INTRODUCTION: Disseminated Peritoneal Adenomucinosis (DPAM) is an infrequent presentation of appendiceal cancer. Infrequently, umbilical or inguinal hernias could be the first clinical manifestation of this condition; DPAM extension to the scrotum may be anatomically viable. Treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of treatment for DPAM. We hypothesize that these same treatment principles, consisting of CRS with hyperthermic chemoperfusion of the scrotum (HCS), could be applied to the scrotal dissemination of DPAM. METHODS: We reviewed our Institution's prospective cancer database and identified two cases of DPAM with extension to the scrotum. Their medical records were examined, and close follow-up was performed. Tumor histopathology and cytoreduction scores were evaluated. Tumor progression was monitored on follow-up by physical examination, tumor markers (CEA, CA 125, CA 19.9) and abdomino-pelvic CT scan. RESULTS: Two patients who previously had CRS/ HIPEC for DPAM were successfully treated with HSC. Both patients are alive and free of disease at 88 and 57 months following initial CRS/HIPEC, and 50 and 32 months following CRS/HCS, respectively. CONCLUSION: Increased awareness by surgeons to the coexistence of inguinal hernia with peritoneal neoplasm and the need for a surgical repair is raised. CRS/HCS may be employed to treat patients with DPAM extension to the scrotum. Successful outcome is dependent on complete cytoreduction of metastatic tumor.
INTRODUCTION:Disseminated Peritoneal Adenomucinosis (DPAM) is an infrequent presentation of appendiceal cancer. Infrequently, umbilical or inguinal hernias could be the first clinical manifestation of this condition; DPAM extension to the scrotum may be anatomically viable. Treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of treatment for DPAM. We hypothesize that these same treatment principles, consisting of CRS with hyperthermic chemoperfusion of the scrotum (HCS), could be applied to the scrotal dissemination of DPAM. METHODS: We reviewed our Institution's prospective cancer database and identified two cases of DPAM with extension to the scrotum. Their medical records were examined, and close follow-up was performed. Tumor histopathology and cytoreduction scores were evaluated. Tumor progression was monitored on follow-up by physical examination, tumor markers (CEA, CA 125, CA 19.9) and abdomino-pelvic CT scan. RESULTS: Two patients who previously had CRS/ HIPEC for DPAM were successfully treated with HSC. Both patients are alive and free of disease at 88 and 57 months following initial CRS/HIPEC, and 50 and 32 months following CRS/HCS, respectively. CONCLUSION: Increased awareness by surgeons to the coexistence of inguinal hernia with peritoneal neoplasm and the need for a surgical repair is raised. CRS/HCS may be employed to treat patients with DPAM extension to the scrotum. Successful outcome is dependent on complete cytoreduction of metastatic tumor.
Authors: Hatem El Halabi; Vadim Gushchin; Jennifer Francis; Nicholas Athas; Ryan Macdonald; Carol Nieroda; Kimberly Studeman; Armando Sardi Journal: Ann Surg Oncol Date: 2011-06-24 Impact factor: 5.344
Authors: Hatem El Halabi; Vadim Gushchin; Jennifer Francis; Nicholas Athas; Ryan Macdonald; Carol Nieroda; Kimberly Studeman; Armando Sardi Journal: Ann Surg Oncol Date: 2011-07-12 Impact factor: 5.344
Authors: Terence C Chua; Brendan J Moran; Paul H Sugarbaker; Edward A Levine; Olivier Glehen; François N Gilly; Dario Baratti; Marcello Deraco; Dominique Elias; Armando Sardi; Winston Liauw; Tristan D Yan; Pedro Barrios; Alberto Gómez Portilla; Ignace H J T de Hingh; Wim P Ceelen; Joerg O Pelz; Pompiliu Piso; Santiago González-Moreno; Kurt Van Der Speeten; David L Morris Journal: J Clin Oncol Date: 2012-05-21 Impact factor: 44.544
Authors: Cyril Omohwo; Carol A Nieroda; Kimberley D Studeman; Heather Thieme; Paula Kostuik; Alexander S Ross; Darlene R Holter; Vadim Gushchin; Barry Merriman; Armando Sardi Journal: J Am Coll Surg Date: 2009-07-09 Impact factor: 6.113
Authors: Terence C Chua; Tristan D Yan; Michelle E Smigielski; Katherine J Zhu; Keh M Ng; Jing Zhao; David L Morris Journal: Ann Surg Oncol Date: 2009-04-23 Impact factor: 5.344