concentration of three patients were 0-0.4 microgram/g throughout the therapy, but peak urine Pt concentrations were observed during one course of the therapy of three patients ranging from 0.5 microgram/g to 3.2 micrograms/g, and decreased gradually for three weeks after the first course. Adverse effects of Plachitin particles for arterial chemoembolization were epigastralgia, nausea, fever, and elevation of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. These adverse effects were observed in all patients, but were transient. Catheter obstruction occurred in one patient (case 2). Cholecystitis, pancreatic pseudocyst, and duodenal ulcer were noticed in case 3. No renal hypofunction was observed. Plachitin might be a useful agent for arterial chemoembolization therapy for primary and secondary liver cancer.

Biliary cystadenocarcinoma arising in a cystadenoma. Report of a case diagnosed by fine needle aspiration cytology

Hepatic cyst fluid cytology tends to yield disappointing results. We report a case of a 56-year-old woman with a biliary cystadenocarcinoma diagnosed by fine needle aspiration cytology. Computed tomography scans had shown a solitary, unilocular hepatic cyst over a five-year period. There was a recent increase in the size and development of a mural echogenic focus. Cytologic examination revealed clusters of malignant glandular cells in a background of cellular debris and mucinophages. The resected specimen confirmed the presence of an adenocarcinoma arising from malignant transformation of a preexisting cystadenoma.

Liver metastases from ovarian cystadenocarcinoma masquerading on CT as lobar fatty infiltration

The CT appearance of fatty infiltration can be variable and can mimic various lesions, including neoplasms. We report a case of ovarian carcinoma metastatic to the liver masquerading as focal lobar fatty infiltration.

Evaluation of cytoreductive surgery with lymphadenectomy including para-aortic nodes for advanced ovarian cancer

The prognosis of 84 patients with advanced ovarian cancer who received the same regimen of postoperative chemotherapy but who received different surgical procedures, was evaluated retrospectively. Of those patients, 41 underwent cytoreductive surgery with lymphadenectomy, including removal of the para-aortic nodes (group A). The other 43 patients received hysterectomy, bilateral salpingoophorectomy and omentectomy (group B). Overall the patients in group A showed a significantly greater survival than those in group B. The performance of lymphadenectomy in patients with positive nodes improves the prognosis to equal that of patients with negative nodes. It is suggested that cytoreductive surgery with lymphadenectomy may be useful for the improvement of the prognosis of patients with advanced ovarian cancer.

False-positive lymph nodes by radioimmunoguided surgery: report of a patient and analysis of the problem

Preoperative administration of radiolabeled monoclonal antibody allows radioimmunoguided surgery with hand-held intraoperative detection devices. From a theoretical perspective, this technology may offer more knowledgable patient management and more complete resection of intra-abdominal cancer. False-positive examinations may seriously jeopardize the widespread application of this apparatus. Our experience with a patient with false-positive lymph nodes following administration of 125I-labeled B72.3 monoclonal antibody is reported. After careful histopathological analysis of five nodes thought to be false-positive for cystadenocarcinoma, one lymph node was found to have a minute nidus of cancer. The cause of false-positive radioimmunoguided tests and their implications for the clinical use of this tool is discussed. We interpreted our data to suggest that tumor antigen-monoclonal antibody complexes processed in reactive lymph nodes, anatomically draining the malignant tissue, may cause false-positive tests.

Choroidal metastasis from primary mucinous cystadenocarcinoma of the ovary

Central nervous system metastases are uncommon in epithelial carcinoma of the ovary; and metastases to the eye are even more rare. This article describes what is believed to be only the third case reported of epithelial carcinoma of the ovary metastatic to the eye.

Solitary recurrent metastasis of epithelial ovarian cancer in the spleen

In epithelial ovarian cancer, solitary metastasis to and recurrences in the parenchyma of the spleen are rare in the absence of apparent disease in other sites. We report four patients who developed isolated, solitary splenic parenchymal recurrences of their epithelial ovarian adenocarcinomas and underwent a splenectomy to remove the recurrent disease. They had undergone optimal cytoreductive surgery for stage III grades 2-3 serous cystadenocarcinoma of the ovary, followed by six to nine cycles of cisplatin and cyclophosphamide chemotherapy and a negative second-look laparotomy. Evidence of relapse developed 2, 4, 6, and 10 years after initial treatment. In two patients, a rising CA-125 heralded the recurrence that was subsequently documented by computed tomography (CT) of the abdomen and pelvis with a single defect noted only in the splenic parenchyma. Two others had only a defect on CT scan. Based on these findings, the otherwise healthy women underwent an exploratory laparotomy, each had a single focus of recurrent poorly differentiated disease that was found in the splenic parenchyma and a splenectomy was performed. Multiple biopsies and cytologies revealed no other evidence of microscopic disease. There was no major postoperative morbidity. Subsequently, one woman was treated with intraperitoneal cisplatin, two with intravenous carboplatin, and one declined further therapy. Three women are alive and free of disease at 6 months to 3 years. The fourth woman is alive with recurrent disease near the site of the resected spleen found 10 months postsplenectomy. Thus, splenic recurrence of epithelial ovarian cancer can occur in the absence of other demonstrable metastasis, and it can be preceded by elevation of CA-125 and an abnormal CT scan. Based on this limited experience with selected patients, splenectomy may have a role in the management of this unusual recurrence.

