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      Metastatic Gastric Adenocarcinoma in the Inguinal Hernia Sac Diagnosed Radiologically: A Case Report

      case-report

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          Abstract

          Macroscopic tumor implants in the hernia sac are a very rare condition. They occur as a result of the implantation of malignant cells in the malignant ascites from the inguinal canal to the hernia sac. In this case report, we share the clinical and radiological findings of the macroscopic tumoral implants in the hernia sac at the level of the inguinal canal and scrotum in a male patient aged 65 years with a history of total gastrectomy for gastric adenocarcinoma and developing malignant ascites six months after the surgery.

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          Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures.

          Suma L Sangisetty, T Miner (2012)
          Malignant ascites indicates the presence of malignant cells in the peritoneal cavity and is a grave prognostic sign. While survival in this patient population is poor, averaging about 20 wk from time of diagnosis, quality of life can be improved through palliative procedures. Selecting the appropriate treatment modality remains a careful process, which should take into account potential risks and benefits and the life expectancy of the patient. Traditional therapies, including paracentesis, peritoneovenous shunt placement and diuretics, are successful and effective in varying degrees. After careful review of the patient's primary tumor origin, tumor biology, tumor stage, patient performance status and comorbidities, surgical debulking and intraperitoneal chemotherapy should be considered if the benefit of therapy outweighs the risk of operation because survival curves can be extended and palliation of symptomatic malignant ascites can be achieved in select patients. In patients with peritoneal carcinomatosis who do not qualify for surgical cytoreduction but suffer from the effects of malignant ascites, intraperitoneal chemotherapy can be safely and effectively administered via laparoscopic techniques. Short operative times, short hospital stays, low complication rates and ultimately symptomatic relief are the advantages of laparoscopically administering heated intraperitoneal chemotherapy, making it not only a valuable treatment modality but also the most successful treatment modality for achieving palliative cure of malignant ascites.
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            Molecular mechanisms of peritoneal dissemination in gastric cancer.

            Mitsuro Kanda, Yasuhiro Kodera (2016)
            Peritoneal dissemination represents a devastating form of gastric cancer (GC) progression with a dismal prognosis. There is no effective therapy for this condition. The 5-year survival rate of patients with peritoneal dissemination is 2%, even including patients with only microscopic free cancer cells without macroscopic peritoneal nodules. The mechanism of peritoneal dissemination of GC involves several steps: detachment of cancer cells from the primary tumor, survival in the free abdominal cavity, attachment to the distant peritoneum, invasion into the subperitoneal space and proliferation with angiogenesis. These steps are not mutually exclusive, and combinations of different molecular mechanisms can occur in each process of peritoneal dissemination. A comprehensive understanding of the molecular events involved in peritoneal dissemination is important and should be systematically pursued. It is crucial to identify novel strategies for the prevention of this condition and for identification of markers of prognosis and the development of molecular-targeted therapies. In this review, we provide an overview of recently published articles addressing the molecular mechanisms of peritoneal dissemination of GC to provide an update on what is currently known in this field and to propose novel promising candidates for use in diagnosis and as therapeutic targets.
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              Malignant Ascites in Ovarian Cancer: Cellular, Acellular, and Biophysical Determinants of Molecular Characteristics and Therapy Response.

              Brittany P. Rickard, Christina Conrad, Aaron Sorrin … (2021)
              Ascites refers to the abnormal accumulation of fluid in the peritoneum resulting from an underlying pathology, such as metastatic cancer. Among all cancers, advanced-stage epithelial ovarian cancer is most frequently associated with the production of malignant ascites and is the leading cause of death from gynecologic malignancies. Despite decades of evidence showing that the accumulation of peritoneal fluid portends the poorest outcomes for cancer patients, the role of malignant ascites in promoting metastasis and therapy resistance remains poorly understood. This review summarizes the current understanding of malignant ascites, with a focus on ovarian cancer. The first section provides an overview of heterogeneity in ovarian cancer and the pathophysiology of malignant ascites. Next, analytical methods used to characterize the cellular and acellular components of malignant ascites, as well the role of these components in modulating cell biology, are discussed. The review then provides a perspective on the pressures and forces that tumors are subjected to in the presence of malignant ascites and the impact of physical stress on therapy resistance. Treatment options for malignant ascites, including surgical, pharmacological and photochemical interventions are then discussed to highlight challenges and opportunities at the interface of drug discovery, device development and physical sciences in oncology.
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                Author and article information

                Contributors
                Ahmed Said Çil:
                ORCID: https://orcid.org/0000-0001-7550-5469
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Writing – original draft
                İbrahim Üntan:
                ORCID: https://orcid.org/0000-0002-6958-3625
                Role: ConceptualizationRole: ResourcesRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Journal
                Journal ID (nlm-ta): Arch Iran Med
                Journal ID (iso-abbrev): Arch Iran Med
                Journal ID (publisher-id): Arch Iran Med
                Journal ID (publisher-id): AIM
                Title: Archives of Iranian Medicine
                Publisher: Academy of Medical Sciences of I.R. Iran
                ISSN (Print): 1029-2977
                ISSN (Electronic): 1735-3947
                Publication date (Print): June 2024
                Publication date (Electronic): 27 April 2024
                Volume: 27
                Issue: 6
                Pages: 341-345
                Affiliations
                1Department of Radiodiagnostic, Ahi Evran University, Faculty of Medicine, Kırşehir, Türkiye
                2Department of Urology, Ahi Evran University, Faculty of Medicine, Kırşehir, Türkiye
                Author notes
                [* ] Corresponding Author: İbrahim Üntan, Email: ibrahimuntan@ 123456erciyes.edu.tr
                Author information
                https://orcid.org/0000-0001-7550-5469
                https://orcid.org/0000-0002-6958-3625
                Article
                DOI: 10.34172/aim.28951
                PMC ID: 11264622
                PubMed ID: 38855804
                SO-VID: 92592fbc-86b0-490b-93c8-0cd7587bda5d
                Copyright © © 2024 The Author(s).
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 February 2024
                Date accepted : 13 March 2024
                Categories
                Subject: Case Report

                Keywords: gastric adenocarcinoma,inguinal hernia,malignant ascites,metastasis,magnetic resonance imaging,ultrasonography
                Data availability:
                Keywords: gastric adenocarcinoma, inguinal hernia, malignant ascites, metastasis, magnetic resonance imaging, ultrasonography

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