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Chatzigrigoriadis C, Goulioumis A, Sperdouli D, Gyftopoulos K. Embryological, anatomical and clinical considerations on pleuroperitoneal communication. Pleura Peritoneum 2023; 8:101-111. [PMID: 37662602 PMCID: PMC10469182 DOI: 10.1515/pp-2023-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/26/2023] [Indexed: 09/05/2023] Open
Abstract
The pleural and peritoneal cavity share many related features due to their common celomic origin. Normally these two spaces are completely separated with the development of the diaphragm. Defects in diaphragm morphogenesis may result in congenital diaphragmatic hernias, which is the most known form of communication between the pleural and peritoneal cavity. However, in several cases, findings of pleuroperitoneal communication (PPC) have been described in adults through an apparently intact diaphragm. In this comprehensive review we systematically evaluate clinical scenarios of this form of "unexpected" PPC as reported in the literature and focus on the possible mechanisms involved.
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Affiliation(s)
| | | | | | - Kostis Gyftopoulos
- Department of Anatomy, School of Medicine, University of Patras, Patras, Greece
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Fu JX, Wang XJ, Xia M, Wang XJ. Peritoneal carcinomatosis secondary to metastatic lung cancer complicated with acute suppurative appendicitis: A case report and literature review. Medicine (Baltimore) 2022; 101:e31866. [PMID: 36626502 PMCID: PMC9750620 DOI: 10.1097/md.0000000000031866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Lung cancer (LC) is a malignant tumor with the highest morbidity and mortality in the world. The most common metastatic sites of LC are the brain (47%), bone (36%), liver (22%), adrenal glands (15%), thoracic cavity (11%) and distant lymph nodes (10%). Peritoneal carcinomatosis (PC) is a rare clinical event in LC patients. Considering the rarity and nonspecific clinical symptoms of peritoneal metastasis among LC patients, a case of peritoneal metastasis secondary to LC incidentally observed by laparoscopic appendectomy is unusual. PATIENT CONCERNS Here, we present a 53-year-old never-smoker woman who presented to the emergency department with a 2-day history of pain in the right abdominal quadrant. Later, laparoscopy revealed acute suppurative appendicitis accompanied by a peritoneal metastatic mass. DIAGNOSIS The patient was diagnosed with PC secondary to metastatic LC complicated with acute suppurative appendicitis by immunohistochemistry. Positron emission tomography computed tomography (PET CT) findings further strengthen the evidence of PC from LC. OUTCOMES Based on the results of genomic analysis, the patient received targeted therapy with osimertinib 80 mg/d. LESSONS Due to the discovery of new targets, the use of molecular therapies improved progression-free survival (PFS) and overall survival (OS), which increases the chance of identifying peritoneal metastasis of LC. For LC patients with abdominal symptoms, clinicians should be aware of the possibility of peritoneal metastasis from LC, especially for patients diagnosed with lung adenocarcinoma or with pleural effusion.
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Affiliation(s)
- Ji-Xin Fu
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, Shandong, China
| | - Xu-Jie Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, Shandong, China
| | - Min Xia
- Department of Ophthalmology, Weihai Central Hospital, Weihai, Shandong, China
| | - Xin-Jian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, Shandong, China
- *Correspondence: Xin-Jian Wang, Department of Gastrointestinal Surgery, Weihai Central Hospital, Qingdao University, No. 3, Mishandong Road Xi, Wendeng District, Weihai 264200, Shandong Province, China (e-mail: )
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Cao B, Liu Y, Yin W, Li Q, Liang L. [A Single Center, Retrospective Analysis of Prognosis in Non-small Cell Lung Cancer Patients with Peritoneal Carcinomatosis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:143-150. [PMID: 30909993 PMCID: PMC6441112 DOI: 10.3779/j.issn.1009-3419.2019.03.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Peritoneal carcinomatosis is a rare clinical event in lung cancer and the prognosis is very poor. There are limited data on what factors predict peritoneal progression and affect the outcome. The aim of this study is to investigate investigate the factors associated with peritoneal carcinomatosis. METHODS The patients with non-small cell lung cancer (NSCLC) from the Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital were eligible for retrospective analysis between August 2010 and August 2018. Clinical factors such as age, gender, histology, pleural effusion and gene mutations with epidermal growth factor receptor/anaplastic lymphoma kinase/ROS proto-oncogene 1 receptor tyrosine kinase (EGFR/ALK/ROS1) were analyzed. Overall survival (OS) was calculated by the Kaplan-Meier method. RESULTS 1.44% (12/836) patients in this study developed peritoneal carcinomatosis and 12 patients with adenocarcinoma had metachronous NSCLC diagnosis and PC. Malignant pleural effusion rates at baseline and at PC diagnosis were separately 50% (6/12) and 100.0% (12/12). Among the 12 patients, 9 patients harbored EGFR/ALK/ROS1 mutation. The outcome of patients with EGFR/ALK/ROS1 mutation was significantly better than that of patients without EGFR/ALK/ROS1 mutation, the mOS1 and mOS2 were separately 26.0 months and 6.0 months versus 10.0 months and 1.5 months (P<0.05). The mOS2 of patients with aggressive treatment after PC diagnosis was 6.0 months, significantly better than 1.0 month of patients with best supportive care (P<0.05). The mOS2 of the patients with angiogenesis inhibitors based-treatment after PC diagnosis was 8.5 months, significantly longer than that of patients with other treatments (P<0.05). CONCLUSIONS Adenocarcinoma and malignant pleural effusion are highly associated with peritoneal carcinomatosis in patients with advanced NSCLC. Aggressive treatment for lung cancer with PC is encouraged when possible. More patients with PC may benefit from the treatment strategies with angiogenesis inhibitors. Further prospective trials are urgently needed.
