Surgical treatment of an isolated omental cervical cancer recurrence: report of a case and review of the literature

AIMS AND BACKGROUND

Recurrent cervical cancer has traditionally been associated with a dismal prognosis. Historically, patients who developed distant metastases from cervical cancer were not considered eligible for surgical resection; only palliative treatment options are available, generally consisting of chemo- and/or radiotherapy. Metastases usually appear in the liver, lung or lymph nodes. The abdominal cavity is a quite unusual site of recurrence and the disease usually has multiple foci. For this reason, peritoneal involvement by cervical cancer is considered a contraindication to local treatment.

METHODS AND STUDY DESIGN

We report the first case of a 30-year-old woman with isolated intra-abdominal cervical cancer recurrence diagnosed with 18F-FDG PET/CT, successfully surgically treated.

RESULTS

Histopathological analysis confirmed the tumor to be an omental relapse of squamous cervical cancer previously treated with anterior pelvic exenteration and platinum based chemotherapy. The patient underwent adjuvant treatment with 3 cycles of topotecan and has remained free of disease during the 4 years of follow-up.

CONCLUSIONS

In selected cases with isolated recurrences, a surgical resection may provide a long term complete remission in recurrent cervical cancer patients.

Angiography-assisted computed tomography for the detection and intervention of a subtle aneurysm of the omentum

Intra-abdominal hemorrhage caused by omental artery rupture is a rare condition traditionally diagnosed via exploratory laparotomy in hemodynamically unstable patients. We experienced a case in which contrast-enhanced multidetector computed tomography (MDCT) and digital subtraction angiography did not identify the rupture site, whereas CT during left omental arteriography depicted a small 4-mm aneurysm. The lesion was then embolized with microcoils and N-butyl cyanoacrylate lipiodol glue. We consider that performing a CT during selective arteriography could be useful in cases in which the rupture site is unclear with other imaging techniques such as contrast-enhanced MDCT and digital subtraction angiography.

[Primary omental actinomycosis]

We report a case of omental actinomycosis in a female patient with an intrauterine device. A computed tomography had shown an inflammatory tumour in the abdomen. The patient was treated with laparoscopic resection of the tumour and prolonged antibiotic therapy. Abdominal actinomycosis should be considered as a differential diagnosis in patients with abdominal symptoms and unspecific clinical, radiological and laboratory findings. Definitive diagnosis of actinomycosis requires histological examination of affected tissue. Laparoscopic resection seems feasible as an alternative to open surgery.

Evaluating the effectiveness of spleen autotransplantation into the liver and the omentum

BACKGROUND

Experimental research into the viability and functionality of splenic tissue placed in the liver and the omentum.

METHODS

There were 4 groups in this study. First group: sham laparotomy, 2nd group: splenectomy, 3rd group: splenectomy and splenic autotransplantation into the greater omentum and 4th group: splenectomy and splenic autotransplantation into the liver. Blood levels of haemoglobin, leukocytes, thrombocytes, immunoglobulin G (IgG), immunoglobulin M (IgM) and complement protein 3 (C3) were studied 1 day before and 6 weeks after the procedure. At the end of 6 weeks, scintigraphy was performed. Splenic tissue in the liver and the omentum were subjected to macroscopic and histopathologically.

RESULTS

Pre- and postoperatively, no significant differences were found in terms of haematological and immunological measurements of groups I, III and IV. An increase in the numbers of thrombocytes and leukocytes and a decrease in the levels of IgG, IgM and C3 were observed in the postoperatively in group II.When the postoperative hematological and immunological values of the second group are compared to those of groups III and IV, the difference was significant in terms of levels of thrombocyte, leukocyte and IgM; insignificant in terms of levels of IgG and C3. In the microscopic and scintigraphic analyses the spleen tissue was found to be viable in all of the six rabbits in groups III and IV.

CONCLUSIONS

The liver is a suitable organ for splenic autotransplantation (Tab. 6, Fig. 2, Ref. 17).

Omental infarction preceded by anatomically upturned omentum

We report the case of a 49-year-old man who presented with acute abdominal pain. Contrast-enhanced computed tomography of the abdomen revealed spontaneous omental torsion with no other noticeable findings. Notably, a computed tomography exam 6 months prior demonstrated the omentum located within the anterior hepatic space, suggesting that the patient had a hypermobile, upturned omentum. To our knowledge, this is the first case report illustrating an anatomically upturned omentum as precursor to omental infarction.

