Peritoneal fluid cytology in patients with ovarian cancer

Peritoneal fluid was examined for the presence of tumor cells in 94 patients with ovarian cancer. The findings were correlated with the type, grade, and stage of the tumor. Fluids that were positive for malignant cells were associated with serous and endometrioid carcinomas more often than with carcinomas of other types. Patients with high-stage tumors of all types had positive fluids more often than those with low-stage tumors. The presence of tumor cells in the fluid indicated a worse prognosis at 2 years. Analysis of other factors that influence prognosis, however, revealed that this difference was related more specifically to the stage of the disease. Since the presence of tumor cells in abdominal fluid is a factor in the subclassification of Stage I and Stage II ovarian cancer, analysis of a larger group of patients with tumors in these stages is needed to establish the prognostic significance of positive cytological findings independent of other prognostic factors.     

Peritoneal cytology in the follow-up control of malignant ovarian tumors

From 1976 to 1982 we practised 247 transvaginal punctures with peritoneal lavage with the aim of cytological follow-up of ovarian malignomas. Those who were submitted to this treatment were 73 women with ovarian carcinoma of stage I to III, in whom after operation, antineoplastic chemotherapy and possibly radiotherapy no tumor was no longer detectable clinically. In case of positive cytology puncture was repeated in intervals of three months, in case of negative findings of 6 to 8 months. 31.6 per cent of all puncture smears were cytologically positive and 53.8 per cent certainly negative. In 14.6 per cent of all cases no well defined statement could be allotted. We can recommend peritoneal lavage for monitoring of efficiency of therapy of ovarian carcinomas on account of its high evidence and trifling annoyance.     

Peritoneal cytology in malignant mixed müllerian tumors of the uterus

Peritoneal cytologic studies (10 ascitic fluids, 18 peritoneal washings) were performed on 28 patients with malignant mixed müllerian tumors of the uterus. The frequency of recovery of malignant cells from the peritoneal cavity was directly related to stage of disease and depth of myometrial invasion. In stage I, positive peritoneal cytology was of greater prognostic importance than depth of invasion: all patients with negative cytology are alive without evidence of disease; all patients with positive cytology are dead.     

Peritoneal fluid analysis in the differentiation of ovarian cancer and benign ovarian tumor.

PURPOSE: The aim of the study was to try to identify the biochemical markers in peritoneal fluid which might be useful in discrimination between ovarian cancer and benign ovarian tumor. METHODS: The study included 75 patients: 43 with invasive ovarian cancer, 6 with borderline ovarian cancer and 26 with benign ovarian tumor. The peritoneal fluid samples from all these patients were subjected to cytologic examination and to analysis of lactate dehydrogenase (LDH), total protein, albumin and cholesterol. In addition, peritoneal fluid to serum ratio of LDH and total protein, as well as serum CA-125 were assayed. The biochemical parameters were compared between cases of ovarian cancer and cases of benign ovarian tumor, as well as between the different histological types and stages of ovarian cancer. RESULTS: All the examined parameters demonstrated a significant difference comparing patients with ovarian cancer and those with benign ovarian tumor (p<0.001). Yet, the greatest diagnostic accuracy was achieved by measuring peritoneal fluid LDH (86%) and cholesterol (93%). Moreover, significant differences in the level of assayed parameters were found when comparing different histological types and stages of ovarian cancer. In order to further corroborate the diagnostic performance, we combined the parameters of LDH and cholesterol with cytology, thus increasing the diagnostic accuracy to 96%. CONCLUSION: The association of peritoneal fluid LDH and cholesterol may represent a primary tool for the discrimination of patients with ovarian cancer (even borderline) from those with benign ovarian tumor, particularly in the presence of negative cytology.     

Diagnostic accuracy of intraoperative imprint cytology in ovarian epithelial tumors.

OBJECTIVE: To evaluate imprint cytology (IC) as the intraoperative pathological consultations for ovarian epithelial tumors (OET). METHOD: We reviewed ICs obtained from 354 consecutive surgical specimens of OET. Cytological specimens were classified into five categories. Final pathological diagnoses were made according to the WHO classification. We performed logistic regression analysis, calculated the limits among benign, borderline, and malignant lesions, and analyzed the diagnostic accuracy. We also made receiver operating characteristic (ROC) curves regarding IC. RESULTS: The accuracies to differentiate benign and malignant lesions were 87.1 and 83.6%, respectively. In contrast, that of borderline lesions was 30.0%. The areas under ROC curves to diagnose benign, and malignant lesions were 0.888 (P<0.05) and 0.951 (P<0.05), respectively, that meant IC was significantly useful for diagnosis of malignancy. CONCLUSIONS: IC applied to OET was proved to be practically useful in establishing an intraoperative diagnosis by ROC curves.     

