Search Results (127)

Tuberculosis remains the deadliest infectious disease worldwide. Among extrapulmonary forms, peritoneal tuberculosis stands out as a rare and challenging diagnosis, often mistaken for intra-abdominal neoplasms or peritoneal carcinomatosis. The clinical, paraclinical, and imaging findings are similar and sometimes indistinguishable between the two entities, making the diagnosis a challenge for the treating physician. Here, we present the case of a young woman with chronic constitutional symptoms who presented to the emergency department with abdominal pain and ascites. An initial differential diagnosis of peritoneal carcinomatosis was considered based on findings in the peritoneal fluid and abdominal CT scan, leading to diagnostic laparoscopy. Histopathological examination of the samples revealed non-caseating granulomas involving the peritoneum, with no findings suggestive of malignancy. Subsequently, molecular testing for Mycobacterium tuberculosis was positive in the biopsies and peritoneal fluid, establishing the diagnosis of peritoneal tuberculosis. This case highlights the importance of awareness of peritoneal tuberculosis as a differential diagnosis of ascites and its significant potential to mimic other pathologies. Full article

Background/Objectives: This study aimed to evaluate the diagnostic accuracy of Apparent Diffusion Coefficient (ADC) values, derived from Diffusion-Weighted Imaging (DWI), in differentiating benign and malignant ascites. Methods: This retrospective study included 150 patients (85 benign, 65 malignant) who underwent abdominal MRI. All patients were scanned on a DWI sequence (b-values: 0, 500, and 1000 s/mm²). Two experienced radiologists, blinded to clinical and cytological outcomes, measured the mean ADC (ADCmean) from three distinct ROIs and the minimum ADC (ADCmin) from the area of lowest signal intensity on the ADC map. The diagnostic performance of ADC parameters and the Serum-Ascites Albumin Gradient (SAAG) was assessed using Receiver Operating Characteristic (ROC) curve analysis. Results: The mean values of ADCmean (3162 ± 204 × 10⁻⁶ mm²/s) and ADCmin (2885 ± 148 × 10⁻⁶ mm²/s) in the malignant group were significantly lower than those in the benign group (3596 ± 239 and 3322 ± 218 × 10⁻⁶ mm²/s; p = 0.006 and p = 0.0016, respectively). Inter-observer agreement was good for both ADCmean (ICC = 0.844) and ADCmin (ICC = 0.879). In the ROC analysis, ADCmin demonstrated the highest diagnostic performance (AUC: 0.930). An optimal cut-off value for ADCmin of ≤ 2983 × 10⁻⁶ mm²/s yielded 81.5% sensitivity and 85.8% specificity. The diagnostic performance of ADCmin was found to be superior to that of ADCmean (AUC: 0.877) and SAAG (AUC: 0.919). Conclusions: ADC values derived from DWI, particularly ADCmin, represent a highly accurate, non-invasive, and reproducible biomarker for differentiating benign from malignant ascites. The identified ADCmin threshold provides quantitative parameter that can aid in patient triage, especially when cytology is inconclusive, potential surrogate for fluid characterization. Full article

Background and clinical significance: Lymphedema is a relatively common clinical manifestation in patients and has a broad differential diagnosis, the main concern being the exclusion of malignancy. However, a rare constellation of lymphedema with systemic features and no underlying malignancy is yellow nail syndrome (YNS). YNS is a lymphatic abnormality, characterized by a triad of yellow nails, primary lymphedema and respiratory manifestations. Case presentation: Here, we report a 74-year-old male patient who presented to us with massive chylous ascites, cough, yellow nails and recurrent bilateral leg edema. During the last 10 years, he had thrice undergone thoracocentesis, which revealed chylous pleural effusion, although there was no documented diagnosis of yellow nail syndrome. We pursued a thorough work-up to rule out underlying cirrhosis and malignancy (the main causes of chylous ascites). There are only few cases of yellow nail syndrome reported in the literature with chylous ascites as a manifestation of YNS. Conclusions: The co-existence of chylous ascites with the classical triad of pleural effusion, lymphedema and yellow nail changes in the same patient has to be included in the diagnostic process to differentiate this entity from liver cirrhosis and solid or hematological cancer. Full article