Variations in the size of the major omentum are primarily determined by fat cell number

OBJECTIVE

Accumulation of visceral adipose tissue (VAT) is strongly linked to insulin resistance. Variations in the size of any adipose depot are determined by alterations in adipocyte volume and/or number. The individual contribution of each of the latter factors was determined in the major omentum, a fully resectable VAT depot.

SUBJECTS

Total removal of the major omentum (omentectomy) was performed in conjunction with bariatric surgery in 55 obese patients. Tissue weight as well as mean adipocyte size and number in the omentum were determined. In subgroups, total VAT was estimated by computerized tomography (n = 17) or dual-energy x-ray absorptiometry (n = 34).

RESULTS

The weight of the major omentum (on average 0.6 kg) correlated significantly with total VAT mass estimated by computerized tomography or dual-energy x-ray absorptiometry (r = 0.48-0.7; P < .01). Omental weight in relation to total body fat correlated with several features of the metabolic syndrome and inversely with serum-leptin (P < .001). Mean adipocyte size and total adipocyte number correlated strongly with omental weight (r = 0.6-0.8; P < .0001), irrespective of body mass index and total body fat mass, and accounted almost in total for interindividual variations in omental size. However, stepwise regression analysis demonstrated that adipocyte number was significantly (P < .0001) more important (62%) than adipocyte size (35%).

CONCLUSION

The size of the major omentum is representative for VAT mass and correlates with a pernicious metabolic profile. Variations in omental weight are primarily determined by adipocyte number and to a lesser degree by adipocyte size, suggesting that increased VAT mass in obesity is predominantly dependent on adipocyte proliferation.

Pseudotumor of the omentum associated with migration of the ingested crab-leg

Foreign body ingestion is not uncommon in clinical practice, and it may occasionally lead to penetration injuries. Emergency physicians and radiologists sometimes fail to obtain complete histories including ingestion and may overlook the possibility of foreign body-induced complications. Herein, we report a case of stomach antrum perforation due to foreign body migration. We were unaware of the patient's history of eating the Korean delicacy "Kanjang-gaejang," which is raw crab seasoned with soy sauce. Several imaging diagnostic modalities had suggested the possibility of a malignant mass in the gastrocolic ligament area. During the operation, a crab leg was discovered as the cause of an intra-abdominal abscess. The patient underwent an antrectomy, a vagotomay, and a transverse colon wedge resection. We present this unusual case of a pseudotumorous lesion caused by ingestion of Kanjang-gaejang.

Infarction of lesser omental fat mimicking an exophytic pancreatic tumor by sonography

We report a case of infarction of lesser omental fat in a 30-year-old woman who presented with epigastric pain. Sonography revealed a painful echogenic mass in the epigastrium that could not be separated from the adjacent hyperechoic pancreas and mimicked an exophytic pancreatic tumor. On CT, the mass was identified as an inflammatory lipomatous mass in the lesser sac, leading to the diagnosis of infarction of lesser omental fat. The patient was successfully treated conservatively.

Adenocarcinoma arising from colonic duplication cyst with metastasis to omentum: A case report

Gastrointestinal tract duplications are uncommon congenital abnormalities. Carcinoma arising from duplication cyst is extremely rare, not to mention metastasis to other organs. We present a case of adenocarcinoma arising from a colonic duplication cyst with invasion of the serosa and metastasis to the omentum in a 40-year-old man. Duplication cysts should be included in the differential diagnosis of cystic masses of the gastrointestinal tract. Because these lesions occur so infrequently, they are often not suspected until encountered intraoperatively. The specific findings and advantages of sonography are reviewed.

Solitary fibrous tumor of the lesser omentum: report of a rare case

We herein describe the case of a 51-year-old male who presented with a mass of the epigastric region. Preoperative contrast enhanced abdominal computerized tomography revealed a solid mass between the left liver lobe and stomach. Histopathologic examination diagnosed the mass as a solitary fibrous tumor. Although solitary fibrous tumors are rare, especially in the abdomen of adults, they are generally benign, but malignant cases have also been reported. Long-term follow-up will be necessary to determine whether the surgery has been curative.

Late recurrence of malignant melanoma mimicking ovarian malignancy

BACKGROUND

Malignant melanoma (MM) is an extremely malignant tumor with an unpredictable profile of spread and variable periods of remission.

CASE

We describe an unusual case of malignant melanoma metastatic to the omentum occurring seven years after diagnosis and treatment of cutaneous malignant melanoma in the patient's arm. She received surgery and chemoimmunotherapy. To date, nine months after detection of malignant melanoma metastatic to the omentum, the patient is alive with no clinical and radiological metastatic disease.

