Malignant ascites

Casper, E. S., Kelsen, D. P., Alcock, N. W., and Lewis, Jr., L. (1983). Ip cisplatin in patients with malignant ascites Pharira-cokinetic evaluation and comparison with the iv route. Cancer Treatm. Rep.. 67, 235-238. 

PI. Pagano, M., Dalet-Fumeron, V., and Engler, R., The glycosylation state of the precursors of the cathepsin-iike proteinase from human malignant ascitic fluid Possible implication in the secretory pathways of these proenzymes. Cancer Lett. 45, 13-19 (1989). 

In the majority of patients, this cancer remains occult and becomes symptomatic after it has already metastasized to the peritoneal cavity. At this stage, it usually presents with malignant ascites. It is important to accurately stage this cancer with laparoscopy, ultrasound, and CT scanning. Patients with stage I disease appear to benefit from whole-abdomen radiotherapy and may receive additional benefit from combination chemotherapy with cisplatin and cyclophosphamide. 

Tarin, D., Vass, A. C., Kettlewell, M. G. and Price, J. E. (1984c) Absence of metastatic sequelae during long-term treatment of malignant ascites by peritoneo-venous shunting. A clinico-pathological report. Invasion Metastasis 4, 1-12. 

Cytology Cytology has a specificity of 97-100% for the detection of malignant ascites. By contrast, the sensitivity is far lower, especially since the endothelial cells of the peritoneum are very similar cytologically to the malignant cells. 

Cholesterol In malignant ascites, the cholesterol level is clearly raised (R.A. Rovelstad et af, 1958). In differentiating the condition from portal ascites, the sensitivity is 90%, and the specificity is 95%. A threshold range of 45-48 mg/dl is deemed appropriate. Cholesterol determination is thus a valuable parameter for ascites. (39,43, 61) (s. fig. 16.10)... 

FIbronectIn The values of fibronectin in malignant ascites are significantly higher than in cases of portal ascites. Given a threshold value of 7.5 mg/dl, it is possible to differentiate between the two forms of ascites with a sensitivity of 100% and a specificity of more than 95%. The combined determination of cholesterol and fibronectin allows malignant ascites to be identified reliably. (33, 39)... 

Lactate The same assessment is true for the determination of lactate in ascitic fluid. The increase in this acid residue in infected ascitic fluid (>4.5 mmol/1) is proportional to the decrease in the pH value. Malignant ascites generally yields values of <4.5 mmol/1. (21,58, 63, 79) (s. fig. 16.10)... 

LDH quotient The LDH quotient (ascites value serum value) is usually <1.4 in portal ascites, whereas in infected or malignant ascites, values of >1.4 are usual. The absolute discrimination value is given as being higher than 400 U/1. 

Colli, A., Buccino, G., Cocciolo, M., Parravicini, R., Mariani, F., Scal-trini, G. Diagnostic accuracy of sialicacid in the diagnosis of malignant ascites. Cancer 1989 63 912-916... 

Urinary levels are slightly elevated in the nephrotic syndrome. Levels are higher in malignant ascitic fluid tlian in nonmalignant ascitic fluid. Increased permeability probably accounts for locally increased levels in areas of inflamma-... 

In women who present with malignant abdominal effusions (malignant ascites), common abdominal sites include ovaries, endometrium, and cervix, whereas men with malignant ascites typically have primary tumor sites in the gastrointestinal tract, predominantly in the colon, rectum, or stomach. Patients with peritoneal carcinomatosis of nongynecologic origin most often have origins in the stomach, colon, or pancreas and have a median survival of 3 months. 

Ringenberg QS, Doll DC, Loy TS, Yarbro JW. Malignant ascites of unknown origin. Cancer. 1989 64 753-755. 

Hampl M, Tanaka T, Albert PS, Lee J, Ferrari N, Fine HA. Therapeutic effects of viral vector-mediated antiangiogenic gene transfer in malignant ascites. Hum Gene Ther 2001 12 1713-1729. 

Harada H, Kizaka-Kondoh S, Itasaka S, et al. The combination of hypoxia-response enhancers and an oxygen-dependent proteolytic motif enables real-time imaging of absolute HIE-1 activity in tumor xenografts. Biochem Biophys Res Commun 2007 360 791-7%. Inoue M, Mukai M, Hamanaka Y, Tatsuta M, Hiraoka M, Kizaka-Kondoh S. Targeting hypoxic cancer cells with a protein prodrug is effective in experimental malignant ascites. Int J Oncol 2004 25 713-720. 

Fig. 18.1. Echogenic malignant ascites in a case of ovarian cancer. The fluid is echogenic with fine corpusculated echoes and declivous sediment...

Frequently, in malignant ascites, the fluid is echogenic (due to the presence of blood and/or neoplastic cells Fig. 18.1),septa are often present (Fig. 18.2), bowel loops are fixed and smashed for mesenteric involvement (Fig. 18.3), and serosal and parietal peritoneal implants are often visible. Indeed, abun-... 

Fig. 18.2. a Ascites with fine hyperechogenic septa are clearly visible in malignant ascites due to pancreatic cancer, b More evident thickened hyperechogenic septa in malignant ascites due to gastric cancer... 

Fig. 18.3. a A case of benign ascites. Note the bowel loops free in the anechoic fluid, b Contrary to what is seen in a, the intestinal loops are fixed and smashed in malignant ascites... 

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