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Affiliation(s)
- Baoshan Cao
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
| | - Yan'e Liu
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
| | - Wencheng Yin
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
| | - Qian Li
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
| | - Li Liang
- Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
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Hayashi K, Hanaoka J, Ohshio Y, Igarashi T. Chylothorax secondary to a pleuroperitoneal communication and chylous ascites after pancreatic resection. J Surg Case Rep 2019; 2019:rjy364. [PMID: 30697412 PMCID: PMC6344917 DOI: 10.1093/jscr/rjy364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/30/2018] [Indexed: 11/28/2022] Open
Abstract
To the best of our knowledge, there have been no previous reports of chylothorax developing after pancreatectomy, although chylous ascites can occur. In patients with a pleuroperitoneal communication, ascitic fluid can flow into the thoracic cavity through a small hole in the diaphragm. A 70-year-old woman underwent total pancreatectomy and was referred to our department for treatment of right chylothorax after removal of her abdominal drainage tubes. An occult pleuroperitoneal communication was detected, and the portion of the diaphragm containing a diaphragmatic fistula was resected using a surgical stapler. After surgery, the chylothorax resolved, but chylous ascites developed. We speculated that this was a rare case of chylous ascites that flowed into the thoracic cavity through a diaphragmatic fistula after a pancreatic resection. When a patient develops chylothorax after an abdominal operation, the combination of a pleuroperitoneal communication and chylous ascites must be considered.
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Affiliation(s)
- Kazuki Hayashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University Medical Science, Setatsukinowa-cho, Otsu, Shiga 5202192, Japan
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University Medical Science, Setatsukinowa-cho, Otsu, Shiga 5202192, Japan
| | - Yasuhiko Ohshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University Medical Science, Setatsukinowa-cho, Otsu, Shiga 5202192, Japan
| | - Tomoyuki Igarashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University Medical Science, Setatsukinowa-cho, Otsu, Shiga 5202192, Japan
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Namba M, Masuda T, Nakamura T, Horimasu Y, Miyamoto S, Nakashima T, Iwamoto H, Fujitaka K, Hamada H, Hattori N. Additional Octreotide Therapy to Sirolimus Achieved a Decrease in Sirolimus-refractory Chylous Effusion Complicated with Lymphangioleiomyomatosis. Intern Med 2017; 56:3327-3331. [PMID: 29021448 PMCID: PMC5790722 DOI: 10.2169/internalmedicine.8645-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Recently, sirolimus, an inhibitor of mammalian target of rapamycin, was reported to decrease chylous effusion in patients with lymphangioleimyomatosis (LAM). We herein report a case of a 34-year-old woman with LAM who developed refractory chylothorax and chylous ascites during sirolimus therapy. In this case, to reduce chylous effusion, we administered octreotide, which is often used to control postoperative chylous effusion, in addition to the sirolimus therapy. This combination therapy reduced the chylothorax and chylous ascites. For patients with LAM, octreotide therapy in addition to sirolimus may be effective for treating sirolimus-refractory chylous effusion.
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Affiliation(s)
- Masashi Namba
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Takashi Nakamura
- Postgraduate Medical and Dental Training Center, Hiroshima University Hospital, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Hiroshi Iwamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Kazunori Fujitaka
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Hironobu Hamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Japan
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Lama A, Ferreiro L, Golpe A, Gude F, Álvarez-Dobaño JM, González-Barcala FJ, Toubes ME, San José E, Rodríguez-Núñez N, Valdés L. Characteristics of Patients with Lymphangioleiomyomatosis and Pleural Effusion: A Systematic Review. Respiration 2016; 91:256-64. [DOI: 10.1159/000444264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/22/2016] [Indexed: 11/19/2022] Open
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Csiszkó A, Herr G, Sz Kiss S, Hallay J, Gyöngyösi Z, Szentkereszty Z. VATS therapy of chylothorax caused by leiomyomatosis complicated with tuberous sclerosis complex. J Minim Access Surg 2013; 9:84-6. [PMID: 23741116 PMCID: PMC3673581 DOI: 10.4103/0972-9941.110970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 07/16/2012] [Indexed: 11/04/2022] Open
Abstract
Lymphangioleiomyomatosis with tuberous sclerosis complex is a rare disease. One of the most frequent complications of lymphangioleiomyomatosis is pleural effusion (chylothorax) wich can be treated with the use of VATS. Authors report a case of pulmonary lymphangioleiomyomatosis in a 56-year-old female patient with tuberous sclerosis complex with an 8-week history of recurrent chylothorax, dyspnea and debilitating weakness. By CT scan a flat tissue proliferation was seen in the site of the thoracic duct and it was supposed to be the reason for the pleural effusion. A VATS resection of this laesion and ligation of the thoracic duct was performed successfully. Chylothorax is often associated with pulmonary lymphangioleiomyomatosis. Lymphangioleiomyomatosis combined with tuberous sclerosis complex is extremely rare. In case of chylothorax VATS treatment is successful and may be the first choice.
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Affiliation(s)
- Adrienn Csiszkó
- Insitute of Surgery, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
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Seyama K, Kumasaka T, Kurihara M, Mitani K, Sato T. Lymphangioleiomyomatosis: A Disease Involving the Lymphatic System. Lymphat Res Biol 2010; 8:21-31. [DOI: 10.1089/lrb.2009.0018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Kuniaki Seyama
- Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Toshio Kumasaka
- The Division of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Masatoshi Kurihara
- Pneumothorax Center, Nissan Tamagawa Hospital, Tokyo, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Keiko Mitani
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
| | - Teruhiko Sato
- Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
- The Study Group of Pneumothorax and Cystic Lung Diseases, Tokyo, Japan
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