-
Clinical Nuclear Medicine Sep 2023Hibernomas are "pseudolipomas" originating from remnants of fetal brown adipose tissue. These rare benign tumors may occur throughout the body but most commonly in the... (Review)
Review
Hibernomas are "pseudolipomas" originating from remnants of fetal brown adipose tissue. These rare benign tumors may occur throughout the body but most commonly in the thigh, shoulder, back, and neck, and are rarely found in the abdominal cavity, retroperitoneum, breast, bones, scrotum, and perirectum. We present a case of a 58-year-old woman with a known mediastinal mass, who was incidentally found to have a very FDG-avid fat-containing lesion in the omentum abutting the stomach. Subsequent endoscopic ultrasound-guided fine-needle aspiration confirmed hibernoma. The review of the literature shows the location is very unusual.
Topics: Male; Female; Humans; Middle Aged; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Omentum; Lipoma; Neck
PubMed: 37351901
DOI: 10.1097/RLU.0000000000004753 -
Journal of Cancer Research and Clinical... Nov 2023Early detection and intervention could significantly improve the prognosis of patients with peritoneal metastasis (PM). Our main purpose was to develop a model to...
BACKGROUND
Early detection and intervention could significantly improve the prognosis of patients with peritoneal metastasis (PM). Our main purpose was to develop a model to predict the risk of PM in patients with colorectal cancer (CRC).
METHODS
Patients from the Surveillance, Epidemiology, and End Results (SEER) database with CRC classified according to the AJCC 8th TNM staging system were selected for the study. After data pre-processing, the dataset was divided into a training set and a validation set. In the training set, univariate logistic analysis and stepwise multivariate logistic regression analysis were utilized to screen clinical features and construct a risk prediction model. Then, we validated the model using the confusion matrix, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves to examine its performance.
RESULTS
The model constructed using stepwise multivariate logistic regression analysis incorporated the following eight clinical features: age, tumor location, histological type, T stage, carcinoembryonic antigen (CEA) level, tumor deposits (TDs), log odds (LODDS) of metastatic lymph nodes, and extraperitoneal metastasis (EM). The areas under the curve (AUCs) of the model in the training and validation sets were 0.924 and 0.912, respectively. The accuracy and the recall ratio were higher than 0.8 in both cohorts. DCA and the calibration curves also confirmed its excellent predictive power.
CONCLUSIONS
Our model can effectively predict the risk of PM in CRC patients, which is of great significance for the timely identification of patients at high risk of PM and further clinical decision-making.
Topics: Humans; Peritoneal Neoplasms; Peritoneum; Extranodal Extension; Area Under Curve; Colorectal Neoplasms; Nomograms
PubMed: 37679653
DOI: 10.1007/s00432-023-05368-9 -
Journal of Minimally Invasive Gynecology Sep 2023As a standard therapy for locally invasive cervical cancer, radical hysterectomy (RH) has been in routine medical practice for more than a century [1]. However,...
OBJECTIVE
As a standard therapy for locally invasive cervical cancer, radical hysterectomy (RH) has been in routine medical practice for more than a century [1]. However, challenges still exist due to the troublesome bleeding during parametrium dissection and resection, which could increase the risk of surgical complications and may probably affect surgical outcomes ultimately [2]. This video illustrated the three-dimensional anatomy of the pelvic vascular system with particular emphasis on "deep uterine vein" and further introduced a vascular-centered surgical approach to performing RH, which could facilitate parametrium dissection with less blood loss and obtain enough resection margins.
DESIGN
A step-by-step, narrated video demonstration SETTING: A university hospital INTERVENTIONS: After systemic pelvic lymphadenectomy, ureter was then identified along the medial leaf of the broad ligament. By continuously exploring the pelvic cavity along the ureter, communicating branches of the uterine artery to the ureter, urinary bladder, corpus uteri, uterine cervix, and upper vagina were clearly identified in a cranial to caudal direction, demonstrating the arterial network surrounding the urinary system. Coagulating and cutting these blood vessels could free the ureter from retroperitoneum and subsequently excavate the ureteral tunnel easily. Next, a precise dissection of the area below the ureter revealed the whole distribution of currently named "deep uterine vein". Originated from an internal iliac vein, it is much more like a venous confluence than an accompanying vein, with branches crossing directly into the bladder, dorsally to the rectum, and traveling caudally to the anterolateral side of the uterus and vagina in a crisscross fashion, which mandates us to describe it as pampiniform-like venous plexus instead of "deep uterine vein" due to its anatomical distribution and function. Finally, after complete exposure of venous network, enough extent of parametrium could be adequately separated and resected by accurate coagulation of blood vessels on an individualized requirement.