CONCLUSIONS

The diagnosis of omentum malignant melanoma in a living patient is uncommon, thus very few individuals and referral centers can build up an adequate experience of handling this disease. Optimal management has been a challenge and a subject of debate and has not yet been established.

Sonographic anatomy of the gastrohepatic ligament

OBJECTIVE

The purpose of this presentation is to illustrate anatomic and pathologic features of the gastrohepatic ligament (GHL) and to show its usefulness for precise localization of abnormalities, particularly in relation to the lesser peritoneal cavity and diseases occurring within the confines of the ligament itself.

METHODS

Cases were selected that illustrate the objectives above.

RESULTS

Illustrations show various anatomic and pathologic features meant to enhance interpretation of left upper quadrant sonograms.

CONCLUSIONS

Illustrations seen in the sonographic literature vaguely interpret the relationships of the GHL. Misunderstanding has led not only to improper nomenclature but also to the use of inappropriate indicators of lesser omental diseases. With a clear understanding of the anatomy of the GHL and its use as a pivotal marker for structures around and within it, one can avoid these pitfalls and better evaluate adult and pediatric lesser omental anatomy.

Modern management of omental torsion and omental infarction: a surgeon's perspective

Omental infarction is a rare cause of acute abdomen that until recently was diagnosed only on exploratory surgery for presumed acute appendicitis or similar abdominal emergency. The increasing use of high-quality imaging, especially computerized tomography, in the diagnosis of appendicitis and the acute abdomen, has allowed preoperative diagnosis to be made much more often. Coupled with the increasing popularity of laparoscopic appendectomy, this finding has led to a spate of recent reports of omental infarction and omental torsion. It has also sparked a debate as to the best management of omental infarction, with strong support for both nonoperative management and definitive laparoscopic surgery. We present a case of omental torsion diagnosed preoperatively by the characteristic whirl sign and ultimately treated by laparoscopic surgery together with a brief review of the condition and our own recommendations.

Benign multicystic peritoneal mesothelioma

Benign multicystic peritoneal mesothelioma is a rare tumor that occurs mainly in women in their reproductive age. It is characterized by the formation of multiple, thin-walled, multilocular cysts that frequently produce large, intra-abdominal masses. The short follow-ups and possible etiologies based on the published reports make it difficult to draw any firm conclusions.

Nodules in the thickened greater omentum: a good indicator of lesions?

OBJECTIVE

In patients with unclear ascites, a thickened greater omentum with variable nodules is usually encountered with high-frequency insonation. The purpose of our study was to assess the importance of nodules in indicating the origin of ascites.

METHODS

In patients suggested for a biopsy of the greater omentum, if nodules were found in the omentum, sonograms of the nodules were recorded, and during the biopsy, 2 passes were made for each procedure in the nodule and the thickest region without nodules, respectively. A biopsy was considered successful if a specific benign or malignant diagnosis was made.

RESULTS

In the 258 patients undergoing sonographically guided biopsies of the greater omentum from November 2001 to November 2008, the percentage of definitive diagnoses was 94.57% (244 of 258), and sonography showed nodules in 62 patients. Nodules were found more often by a 10-MHz transducer (62 cases) than by a 3.5-MHz transducer (15 cases). The percentage of definitive diagnoses by sonographically guided biopsies was 100% (62 of 62) at the sites of the nodules and decreased to 87.1% (54 of 62) at the sites without nodules. According to the pathologic results, 48 cases were peritoneal carcinomatosis, and 14 cases were tuberculous peritonitis. The sensitivity and specificity of nodules for indicating malignant ascites were 77.42% and 75.27%, respectively.

CONCLUSIONS

Nodules in the greater omentum were good indicators of lesions and were well shown by a high-frequency transducer. A biopsy at the site of a nodule could substantially increase the positive biopsy result rate.

MDCT findings in primary amyloidosis of the greater omentum and mesentery: a case report

Imaging findings of amyloid infiltration of the greater omentum, mesentery, and retroperitoneal spaces have only extremely rarely been reported in the radiological literature. This report illustrates the MDCT findings fortuitously found in a 70-year-old male presenting with a known latent myeloma.Extra abdominal deposits-axilla and cardiophrenic angles-were first fortuitously found during thoracic MDCT. Secondary abdominal MDCT revealed the extensive abdominal spread that consisted of very diffuse but asymptomatic pseudo carcinomatous hazy omental, mesenteric and-in a minder proportion-retroperitoneal deposits; these remained isolated without calcification, lymphadenopathy, ascites, or any sign of associated bowel wall thickening. A specific definite histologic diagnosis was made without laparotomy through a biopsy in the right axilla.