Peritoneal seeding

Ovarian cancer usually is confined to the abdominal cavity, but spread can occur to the lung, liver, and less commonly, bone or brain. Disease is spread by direct extension, peritoneal seeding, lymphatic dissemination, and blood-borne metastasis. 

Miki, K., Makuuchi, M., Taka.yama, T., Matsukura, A., Minagawa, M., Kubota, K., Hirata, M. Peritoneal seeding of hepatocellular carcinoma after ethanol injection therapy. Hepato-Gastroenterol. 2000 47 1428-1430... 

Radiographic imaging studies evaluate the extent of disease involvement. A chest x-ray should be performed to rule out the presence of metastatic spread to the lungs. A CT scan of the abdomen and pelvis is often performed to evaluate hepatic and retroperitoneal involvement and occult abdominal and pelvic disease, and to determine the depth of tumor penetration into the bowel wall and/or invasion to adjacent organs. Detection of lymph node involvement with either smdy is limited by the difficulty of distinguishing inflammatory or reactive lymph nodes from those infiltrated with tumor. Because CT scans may not adequately detect peritoneal seeding, small distant lymph node metastasis, or liver metastasis in colon cancer, an occasional patient may... 

Fig. 10.28. Juvenile type of granulosa cell tumor. CT in a 17-year-old girl who presented with primary amenorrhea. A large, well-defined cystic ovarian tumor with multiple irregular septations and solid areas is demonstrated in the midpelvis. Small amounts of ascites (asterisk) without evidence of peritoneal seeding at surgery...

Peritoneal spread. Peritoneal seeding is caused by distribution of tumor cells into the normal peritoneal fluid. Peritoneal metastases are usually nodular soft tissue lesions or plaque-like thickening of the parietal or visceral peritoneum. They usually show moderate enhancement. Diagnosing small peritoneal implants can be difficult, with very low detection rates for CT (Coak-... 

Currently, recommendations for routine application of comprehensive treatment in colorectal cancer with peritoneal seeding are less secure. Certainly, systemic chemotherapy does not provide any patient with a hope for cure. The combined approach when used in peritoneal carcinomatosis from colorectal cancer is supported by results from numerous phase II studies at different institutions. The 5-year survival rate of approximately 30% is consistent in all reports. 

Despite several warnings over many years, the use of mercuric chloride solutions during operations in an attempt to kill cancer cells implanted in healthy tissues persists in some countries. Intraperitoneal administration, when seeding of a visceral cancer is feared, carries the risk of mercury absorption and nephrotoxicity. Death from intoxication after peritoneal lavage with a mercuric chloride solution has been reported (3). 

The two primary pathways of metastasis are hematogenous and lymphatic. Other, less-common modes of disease spread include dissemination via cerebrospinal fluid and transabdominal spread within the peritoneal cavity. Tumors are constantly shedding neoplastic cells into the systemic circulation or surrounding lymphatics. This process may begin early in the hfe of the tumor and often increases with time. The time course for metastasis depends largely on the biology of the tumor. Breast cancer, for example, tends to metastasize very early. Not all of the shed cancer cells, or seeds, result in a metastatic lesion. The seed must first find the appropriate soU, or an environment suitable for growth. This process is illustrated in the diverse patterns... 

Tumor seeding is demonstrated as a hypoechoic nodule on the visceral or parietal peritoneum (Fig. 16.10c). Often ascites with floating echogenic particles accompanies tumor seedings, indicating peritonitis carcinomatosa. 

Clarke JM, Pittilo RM, Nicholson LJ, Woolf N, Marston A. Seeding Dacron arterial prostheses with peritoneal mesothelial cells a preUminary morphological study. Br. J. Surg. 71 492-494,1984. 

Livraghi et al. (2003) recently reported in a multi-center study on complications encountered in patients treated with RFA of liver tumors 2320 patients with 3554 lesions treated were analyzed. Of these patients 1610 patients were suffering from HCC. The depicted mortality rate and major complications rate was 0.3% (n = 3) and 2.2% (w = 50), respectively. The most frequent complications were peritoneal hemorrhage, neoplastic seeding, intrahe-patic abscesses, and intestinal perforation. The incidence of complications was related to the number of RF sessions performed in the individual patient. Minor complications (no further action required, no prolonged hospital stay) were observed in less than 5% of the patients. 

Mustard seeds are the small round seeds of three different plants black mustard, brown Indian mustard, and white mustard. Mustards have been used in traditional folk medicine as a stimulant, diuretic, and purgative to treat a variety of ailments including peritonitis and neuralgia. They are also used in mustard plasters to treat rheumatism, arthritis, chest congestion, back pain and muscular ache. Prolonged application of mustard plaster can result in bums to the skin and nerve damage [35 ]. 

Seeding with tumour within the peritoneal cavity is characterised by nodules or fluid collections around peritoneal reflections and within the mesentery or generalised ascites (Fig. 6.1.16a,b). Full CT examination should include the pelvis to exclude the presence of metastases to the ovaries (Kruken-berg tumours). Typically these are bilateral and are usually associated with signet ring tumours of the... 

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