CONCLUSION
Recognizing the precise anatomy of pelvic vascular system, especially the entire distribution of currently named "deep uterine vein" and isolating the venous branches connecting to all three parts of parametrium, are key to the RH procedure. Careful attention to the complex vascular anatomy is critical to reducing intraoperative bleeding and avoiding complications in RH.
Topics: Female; Humans; Hysterectomy; Uterus; Pelvis; Uterine Cervical Neoplasms; Laparoscopy
PubMed: 37321296
DOI: 10.1016/j.jmig.2023.06.006 -
British Journal of Cancer Nov 2023Peritoneal metastases from various abdominal cancer types are common and carry poor prognosis. The presence of peritoneal disease upstages cancer diagnosis and alters... (Review)
Review
Peritoneal metastases from various abdominal cancer types are common and carry poor prognosis. The presence of peritoneal disease upstages cancer diagnosis and alters disease trajectory and treatment pathway in many cancer types. Therefore, accurate and timely detection of peritoneal disease is crucial. The current practice of diagnostic laparoscopy and peritoneal lavage cytology (PLC) in detecting peritoneal disease has variable sensitivity. The significant proportion of peritoneal recurrence seen during follow-up in patients where initial PLC was negative indicates the ongoing need for a better diagnostic tool for detecting clinically occult peritoneal disease, especially peritoneal micro-metastases. Advancement in liquid biopsy has allowed the development and use of peritoneal tumour DNA (ptDNA) as a cancer-specific biomarker within the peritoneum, and the presence of ptDNA may be a surrogate marker for early peritoneal metastases. A growing body of literature on ptDNA in different cancer types portends promising results. Here, we conduct a systematic review to evaluate the prognostic impact of ptDNA in various cancer types and discuss its potential future clinical applications, with a focus on gastrointestinal and gynaecological malignancies.
Topics: Female; Humans; Peritoneum; Peritoneal Neoplasms; Prognosis; Genital Neoplasms, Female; Peritoneal Diseases; DNA; Stomach Neoplasms; Neoplasm Staging
PubMed: 37700064
DOI: 10.1038/s41416-023-02424-6 -
Annals of Surgical Oncology Oct 2023
Topics: Humans; Cell-Free Nucleic Acids; Pancreatic Neoplasms; Peritoneum; Biomarkers; Peritoneal Lavage
PubMed: 37482596
DOI: 10.1245/s10434-023-13947-w -
BMJ Case Reports Dec 2023A man in his early 20s presented to us in the outpatient department with a history of diarrhoea for 4 months. Investigations revealed elevated serum chromogranin...
A man in his early 20s presented to us in the outpatient department with a history of diarrhoea for 4 months. Investigations revealed elevated serum chromogranin levels and an intensely avid lesion in the gastrohepatic ligament in Gallium DOTATATE positron emission tomography (PET). The tumour was excised laparoscopically, and no other lesions were seen. The patient improved clinically and had a normal serum chromogranin level postoperatively. He is currently much improved at the 1year follow-up. We did an extensive workup to look for a primary tumour. It was concluded that it was a de novo tumour arising from the lesser sac. The recommended investigations in case of neuroendocrine tumour (NET) with unknown primary include blood investigations to look for the functional status of the tumour, histopathological examination, including immunohistochemistry, and radiological imaging, which must include a Gallium DOTATATE PET. An isolated NET of the lesser sac has not been reported in the literature.
