Devita, Hellman, and Rosenberg's Cancer

LWBK1006-37 LWW-Govindan-Review November 24, 2011 11:29

Chapter 37•Peritoneal Carcinomatosis 495

Answer 37.18. The answer is D.

The differential diagnosis for this patient’s cancer is primary peritoneal

carcinoma versus ovarian carcinoma versus carcinoma of unknown ori-

gin. The elevated CA-125 and the large heterogeneous mass in the right

ovary favor ovarian carcinoma, although the serous histology is more con-

sistent with primary peritoneal carcinoma. However, treatment programs

for primary peritoneal carcinoma usually follow those established for

ovarian carcinoma. These regimens traditionally involve surgical debulk-

ing supported by intraperitoneal chemotherapy and followed by systemic

chemotherapy with a combination of a platinum and a taxane.

Answer 37.19. The answer is B.

Diffuse carcinomatosis often results in functional, not anatomic, obstruc-

tion that may only be effectively palliated through placement of a gas-

trostomy tube.

Answer 37.20. The answer is B.

Conservative management of recurrent malignant ascites through diuretic

therapy is effective in up to 47% of patients and should be initiated first.

Spironolactone therapy starting at 150 mg per day may be necessary

for prolonged periods to establish and maintain control of the ascites.

Direct drainage of ascitic fluid through repeated paracentesis or a surgi-

cally placed peritoneovenous shunt provides immediate relief but carries

increased risk of infection and protein loss. Peritoneal shunts (Denver

catheter) remove ascitic fluid and return it to the systemic circulation. Suc-

cessful, prolonged control of ascites is possible in up to 70% of patients;

however, disseminated intravascular coagulation, pulmonary emboli, pul-

monary edema, and rarely tumor emboli are the complications associated

with these catheters.

Answer 37.21. The answer is B.

Desmoplastic small round cell tumor commonly involves the peritoneum

and can present with metastasis to the liver. The tumor is usually positive

for both epithelial and mesenchymal markers. The presence of t(11;12) is

specific to this tumor.