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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peritoneal tuberculosis mimics advanced ovarian cancer because of the similarities in clinical signs and symptoms such as ascites, pelvic and abdominal pain and mass, and elevation of serum CA125 level. We have presented four cases of peritoneal tuberculosis that underwent exploratory laparotomy for suspected advanced ovarian cancer during a 3-year period. Definitive diagnosis of tuberculosis was performed at laparotomy in all the cases. The frozen-section analysis seems to be the gold standard in the differential diagnosis. In view of these data, clinical diagnosis of advanced ovarian cancer is not sufficient for administering neoadjuvant chemotherapy. Cytologic or pathologic findings must be consistent with ovarian cancer for candidates who are being considered for neoadjuvant chemotherapy.
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PMID:Peritoneal tuberculosis simulating advanced ovarian carcinoma: is clinical impression sufficient to administer neoadjuvant chemotherapy for advanced ovarian cancer? 1651 10

Synchronous primary cancers of the endometrium and ovary are found in 5% of women with endometrial cancer and 10% of women with ovarian cancer. In the present case, a multigravid 46-year-old woman complained of lower abdominal pain and abdominal distension. She did not define abnormal uterine bleeding. Screening ultrasound revealed a papillary containing structure, irregular, cystic 16 x 15 x 10 cm right ovarian mass. Preoperative endometrial biopsy revealed endometrioid adenocarcinoma. Ascites sampling, radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, omentectomy, appendectomy and cytologic sampling of the undersurface of the diaphragm were carried out. Intraoperative and histological examinations showed Stage IIIC papillary serous carcinoma and stage IC endometrioid adenocarcinoma. Synchronous genital tract neoplasms constitute a more common clinical problem than would generally be expected.
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PMID:Synchronous primary cancers of the endometrium and ovary: a case report. 1700 44

This study was undertaken to evaluate the clinical features and survival outcomes of ovarian cancer patients who had associated pelvic endometrioisis. The medical records of 1076 patients with ovarian cancer treated at Chiang Mai University Hospital between 1995 and 2005 were reviewed. Among of these patients, 37 (3.4%) had associated pelvic endometriosis. The mean age of the patients was 44 years (25-62 years). The most common presenting sign and symptom was an abdominal mass (12), followed by abdominal pain (10), abdominal distension (7), abnormal uterine bleeding (2). Twenty-one (56.8%) patients were nulliparous and 14 (37.8%) were single. The stage distribution was stage I (24), stage II (4), stage III (4), and stage IV (1). Four patients had 2 primary carcinomas. The most common histology of the 37 patients was clear cell carcinoma (17) followed by endometrioid carcinoma (11). The estimated 5-year disease - free survival was 55.4%. In conclusion, most patients associated with endometriosis- associated ovarian carcinoma present with abdominal masses and pain. Clear cell CA is the most common histology in ovarian cancer patients who have associated endometriosis. Three fourths of the patients are in stage I and have favorable prognosis.
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PMID:Clinicopathological features and prognosis of Thai women with endometrioisis-associated ovarian carcinoma. 1725 Apr 43

A 49-year-old premenopausal woman presented with acute onset of lower abdominal pain. Physical examination revealed her abdomen was distended and nontender. Her white blood cell count and serum markers for ovarian cancer were normal (alpha-fetoprotein level, 1.6 microg/L; Ca-125 level, 15 U/mL; beta-human chorionic gonadotrophin level < 2 IU/mL). She had no important medical history; in particular, she had no history of malignancy. She denied having any chest symptoms; in particular, she denied experiencing chest pain, cough, or dyspnea. She had stopped smoking at the age of 40 years after having smoked for a total of 20 pack-years. A computed tomographic (CT) examination of the abdomen and pelvis was performed. Helical CT was performed with 150 mL of intravenous contrast material (iohexol, Omnipaque; Amersham Healthcare, Cork, Ireland) and 750 mL of oral contrast material (diatrizoate sodium, Hypaque; Amersham Health, Princeton, NJ). CT sections were 5 mm thick and were acquired from the top of the diaphragm through the ischial tuberosities with a rotation time of 13.5 seconds per rotation and use of a LightSpeed 16 CT scanner (GE Medical Systems, Milwaukee, Wis).
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PMID:Case 116: lymphangioleiomyomatosis. 1758 10

Desmoplastic small round cell tumor (DSRCT) is a rare abdominal malignancy usually diagnosed in young adult males. Most patients have widespread disease at presentation, with an organ of origin difficult to ascertain. A 33-year-old female presented to her gynecologist with complaints of suprapubic pressure, abdominal pain, and increased abdominal girth. She had a large intraabdominal tumor on ultrasound, thought to be ovarian cancer. She underwent surgical exploration, which confirmed a malignancy, but the exact etiology was uncertain. Final pathology was consistent with DSRCT. DSRCT is a rare malignancy that can mimic other more commonly seen tumors such as lymphoma and ovarian cancer. When encountering an extensive intraabdominal malignancy of uncertain etiology, DSRCT should be in the differential diagnosis.
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PMID:Desmoplastic small round cell tumor masquerading as advanced ovarian cancer. 1808 91

