Online Second Opinion – Peritoneal Carcinosis of Undefined Nature

March 4, 2010 by admin
Filed under: Peritoneal Mesothelioma

Second Opinion – Peritoneal by Undefined Type

This is a summary of 57 years old female patient who are interested in receiving a second opinion. When the patient was 2 years old, he had an appendectomy at age 9 – Operation intussusception, the right side of the iliac fossa, with subsequent hardening of the scar and the occurrence of a sub-scar mass asymptomatic, as a reaction scarring. When the patient was 38 years – 50 years and Dupuytren – Laparoscopic cholecystectomy.

In December 2004, and several months later, the patient suffered from an under-bowel obstruction. A colonoscopy was performed which was negative. In the November 2005 surgery took place the discovery of a mass of grip in the right middle abdomen. 700 cc of exudate Brown was drained.

With the right hemi-colectomy was the precursor. The sections that have been tested, was macroscopically sticky mass of size 8 * 10 * 6 cm found that the terminal was iliem and the appendix with a length of 18 cm. Microscopic sections of the intestine have been diagnosed (through cytodiagnosis and histopathology laboratory at the hospital Riun Trieste) inferior to cancer differentiation. The same results were in the fatty tissue of the pseudo-glands. Other parts of the intestine showed the same appearance as microscpical with papillary aspects.

Markers – negative (CEA-2. 10, CA19. -2. 5, CA125 5th 4). CT: small amount of liquid. Modest signs of peritonitis and adhesions in the abdominal wall. Re-examination of medical devices, 5 January period, the National Cancer Institute suggested that the diagnosis of malignant mesothelioma of epithelial type single phase.

Conclusion: Patients with Ectopic peritoneal mesothelioma, which experienced their first episode of the sub-bowel obstruction from the year 2004. On 01 10. 06 subjected to further scrutiny of the patient in clinical pharmacology and pharmaceutical division of the New European Institute of Oncology, told a story. In December 2004 a sub-occlusive episode was reported that the small intestine that heals spontaneously.

A scan carried out with irrelevant results. During the summer of 2005, enter the above consequences and that the patient undergoes a colonoscopy with irrelevant results. In November 2005 he underwent tests and operation as we have in the previous report. In view of the above information suggests that the experts are waiting for the results of histological analysis of new and repeat chest, abdomen and pelvis CAT scan.

If confirmed, the hypothesis, mesothelioma, it is proposed, the advice of a colleague, the surgeon considered an expert in the treatment and intraperitoneal peritonectomy, since this is the most effective approach to ask. Alternatively, it is proposed that the clinical course over the years to follow (CAT and PET prior to 3 months), but only with an evolving situation, or if a disease is clearly condemned by the CAT scan, the expert is proposing a systematic approach to chemotherapy.

On the other hand, if the histology to be different, it is proposed to repeat a cat and a PET scan in a month, and in the absence of a clear primitive, it is advisable to consult further Surgeons peritonectomy a colleague. The histopathological examination performed in the new European Institute of Oncology, 01 11. 2006 reports: “The evidence, with one infiltrating malignant epithelial mesothelioma of the small intestine.

Immunophenotype of the neoplastic population: negative After Calretinin positive cytokeratin 5 / 6 and WT1, 2-MEX, CEA 5 and desmin.” Another histological study of the Cancer Institute, Milan on 01 .. 13 2006 reports “Morphological and immunophenotypic picture consistent with an epithelial malignant mesothelioma. Immunoreactivity: + calretinin, CK 5 / 6 +, 180 + WT, CD31 -.” The chest-abdominal CT with contrast medium affects 01 made. 16. Have reported changes in 2006: “In the area of the thorax or pleural parenchyma not stated or mediastinal lymphadenopathy.

We’re evaluated in the abdominal region no focal liver lesion, and no indications of an enlarged bile ducts after cholecystectomy. A minimal perihepatic perisplenic liquid layer and a significant time, peritoneal thickening with small and homogeneous areas of liver and suprasplenic;, pancreas and kidneys, adrenal glands) under normal conditions (30 mm cortical cysts with greater diameter between the middle third and bottom third of the right kidney, lymph nodes, granular (with dimensions not more than a centimeter) in the area and along the axis periaortocaval iliac, femoral.

Modest and diffuse thickening of the month with Ansa appear to be slightly stuck and compliance of the abdominal wall and a small reduction in the transparency of the mesenteric adipose tissue in a situation that even with the repeated sequence of sub-occlusive episodes could be consistently and activities under the operation. In the hole in the pelvis, the bladder is usually enlarged with shared walls, no abnormal swelling is apparent. “On 01 20. 2006, visited the patient after the surgeon he had the doctor who examined her was sent to 01. 10. 2006, and the former provided the following conclusion: “Patient peritoneal epithelial mesothelioma, which tends to decrease through the interpretation of the first sub-occlusive episode in 2004 as secondary to this pathology, some time ago and appears with a low degree of biological diversity malignancy .

The CAT scan suggests the involvement of the diaphragm and a syndrome of adhesion significantly between ANSA and abdominal wall. To a certain surgical indication, an interview with the surgeon who operated on the patient seems to hold in November 2005 important, the participation assess the visceral peritoneum and especially the small intestine, it is a contradiction – a clear indication of a surgical procedure. cytoreduction of the chemo-hyperthermia with systemic chemotherapy be the best solution (although seems to experimental).

If there is, on the other side, doubts about the surgical indication, we opted for systemic chemotherapy, possibly with neoadjuvant intent. It is very important for patients to know whether there are other diagnostic procedures. Assuming the histological diagnosis of peritoneal mesothelioma, the recommended treatment is and whether experimental protocols, including immunotherapy. The case was reserved to the medical opinion (www. meters. Com) for the second opinion assessment.

The case was referred to the teacher at the University of Tel Aviv in the case expected to be discussed. The teacher assumed that the diagnosis of mesothelioma, as reported by various diseases. It is important to immunohistochemical staining for c-kit Surgery, EGFR, VEGFR, PDGFR-alpha targeted for possible therapies.

The best treatment option for mesothelioma radically peritonectomy + hyperthermia intra-operative administration of chemotherapy. However, it is difficult to imagine the actual involvement of intra-abdominal tumor from the descriptions provided by radiologists. It is recommended that the CT scan, and run a PET-CT with fog all tumor sites can be checked. If the tumor is inoperable, it is better to go for chemotherapy: cisplatin + pemetrexed (Alimta) and cisplatin + gemcitabine as a palliative treatment or as neoadjuvant treatment.

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