Experimental heterotransplantation of human ovarian tumors in nude mice

Human ovarian tumors tissue taken from four surgical specimen were transplanted subcutaneously into female nude mice. The primary tissue transplantations were all successful, and the mean survival time was 15 weeks. One of the four ovarian carcinomas has been successfully transplanted to the 9th passage. Time needed for each passage was 4-6 weeks. The transplanted tumors examined histologically, cytologically and by electro-microscope, resembled the original ovarian cancer. Immunohistochemical tests were positive. Chromosome number was subdiploid and aneuploid.     

CEA determination in aspired fluid of cystic ovarian tumors and ovarian cysts and in ascites and serum samples of patients with ovarian tumors

Carcinoembryonic antigen (CEA) was assayed by radioimmunoassay in serum of 47 patients with cystic ovarian tumors, in 51 cases of cyst fluids of ovarian tumors and ovarian cysts, and in 16 cases of peritoneal effusions (ascites). In order to differentiate between cystic tumors and retentional cysts there was found, in consideration of a changed prevalence (0.65), a sensitivity of 55% and a specificity of 94%. The predictive value in regard to a positive assay result was 94% and in regard to a negative one was 53%. Elevated CEA-levels in ovarian tumor cyst fluids are mainly diagnostic for mucinous ovarian tumors. In regard to elevated CEA-levels in cyst fluids of ovarian tumors it is claimed the laparotomy and histological investigation.     

Peritoneal cytology in patients with endometrial carcinoma

Peritoneal cytology was obtained in 61 patients with carcinoma of the endometrium at the time of laparotomy. The incidence of positive peritoneal cytology was 23.0%. It increased as the clinical stage advanced. The incidence of positive peritoneal cytology in patients with well-differentiated carcinoma or superficial myometrial invasion was low. The rate of paraaortic lymph node metastasis was higher in patients with positive peritoneal cytology than in patients with negative peritoneal cytology. However, this trend was not recognized in pelvic lymph node metastasis. In the positive peritoneal cytology group, 64.3% had disease outside of the uterus, while in the negative group only 12.8%. The 2-year survival rate in patients with positive peritoneal cytology was 57.1% and it was 86.4% in patients with negative peritoneal cytology. It is concluded that the findings of positive peritoneal cytology is an important prognostic factor and routine peritoneal cytology should be obtained at the time of laparotomy in patients with carcinoma of the endometrium.     

Peritoneal cytology of ovarian cancer patients receiving intraperitoneal therapy: quantitation of malignant cells and response

An analysis was performed of malignant and host cells found in peritoneal fluids obtained during intraperitoneal chemotherapy and immunotherapy in patients with ovarian cancer. The concentration of malignant cells and the surgically documented response to the intraperitoneal treatment were correlated. Twenty-three patients were treated with intraperitoneal cisplatin or alpha-2 interferon (rIFN-alpha 2) after persistent carcinoma was documented at second-look laparotomy. Six patients (26%) had a complete response to therapy, and all of these patients had a malignant cell concentration of less than 10(2)cells/cm2/dL. No responses were seen in patients whose initial malignant cell concentration was greater than 10(3)cells/cm2/dL. Among patients treated with intraperitoneal alpha-interferon, five of 11 whose initial concentration of malignant cells was less than 10(2) cells/cm2/dL responded to therapy, whereas none of the patients whose malignant cell concentration was 10(2) cells/cm2/dL or greater responded. In patients treated with intraperitoneal cisplatin, the initial concentration of malignant cells associated with any surgically documented response was less than 10(3)cells/cm2/dL. A host mesothelial reaction was prominent after intraperitoneal alpha-interferon, but not observed in women treated with intraperitoneal cis-platin. The fluctuating pattern of peritoneal white blood cells documented during therapy did not correlate with response. THe evaluation of peritoneal cytology specimens during intraperitoneal chemotherapy should include a quantitative assessment of malignant cells and reactive mesothelial cells in order to reflect more accurately the histologically documented findings. Initial quantitative cytology appears to correlate with the likelihood of a surgically documented response to intraperitoneal therapy.     

Peritoneal fluid evaluation in infertility

Cul-de-sac fluid collected at laparoscopy from 58 women during various stages of the menstrual cycle was evaluated by volume and by estradiol and progesterone content. Volumes were consistently higher in the third cycle week, especially with evidence of a fresh corpus hemorrhagicum. Peritoneal hormonal values were equal to serum values before ovulation, but were significantly elevated after ovulation. In the present study, maximal fluid volume was 78 ml, maximal peritoneal estradiol exceeded 3000 pg/ml, and maximal peritoneal progesterone exceeded 265 ng/ml. Luteal phase peritoneal fluid volumes and hormonal values were not significantly different in women with or without endometriosis. Aspiration of peritoneal fluid at laparoscopy in the infertile woman may provide significant information regarding ovulation.     