The use of intraperitoneal (IP) chemotherapy has been advocated in different settings of patients with ovarian cancer. Cisplatin is the drug of choice because of its high response rate and minimal local toxicity. This treatment can be given to women with small residual disease after second look, with surgically assessed complete response rates of approximately 30%, and with a prolonged survival in small subset of patients. However, the use of IP chemotherapy as consolidation treatment of pathologically complete responders after first-line systemic chemotherapy has not been definitively evaluated in a phase III trial. There is much debate in the literature both for and against the use of IP chemotherapy in the first-line treatment of optimally debulked ovarian cancer patients. The recent Cochrane meta-analyses of eight randomized trials enrolling 1819 patients has shown that first-line IP chemotherapy improves progression-free survival and overall survival of patients with minimal residual disease after initial surgery. However, the potential for catheter-related complications, abdominal pain with infusion, and toxicities needs to be taken into consideration for decision making in each individual woman. Rectosigmoidal surgery can be associated with gross contamination of the operative field, and in this case, the catheter placement should not be performed during primary surgery but should be delayed to 3 weeks later. Patients should be provided with information on the survival and toxicity for both IP and systemic treatments, as well as practical information about the administration of each regimen, so that they may be involved in the decision-making process.
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PMID:Intraperitoneal chemotherapy in the management of patients with advanced epithelial ovarian cancer: a critical review of the literature. 1824 92

We report the case of a 62-year-old woman who presented with a 2-week history of fever, abdominal pain and ascites. Her serum CA-125 level was very high (1070 U/ml), that in addition to clinical finding and ultrasonography suggested genital malignancy. Unexpectedly, the diagnosis of pelvic-peritoneal tuberculosis was reached by hystopathology after abdominal hysterectomy with bilateral adnexectomy. Cultures of ascitic fluid taken on admission grew Mycobacterium tuberculosis six weeks later. Serum levels of CA-125 returned to normal during antituberculous drug treatment. This observation should help clinicians to entertain a differential diagnosis of pelvic-peritoneal tuberculosis in patients with ascites and raised CA-125 serum levels, and in some cases to prevent unnecessary laparotomy. Moreover, it indicates that his tumour marker, widely used to monitor patients undergoing treatment for ovarian cancer, may be also used to follow disease activity in non-neoplastic ascitic states, particularly to monitor response to treatment of pelvic-peritoneal tuberculosis.
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PMID:[Active pelvic-peritoneal tuberculosis with ascites and very high CA-125 level--a case report]. 1895 23

Tuberculous peritonitis is rare in most Western counties, and can cause significant diagnostic and therapeutic problems. A 28-year-old pregnant female presented with nausea and vomiting, right lower quadrant abdominal pain, fever and intra-abdominal fluid. During surgery for presumed complicated acute appendicitis, many small masses (considered to be 'implants') were found within the peritoneal cavity, with a larger mass in the pelvis, mainly on the right. The clinical intra-operative diagnosis was advanced ovarian cancer and multiple biopsies were taken. The histological diagnosis was peritoneal tuberculosis. The patient was successfully treated conservatively. Hasty decisions to undertake radical and irreversible surgery should be avoided; this type of surgery should be performed only after histological confirmation.
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PMID:Peritoneal tuberculosis in pregnancy mimicking advanced ovarian cancer: a plea to avoid hasty, radical and irreversible surgical decisions. 1913 1

Development of the pros and cons of intraperitoneal (IP) chemotherapy in the treatment of epithelial ovarian cancer based on the most prominent data published on the evolution of IP chemotherapy and on experience with this therapeutic strategy in clinical routine. The literature published on IP chemotherapy in ovarian cancer between 1970 and 2008 was identified systematically by computer-based searches in MEDLINE and the Cochrane Library. Furthermore, a preliminary analysis of data recorded during an observational nationwide multicenter study of the Austrian AGO on IP-IV chemotherapy using the GOG-172 treatment regimen was performed. The literature review unequivocally revealed a significantly greater toxicity for IP than for intravenous (IV) cisplatin-based chemotherapy. However, according to a Cochrane meta-analysis, IP-IV administration of chemotherapy is associated with a 21.6% decrease in the risk for death. In agreement with earlier reports, the most frequently mentioned side-effects in the Austria-wide observational study were long-lasting neurotoxicity, abdominal pain, fatigue, gastrointestinal and metabolic toxicities, and catheter-related complications. Most of these toxicities were identified as mirroring the toxicity profile of high-dose IV cisplatin (>or=100 mg/m(2)). In some patients, the classic IP-IV regimen with cisplatin/paclitaxel was changed to an alternative schedule comprising carboplatin AUC 5 (d1) and weekly paclitaxel 60 mg/m(2) (d1, 8, 15) completely administered via the IP route. This treatment was better tolerated and quality of life was significantly less compromised. However, neutropenia and thrombocytopenia were the limiting side-effects of this IP regimen. In cases where optimal cytoreduction with residual disease <or=1 cm was achieved during primary surgery and disease was confined to the peritoneal cavity, IP chemotherapy should be given serious consideration, even at the expense of significantly increased, but manageable toxicity.
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PMID:Pros and cons of intraperitoneal chemotherapy in the treatment of epithelial ovarian cancer. 1959 65

Tuberculosis, and specially its extrapulmonary location still causes diagnostic difficulties. In 2007, in Poland 7.3% of newly registered cases of tuberculosis in Poland were located extrapulmonary. Peritoneal tuberculosis is often wrongly diagnosed as an ovarian cancer, it is due to similar symptoms like abdominal pain, abdominopelvic masses, ascites and elevated serum CA-125. Two patients who were admitted to our department with suspicion of ovarian cancer are presented. Subjective symptoms suggested the ovarian cancer, elevated levels of CA-125, chest x-rays without abnormal findings or with minimal fibrotic changes and uncharacteristic results of additional investigations were disclosed. A diagnostic laparoscopy was made to establish the diagnosis. Because of clinical and operative picture suggesting ovarian cancer in both cases resections were performed. The procedure consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy. Biopsy specimens were taken up and verified histopathologically. The peritoneal tuberculosis was recognized in both cases.
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PMID:[Peritoneal tuberculosis mimicking ovarian cancer--diagnostic difficulties. Two cases reports]. 1972 50


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