Topics: Humans; Male; Chromogranins; Gallium; Neuroendocrine Tumors; Omentum; Organometallic Compounds; Peritoneal Cavity; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Tomography, X-Ray Computed; Young Adult
PubMed: 38123316
DOI: 10.1136/bcr-2023-258366 -
Peritoneal Dialysis International :... Jan 2024Long-term peritoneal dialysis is associated with the development of peritoneal membrane alterations, both in morphology and function. Impaired ultrafiltration (UF) is... (Review)
Review
Long-term peritoneal dialysis is associated with the development of peritoneal membrane alterations, both in morphology and function. Impaired ultrafiltration (UF) is the most important functional change, and peritoneal fibrosis is the major morphological alteration. Both are caused by the continuous exposure to dialysis solutions that are different from plasma water with regard to the buffer substance and the extremely high-glucose concentrations. Glucose has been incriminated as the major cause of long-term peritoneal membrane changes, but the precise mechanism has not been identified. We argue that glucose causes the membrane alterations by peritoneal pseudohypoxia and by the formation of advanced glycosylation end products (AGEs). After a summary of UF kinetics including the role of glucose transporters (GLUT), and a discussion on morphologic alterations, relationships between function and morphology and a survey of the pathogenesis of UF failure (UFF), it will be argued that impaired UF is partly caused by a reduction in small pore fluid transport as a consequence of AGE-related vasculopathy and - more importantly - in diminished free water transport due to pseudohypoxia, caused by increased peritoneal cellular expression of GLUT-1. The metabolism of intracellular glucose will be reviewed. This occurs in the glycolysis and in the polyol/sorbitol pathway, the latter is activated in case of a large supply. In both pathways the ratio between the reduced and oxidised form of nicotinamide dinucleotide (NADH/NAD ratio) will increase, especially because normal compensatory mechanisms may be impaired, and activate expression of hypoxia-inducible factor-1 (HIF-1). The latter gene activates various profibrotic factors and GLUT-1. Besides replacement of glucose as an osmotic agent, medical treatment/prevention is currently limited to tamoxifen and possibly Renin/angiotensis/aldosteron (RAA) inhibitors.
Topics: Humans; Peritoneal Dialysis; Glucose; Glycosylation; Peritoneum; Dialysis Solutions; Water; Ultrafiltration
PubMed: 37723976
DOI: 10.1177/08968608231196033 -
Journal For Immunotherapy of Cancer Nov 2023Peritoneal carcinomatosis is an advanced stage of cancer in which the disease has spread to the peritoneal cavity. In order to restore antitumor immunity subverted by...
Intraperitoneal administration of a modified vaccinia virus Ankara confers single-chain interleukin-12 expression to the omentum and achieves immune-mediated efficacy against peritoneal carcinomatosis.
BACKGROUND
Peritoneal carcinomatosis is an advanced stage of cancer in which the disease has spread to the peritoneal cavity. In order to restore antitumor immunity subverted by tumor cells in this location, we evaluated intraperitoneal administrations of modified vaccinia virus Ankara (MVA) engineered to express single-chain interleukin 12 (scIL-12) to increase antitumor immune responses.
METHODS
MVA encoding scIL-12 (MVA.scIL-12) was evaluated against peritoneal carcinomatosis models based on intraperitoneal engraftment of tumor cells. CD8-mediated immune responses, elucidated antitumor efficacy, and safety were evaluated following intravenous, intratumoral, or intraperitoneal administration of the viral vector. The immune response was measured by ELISpot (enzyme-linked immunosorbent spot), RNA sequencing, flow cytometry, intravital microscopy, and depletion of lymphocyte subsets with monoclonal antibodies. Safety was assessed by body-weight follow-up and blood testing. Tissue tropism on intravenous or intraperitoneal administration was assessed by bioluminescence analysis using a reporter MVA encoding luciferase.
RESULTS
Intraperitoneal or locoregional administration, but not other routes of administration, resulted in a potent immune response characterized by increased levels of tumor-specific CD8 T lymphocytes with the ability to produce both interferon-γ and tumor necrosis factor-α. The antitumor immune response was detectable not only in the peritoneal cavity but also systemically. As a result of intraperitoneal treatment, a single administration of MVA.scIL-12 encoding scIL-12 completely eradicated MC38 tumors implanted in the peritoneal cavity and also protected cured mice from subsequent subcutaneous rechallenges. Bioluminescence imaging using an MVA encoding luciferase revealed that intraperitoneal administration targets transgene to the omentum. The omentum is considered a key tissue in immune protection of the peritoneal cavity. The safety profile of intraperitoneal administration was also better than that following intravenous administration since no weight loss or hematological toxicity was observed when the vector was locally delivered into the peritoneal cavity.