Peritoneal cytology in endometrial cancer: a review

Utilization of literature review to evaluate peritoneal cytology as a test for the detection of malignant cells in the peritoneal cavity is limited by the size of the study populations, varied use of preoperative radiation, the lack of consistent methodology for specimen retrieval and processing, and the inherent subjectivity of cytologic interpretation. A standardized methodology for retrieval and processing of peritoneal cytologic specimens should be developed to allow meaningful comparisons of future studies. However, certain conclusions are permitted from published data: 1. The incidence of positive peritoneal cytology is 11.4 per cent among 3091 patients with FIGO stage I endometrial cancer. 2. The depth of the uterus does not influence the incidence of positive peritoneal cytology. 3. Positive peritoneal cytology is predictive of other known prognostic factors including advanced histologic grade, depth of myometrial invasion, and pelvic/periaortic lymph node metastases. 4. The presence of malignant cells in the peritoneal washings from some patients with no myometrial invasion and the high incidence of lymph node metastases in other patients with positive peritoneal cytology suggest that malignant cells gain access to the peritoneal cavity in a variety of ways. It is unclear whether each of these modes of access result in viable tumor cells with the potential for viable metastasis. The high incidence of lymph node metastasis in such patients suggests that lymphatic dissemination of malignant cells plays a significant role in the development of positive peritoneal cytology. In this setting positive peritoneal cytology clearly identifies that individual at high risk for recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)     

Peritoneal cytology and invasive carcinoma of the cervix

One hundred thirty-nine patients with invasive carcinoma of the cervix underwent laparotomy at the University of South Florida between February 1980 and November 1983. One hundred nineteen had laparotomy prior to treatment and 20 after treatment for recurrence or some other reason. One hundred twenty patients had negative peritoneal cytology, 8 had equivocal cytology and 11 had positive cytology. Positive peritoneal cytology was more common in higher-stage disease and was statistically significantly more common in patients with positive retroperitoneal lymph nodes (P less than 0.05). The rate of peritoneal cytologic positivity in patients with squamous carcinoma was the same as that for adenocarcinoma and adenosquamous carcinoma. Positive peritoneal cytology was associated with a very poor prognosis but was associated with other poor prognostic factors in all but 1 patient. Equivocal cytology did not seem to be of any particular significance. No patient in this series had an alteration in treatment planning based on peritoneal cytology. The utility and future of peritoneal cytology in invasive carcinoma of the cervix are discussed.     

Peritoneal tuberculosis mimicking ovarian cancer

Objective

To evaluate the clinical and urodynamic outcomes of transvaginal mesh repair (TVM) for the treatment of pelvic organ prolapse (POP).

Study design

One hundred and twenty-four women with POP stage II to IV were scheduled for a TVM procedure. Preoperative and postoperative assessments included pelvic examination, urodynamic testing, and a personal interview about urinary symptoms using a standard questionnaire.

Results

We found a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.001) except for total vaginal length (P = 0.08), and the overall success rate was 93.5% (116/124). Various urinary symptoms improved significantly following TVM (P < 0.01). In addition, residual urine, functional urethral length, and the rate of detrusor overactivity, improved significantly after surgery (P < 0.05). Apart from vaginal erosion (14/124; 11.3%), the rates of other surgical complications were acceptably low.

Conclusion

TVM is an effective procedure for the treatment of POP and urinary symptoms, this being possibly related to postoperative release of urethral obstruction. Vaginal erosion is less likely to occur beyond the learning curve.     

Peritoneal tuberculosis mimicking ovarian cancer

Objective

To evaluate the characteristics of 20 patients diagnosed as tuberculous peritonitis (TBP) mimicking ovarian cancer during a 10-year period at a single center.

Study design

Among 612 operations for ovarian malignancy we retrospectively reviewed the surgical and pathological reports of 20 patients suspected preoperatively as having ovarian malignancy but whose pathological results revealed TBP, between 2000 and 2011 in a university clinic. Demographic characteristics, physical and pelvic examination, laboratory investigations and radiological imaging of the patients were evaluated retrospectively.

Results

Diagnostic laparotomy, laparoscopy and ultrasound guided tru-cut biopsy were performed in 11, 2 and 7 of the 20 patients, respectively. The mean age of the patients was 37.5 ± 17.3 years (range 16–70 years). The most common symptoms were abdominal pain (n = 14%, 70%) and abdominal distension (n = 13%, 65%). Serum CA 125 was elevated in 16 (80%) cases and the average CA 125 level was 289 ± 186.2 IU/ml. During ultrasonographic imaging and CT scans, ascites and a pelvic mass were detected in 19 (85%) and 12 (60%) patients respectively. TBP was suspected in 7 (35%) patients and ultrasound guided tru-cut biopsy was preferred as a first-line approach. Surgery was performed in 11 patients (55%) and during exploration widespread miliary nodules (n = 9%, 81%), widespread adhesion (n = 5%, 45%), adnexal mass (n = 8%, 72%) and caseous necrotic substance (n = 4%, 36%) were observed. Patients underwent unilateral (n = 3% 27%) or bilateral (n = 4%, 36%) salpingo-oophorectomy in seven (63%) cases.

Conclusion

Since ovarian cancer is a serious condition and preoperative diagnosis of TBP is difficult, laparotomy is usually mandatory to distinguish these two entities. Ultrasound guided tru-cut biopsy is useful in selected patients and frozen section analysis avoids hazardous radical surgery at operation.