[Ovarian tumors of low malignant potential: an intra- and retroperitoneal disease?]

Between 1987 and 1992, 13 patients underwent surgery for ovarian tumours of low malignant potential at the First Department of Gynaecology and Obstetrics of the University of Munich. In addition to intraperitoneal surgery, pelvic and para-aortic lymphadenectomy were conducted. In 8 of 11 tumours of the serous type, we found a microscopic extension extending beyond one ovary. In accordance with Russell and other investigators, we consider these alterations to be a disease of multicentric origin. In 3 cases we found within the lymph nodes similar structures to those we had found intraperitoneally, and described these as metastases. In 5 cases, we considered the epithelial lesions in lymph nodes to be mesothelial glandular inclusions. Two of those showed marked proliferations with occasional atypia, so they could be mistaken for metastases. In one case, we found proliferating glandular inclusions adjacent to tumour metastases. Altogether, we identified epithelial lesions within lymph nodes in 6 of 11 cases of serous ovarian tumours of low malignant potential. We call these lesions "tertiary Müller'sches System", independent of whether they are in situ mesothelial proliferations or a result of lymphatic transport of endometrial or tubal glands. Future studies must focus on the question of whether metaplastic and, in particular, neoplastic alterations of these structures have the same prognostic significance as lymph node metastases of ovarian carcinomas.

[Human ovarian epithelial adenocarcinoma with peritoneal metastasis and ascites established in murine models]

By means of SKOV3 subcutaneous xenografts in nude mice, both carcinoma cells and cell suspensions were administrated intraperitoneally to establish a model of metastatic ovarian carcinoma with ascites. The intraperitoneal metastasis and cancer cells in the ascitic fluid were all prove to be adenocarcinoma by microscopic and electromicroscopic examinations. The immunohistochemical and immunocytochemical stainings with monoclonal antibody COC166-9 were the same as SKOV3 cells. The median survival of these nude mice was 68.7 days. This may serve as a good experimental model for testing chemotherapy as well as immunotarget therapy. Similar results obtained by xenografts of OSC2. 40 nude mice were included in this study.

Molecular genetic evidence of a unifocal origin for human serous ovarian carcinomas

The hypothesis that ovarian cancer is multifocal in origin was examined using molecular genetic techniques. Patterns of allelic deletion on chromosome 17 were studied in 16 informative cases of Stage III serous epithelial ovarian carcinoma. DNA was extracted from specimens collected from the omentum and both ovaries, and the specific alleles and chromosomal loci involved in the deletion were identified and compared. In all cases, the patterns of allelic deletion were identical for the tumors that had been collected from different sites in the same patients. In addition, 4 of the 16 cases were heterozygous for the hypoxanthine phosphoribosyl transferase (HPRT) gene on the X-chromosome and were examined for methylation status. In all 4, the same parental allele of the HPRT gene was methylated in tumor cells collected from both ovarian and omental sites, suggesting that the patterns of inactivation of the X-chromosome are identical. This pattern of allelic deletion and HPRT-gene methylation in tumor samples collected from different sites implies that ovarian carcinomas have a unifocal origin.

Bone metastasis in ovarian cancer

Bone involvement in carcinoma of ovary occurs rarely. In a review of 103 patients over last 3 years we have seen 4 such patients (serous-2, mucinous-1, mixed germ cell tumour-1). Patients presented with severe localized bone pain, bony swelling and difficulty in walking. The common sites of involvement were vertebrae, pelvic bones and skull. Radiologically the osteolytic lesions were commonest. Bone lesions were associated with abdomino-pelvic disease in 3 patients. Cisplatinum based chemotherapy in addition to local radiation resulted in significant response in 2 patients; one complete and one partial response. The median survival was 7.5 months (range 6-39 months) after bone metastasis. We conclude bone involvement in cancer ovary is associated with poor prognosis.

