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Second Opinion - Peritoneal carcinomatosis Undefined Nature

This is a summary of 57-year-old woman who was interested to receive an expert second opinion. When the patient was 2 years old, he had an appendectomy at age 9 - Operation intussusception affecting the right side and the iliac fossa, with subsequent hardening of the scar and the emergence of a mass in asymptomatic scar-interpreted as a reaction scar. When the patient was 38 years - 50 years and Dupuytren - laparoscopy.

In December 2004 and several months later, the patient suffered from intestinal obstruction under-bowel obstruction. A colonoscopy was performed which was negative. The November 2005, surgery took place the discovery of a mass membership in mid abdomen right. 700 cc of exudate Brown was drained. Right Hemi-colectomy was preformed.

The sections were tested macroscopically adhesive was a mass the size of 8 * 10 * 6cm found that the compound of the cecum and terminal iliem to a length of 18 cm.

Microscopic sections of the intestine have been diagnosed (by histopathology and cytodiagnosis laboratory at the hospital Riun of Trieste) and carcinoma of low grade differentiation. same findings were found in adipose tissue with glandular aspects nickname. Other parts of the intestine have the same appearance microscpical also papillary aspects. Markers - negative (CEA-2.10, Ca19.-2.5, CA125-5.4).

CT: small amount of liquid. Modest evidence of peritoneal inflammation and adhesions on the abdominal wall.

Re-examination of surgical equipment on January 5 by the National Institute of tumors suggested the diagnosis of malignant mesothelioma monophasic epithelial type.

Conclusion: Patients with peritoneal mesothelioma Epithelia that had its first episode of the sub-intestinal obstruction from 2004.

On 01/10/2006, the patient underwent a further examination in clinical pharmacology and new drugs division of the European Institute of Oncology, which reported a history. In December 2004, a sub-occlusive episode was reported, affecting the small intestine, which spontaneously healed. A scan is performed with irrelevant results. During the summer of 2005, the episodes above occur again and the patient underwent a colonoscopy with irrelevant results.

In November 2005, he underwent tests and operations which we discussed in the previous report.

In light of the above information, the expert suggests waiting for the results of histological analysis of new and repeat the chest, abdomen and pelvis scan.

If the assumption of mesothelioma is confirmed, it is suggested to consult the advice of a colleague who is an expert surgeon in intraperitoneal hyperthermic treatment peritonectomy and because it is considered the most effective approach.

Alternatively, it is suggested to follow the clinical course over time (CAT and PET scans after 3 months), but only upon presentation of an evolving situation, or if a disease is clearly condemned by the scanner, the expert proposes a systemic approach of chemotherapy.

On the other hand, if the histology be different, it is suggested to repeat all of a cat and a PET scan in one month, and in the absence of a clear primitive, it is always advisable to consult Surgeons peritonectomy a colleague.

The histopathological examination performed in the new European Institute of Oncology, 01 .11.2006 reports: "The evidence consistent with an epithelial malignant mesothelioma infiltrating the wall of the small intestine. Immunophenotype of the neoplastic population: positive as calretinin, cytokeratin 5 / 6 and WT1; negative depending CDX-2, 5 and desmin ECA. "

Another histological examination performed at the Milan Cancer Ins.