CONCLUSION
Intraperitoneal administration of MVA vectors encoding scIL-12 targets the omentum, which is the tissue where peritoneal carcinomatosis usually begins. MVA.scIL-12 induces a potent tumor-specific immune response that often leads to the eradication of experimental tumors disseminated to the peritoneal cavity.
Topics: Animals; Mice; Interleukin-12; Peritoneal Neoplasms; Omentum; Vaccinia virus; Luciferases
PubMed: 37918917
DOI: 10.1136/jitc-2023-006702 -
Peritoneal Dialysis International :... Sep 2023Incremental peritoneal dialysis (PD), defined as less than Full-dose PD prescription, has several possible merits, including better preservation of residual kidney... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Incremental peritoneal dialysis (PD), defined as less than Full-dose PD prescription, has several possible merits, including better preservation of residual kidney function (RKF), lower peritoneal glucose exposure and reduced risk of peritonitis. The aims of this study were to analyse the association of Incremental and Full-dose PD strategy with RKF and urine volume (UV) decline in patients commencing PD.
METHODS
Incident PD patients who participated in the balANZ randomised controlled trial (RCT) (2004-2010) and had at least one post-baseline RKF and UV measurement was included in this study. Patients receiving <56 L/week and ≥56 L/week of PD fluid at PD commencement were classified as Incremental and Full-dose PD, respectively. An alternative cut-point of 42 L/week was used in a sensitivity analysis. The primary and secondary outcomes were changes in measured RKF and daily UV, respectively.
RESULTS
The study included 154 patients (mean age 57.9 ± 14.1 years, 44% female, 34% diabetic, mean follow-up 19.5 ± 6.6 months). Incremental and Full-dose PD was commenced by 45 (29.2%) and 109 (70.8%) participants, respectively. RKF declined in the Incremental group from 7.9 ± 3.2 mL/min/1.73 m at baseline to 3.2 ± 2.9 mL/min/1.73 m at 24 months ( < 0.001), and in the Full-dose PD group from 7.3 ± 2.7 mL/min/1.73 m at baseline to 3.4 ± 2.8 mL/min/1.73 m at 24 months ( < 0.001). There was no difference in the slope of RKF decline between Incremental and Full-dose PD ( = 0.78). UV declined from 1.81 ± 0.73 L/day at baseline to 0.64 ± 0.63 L/day at 24 months in the Incremental PD group ( < 0.001) and from 1.38 ± 0.61 L/day to 0.71 ± 0.46 L/day in the Full-dose PD group ( < 0.001). There was no difference in the slope of UV decline between Incremental and Full-dose PD ( = 0.18).
CONCLUSIONS
Compared with Full-dose PD start, Incremental PD start is associated with similar declines in RKF and UV.
Topics: Female; Humans; Adult; Middle Aged; Aged; Male; Peritoneal Dialysis; Glomerular Filtration Rate; Dialysis Solutions; Peritoneum; Kidney; Kidney Failure, Chronic
PubMed: 37259236
DOI: 10.1177/08968608231175826 -
Surgery Jul 2024Postoperative anastomotic recurrence of Crohn's disease is challenging and can lead to symptom recurrence and further surgery. The mesenteric pole of the intestine is... (Review)
Review
Postoperative anastomotic recurrence of Crohn's disease is challenging and can lead to symptom recurrence and further surgery. The mesenteric pole of the intestine is the initial site of macroscopic anastomotic recurrence, and the mesentery may play an important role in recurrence after surgical resection. Therefore, "mesenteric-based surgery" has gained increasing attention by clinicians. However, the role of mesentery in the postoperative recurrence remains controversial. This review will examine mesenteric changes in Crohn's disease, proposed roles for mesentery in disease progression, and the potential for mesenteric-based surgery in the surgical management of Crohn disease.
Topics: Crohn Disease; Humans; Mesentery; Recurrence; Anastomosis, Surgical; Disease Progression
PubMed: 38594102
DOI: 10.1016/j.surg.2024.02.025