An Improbable Case of Ascites

Prostate cancer is the most frequent malignancy seen in males, with about 15% of cases showing metastatic disease at diagnosis, most commonly in bones (vertebrae, ribs, long bones). However, peritoneal metastasis with malignant ascites is extremely rare and may be overlooked by physicians. We report the case of a 77-year-old man presenting with symptoms of abdominal distension, nausea and weight loss. Abdominal ultrasound and computerised tomography confirmed ascites, peritoneal carcinomatosis and an enlarged prostate. Serum and ascitic prostatic-specific antigen were both elevated. Prostate biopsy identified a prostate adenocarcinoma, while biopsy of a peritoneal implant identified a prostate cancer metastasis, which responded well to hormonal therapy.

Case Report -An Unusual Peritoneal Endometriotic Implant

Endometriosis is defined as ectopic presence of endometrial tissue outside of uterine cavity. Superficial peritoneal endometriosis is characterized by small superficial lesions modifying from white to dark brown shades. Dimension goes from few millimetres to 3 centimetres. We report a case of a 38 years old patient who has not had a signification in gynaecological pathology until five-six months before the gynecological check, when dysmenorrhea conditions associated at depth dyspareunia arose. Clinical and ultrasound investigations showed the presence of a pelvic cystic lesion, around 5 cm in diameter, diagnosed in the first instance as endometriotic cyst of the left ovary. The cystic lesion in the pelvis was confirmed by laparoscopic inspection. Really it was a large peritoneal implant (the left ovary was perfectly normal). The pathological report confirmed that a component of the lesion had nodules of florid endometriosis. It doesn’t exist ovarian cortex, but definitely a responsive mesothelium: the examined tissue has to be diagnosed with peritoneal endometriotic implant. Conclusions We refer to a case of peritoneal endometriotic implantation that has unusual dimensions (5 cm in diameter) late-onset in a woman who has experienced a specific symptomatology only in the last 6 months before the diagnosis

Magnetic Resonance Evaluation of Pelvic Mass Lesions in Females with Histopathological Correlation: An Institutional Experience

Introduction Magnetic resonance imaging (MRI) is often used in the detection and staging of large pelvic masses. Many large masses in the female pelvis arise from the reproductive organs. These pelvic masses most commonly arise from the uterus, cervix, ovaries, and fallopian tubes. Objective This study was aimed to assess the role of MRI in female pelvic mass lesions. Also, it presents a pictorial review of MRI images of such pelvic masses. Materials and Methods This study was conducted on 50 female patients with clinically suspected pelvic masses at physical examination and referred for MRI at a tertiary care hospital over a 2-year period between July 2017 and June 2019. Results Most common lesions evaluated on imaging were benign uterine lesions (15 cases, 34.09%), benign adnexal lesions (13 cases, 29.54%), malignant adnexal (10 cases, 22.73%), malignant uterine cervical lesions (6 cases, 13.64%); two cases had indeterminate type lesions, two lesions proved to be normal bowel loops on MRI, and in two cases MRI could not be performed. Cystic lesions were commonly seen in adnexa (15 out 21) while solid lesions were common in uterine cervical region (18 out 23). Out of these, 14 were complex cystic adnexal masses and 10 were malignant. Uterine cervical lesions were carcinoma cervix. Better assessment with improved imaging capability was possible on MRI for invasion of surrounding structures in 10 cases, lymphadenopathy in 3 cases, ascites in 13 cases, peritoneal implant in 6 cases, encasement in 1 case, and distant metastases in 1 case. Conclusion In conclusion, pelvic mass lesions in females are more common above the age of 45 years. Adnexal masses are usually cystic, while the uterine masses are solid in texture. As the complexity and size of the cystic adnexal masses increases, there are increased chances of malignancy. Pretreatment staging and assessment of malignancy, invasion of surrounding structures, encasement, invasion of vessels or assessment of lymphadenopathy, peritoneal implant, ascites, and distant metastases are better appreciated by MRI.

Ubiquitin–Proteasome Axis, Especially Ubiquitin-Specific Protease-17 (USP17) Gene Family, is a Potential Target for Epithelial–Mesenchymal Transition in High-Grade Serous Ovarian Cancer

Objectives: To investigate gene expression differences and related functions between primary tumor, malignant cells in ascites, and metastatic peritoneal implant in high-grade serous ovarian cancer. Methods: Biopsies from primary tumor, peritoneal implant, and ascites were collected from 10 patients operated primarily for high-grade, advanced-staged serous ovarian cancer. Total RNA isolation was performed from collected tissue biopsy and fluid samples, and RNA expression profile was measured. Messenger RNA expression profiles of 3 different groups were compared. Functional analyses of candidate genes were carried out by gene ontology and pathway analysis. Results: There were significant differences in the expression of 5 genes between primary tumor and peritoneal implant, 979 genes between primary tumor and malignant cells in ascites, and 649 genes between peritoneal implant and malignant cells in ascites. Three commonly enriched gene ontology functions between “primary tumor and malignant cells in the ascites” and “peritoneal implant and malignant cells in the ascites” were protein deubiquitination, ubiquitin-dependent protein catabolism, and apoptotic processes. All genes related to these functions belonged to USP17 gene family. Conclusion: Gene expression difference between primary tumor and the peritoneal implant is not as much as the difference between primary tumor and free cells in the ascites. These results show that malignant cells in the ascites return into its genetic origin after they invade on the peritoneum. Significantly increased expression of DUB-enzyme genes, SNAR gene family, and ribosomal pathway genes in epithelial–mesenchymal transition suggests that this regulation is ubiquitin–proteasome dependent. Especially, this is the first study that offers USP17 as a potential target for epithelial–mesenchymal transition.

Unilateral minimal ovarian cancer with peritoneal implant and an intraepithelial carcinoma in the contralateral fallopian tube

Here we present postoperative pathology of an 82-year-old woman who presented with massive ascites, and an implant-like adenocarcinoma on her intrapelvic peritoneum, which revealed a minimal (<5mm) serous adenocarcinoma on her left ovary and an intraepithelial carcinoma on inner surface of her right Fallopian tube. The left ovarian serous adenocarcinoma may have originated as an intraepithelial carcinoma on contralateral Fallopian tube.