[A case of secondary lung cancer of cystadenocarcinoma showing multiple thin-walled cavities]

A 74-year-old woman was admitted to our hospital with the complaint of general fatigue. Chest X-ray revealed multiple thin-walled cavities in both lung fields. Cystadenocarcinoma in the liver and secondary lung cancer were diagnosed on the basis of chest X-ray, abdominal CT, and lung biopsy. She died of respiratory failure, in spite of treatment with chemotherapy for 8 months. At autopsy, the liver mass was diagnosed as cystadenocarcinoma, which had developed from a benign cystadenoma with the capacity to produce mucinous material. Thin-walled cavities in the lungs showed the same histological findings. Therefore, the mechanism of cavity formation in this case was speculated to have been metastasis of mucin-producing cystadenocarcinoma, with entry of air secondary to communication with the terminal bronchiole.

Gonadotropins, estradiol, and growth factors regulate epithelial ovarian cancer cell growth

Indirect evidence suggests that gonadal steroids and gonadotropins may have a role in the genesis of epithelial ovarian cancer. In the studies reported herein, we established 17 beta-estradiol (E2) secreting cell cultures from an omental metastasis of an epithelial ovarian cancer. We demonstrate that human chorionic gonadotropin (hCG), human follicle-stimulating hormone, and epidermal growth factor (EGF) increased cell growth in a dose- and time-dependent manner, whereas E2 inhibited cell growth in the nanomolar range. Epidermal growth factor was able to partially block the negative effect of E2; a similar but quantitatively lesser effect was observed with hCG. These results provide direct evidence to support the view that gonadotropins, EGF, TGF beta (transforming growth factor), and estradiol may modulate growth of metastatic epithelial ovarian cancer cells.

Bronchial metastases from ovarian carcinoma. Report of a case and review of the literature

A patient with ovarian cystadenocarcinoma developed respiratory insufficiency due to bilateral endobronchial metastases, 6.5 years after treatment of the primary tumor. Ovarian cancers frequently metastasize to the pleura and lung parenchyma. Clinically significant bronchial metastases are rare. Only three cases have been reported previously. As in our patient, bronchial metastases tend to occur after a relatively long interval from diagnosis of the primary tumor, and survival may be prolonged after their appearance.

Surgical reversal of a subacute complete unilateral visual loss from an ovarian metastasis to the pituitary gland

A 56-year-old woman with ovarian papillary cystadenocarcinoma that metastasized to the pituitary gland sought treatment with a 7-day history of total loss of vision in one eye. Ten days after transsphenoidal tumor resection, the patient's vision suddenly returned to baseline. This unusual case indicates that surgical decompression of the optic nerve and chiasm can completely salvage vision, even after prolonged total visual loss.

The role of appendectomy in surgical procedures for ovarian cancer

To assess the role of appendectomy in the surgical procedures for ovarian cancer, we evaluated retrospectively the clinical charts of 435 patients who underwent surgery after diagnosis of ovarian cancer. The appendix was removed in 160 cases and pathological examination revealed 37 with metastatic implants (23%). All the patients with appendiceal metastases showed advanced disease (stages III-IV) with an incidence of 43%. Ninety-one percent (31/34) of the tumors with appendiceal involvement at the staging operation were of the serous cell type and grade II or III. No case with early stage, right ovary carcinoma showed appendiceal metastatic foci, denying the existence of a preferential lymphatic pathway. Microscopic involvement was found only in 4 patients with advanced disease (11.7%). No intra- or postoperative complication directly related to the appendectomy was recorded. We conclude, with these results, that appendectomy should be part of the cytoreductive operation for ovarian cancer.

A rare case of serous cystadenocarcinoma of the pancreas

Serous cystadenocarcinoma of the pancreas, a rare disease, developed in a 63-year-old Japanese woman. Pathologic examinations of the pancreatic tumor at the subtotal pancreatectomy showed it to be serous cystadenoma with focal atypical lesions. Three years after the operation, however, metastatic liver nodules were found, and the histologic characteristics of these lesions were quite similar to those of the pancreatic neoplasm. Both primary and metastatic tumors were composed of multiple cysts separated by fibrous septa. The epithelium of cysts was cuboidal and had clear cytoplasm, which had positive results for periodic acid-Schiff (PAS) and negative results for PAS with diastase, Alcian blue, and mucicarmine. To the knowledge of the authors, serous cystic neoplasms of the pancreas have been uniformly benign in biologic behavior. Recently, however, serous cystadenocarcinoma of the pancreas has been reported as a new entity. The current case is the second reported case and might support the existence of serous cystadenocarcinoma of the pancreas.

Ovarian carcinoma preceded by cerebral metastasis: review of the literature

A patient with an asymptomatic primary ovarian carcinoma preceded several months before by a solitary intracranial metastasis is reported. The rarity of this phenomenon, the therapeutic experience in this patient, and the possible mechanism of spread are discussed. Also, a review of the literature is made.