The ultrasound-assisted extraction (UAE) method was optimized to extract bioactive compounds from Licaria armeniaca tissues. Extraction time, solid–liquid ratio (m/v), and ethanol percentage were investigated using a central composite rotational design and response surface methodology (RSM). Antioxidant activity (DPPH) and total phenolic content (TPC) served as the response variables. Most efficient extraction conditions were obtained for leaves (64.88% ethanol, 26.07 min, 6.23% m/v; R² = 0.93) and thin branches (73.81% ethanol, 31.34 min, 11% m/v; R² = 0.74). For thick branches, no significant predictive model was obtained, and optimal points were defined based on the best observed TPC and DPPH results (50% ethanol, 35 min, 11% m/v). The optimized extracts were analyzed by liquid chromatography–tandem mass spectrometry associated with molecular networking, GNPS (Global Natural Products Social Molecular Network) library searching, and machine learning tools. Metabolomic profiling indicated that leaves contained mainly alkaloids (46.34%), amino acids and peptides (19.51%), and shikimate derivatives and phenylpropanoids (12.20%). Thin branches showed predominance of alkaloids (35.97%), amino acids and peptides (20.86%), and carbohydrates (12.23%), while thick branches contained alkaloids (46.34%), amino acids and peptides (25.00%), and fatty acids (14.26%). Additionally, the extracts displayed significant cytotoxic activity against cancer cell lines of AGP-01 (malignant gastric ascites), AHOL (Human glioblastoma) and A549 (lung cancer) with IC50 values less than 50 μg/mL. Full article

Peritoneal carcinomatosis (PC) and malignant pleural effusions (MPE) are two common complications of cancers metastatic to the respective body cavities. A PC diagnosis indicates metastasis to the tissue lining the abdominal cavity and is most common in patients with gastrointestinal and gynecological cancers. It is often accompanied by ascites, an accumulation of serous fluid in the abdomen. MPE presents as the accumulation of fluid in the space between the lungs and chest wall. It is a common terminal event in patients diagnosed with breast cancer, lung cancer, lymphoma, and mesothelial cancers, and less commonly, in a wide variety of other epithelial cancers. Due to the aggressive nature of cavitary tumors, the outcome of current treatments for both PC and MPE remains bleak. Although PC and MPE are characteristically affected by different sets of primary tumors (lung/breast/mesothelioma for MPE and gynecologic/gastrointestinal for PC), their environments share common cytokines and cellular components. Owing to the unique cytokine and chemokine content, this environment promotes aggressive tumor behavior and paradoxically both recruits and suppresses central memory and effector memory T cells. The cellular and secretomic complexity of the cavitary tumor environment renders most currently available therapeutics ineffective but also invites approaches that leverage the robust T-cell infiltrate while addressing the causes of local suppression of anti-tumor immunity. Interactions between the heterogeneous components of the tumor environment are an area of active research. We highlight the roles of the immune cell infiltrate, stromal cells, and tumor cells, and the soluble products that they secrete into their environment. A more comprehensive understanding of the cavitary tumor environment can be expected to lead to better immunotherapeutic approaches to these devastating conditions. Full article

Peritoneal carcinomatosis (PC) is a late-stage manifestation of abdominopelvic malignancies with poor prognosis and limited treatment options. Unique biochemical mechanisms within the peritoneal cavity play a key role in disease progression and resistance to therapy. Despite current therapies like systemic chemotherapy and cytoreductive surgery, patients frequently develop severe complications, including bowel obstruction, nutritional decline, and ascites, driving the need to address the pro-tumorigenic niche in the peritoneal cavity. The immune microenvironment in PC is marked by elevated proinflammatory mediators, such as IL-6 and IL-8, which skew the response toward innate rather than adaptive immune responses. IL-8 signaling, through its receptors CXCR1 and CXCR2, promotes neutrophil recruitment, chronic inflammation, angiogenesis, epithelial–mesenchymal transition, and immune evasion, making the IL-8/CXCR1/CXCR2 axis a potential therapeutic target in PC. Pre-clinical models provide evidence that IL-8 or CXCR1/CXCR2 blockade may be a valuable therapeutic strategy. IL-8 targeting agents such as monoclonal antibodies (BMS-986253) and small-molecule inhibitors (SX-682, AZD5069, navarixin) have shown efficacy in mitigating tumor growth and improving the efficacy of immune checkpoint inhibitors. Phase I and II trials have demonstrated encouraging safety profiles and preliminary efficacy when treating multiple abdominopelvic malignancies. In this review, we discuss the influence of the IL-8/CXCR1/CXCR2 axis within the peritoneal immune environment in PC and highlight recent work using IL-8 or CXCR1/CXCR2 blockade as a therapeutic strategy for PC. Continued research into the peritoneal immune microenvironment and the development of targeted therapies are essential for improving the management and prognosis of PC, potentially enhancing antitumor immunity and patient outcomes. Full article

Background and Objectives: Diagnosing the underlying cause of ascites remains complex, especially when cytology results are inconclusive. Measuring biomarkers directly in ascitic fluid may offer better diagnostic insight than serum testing alone. This review evaluated the clinical utility of tumor and inflammatory markers in ascitic fluid. Materials and Methods: A systematic search was conducted in PubMed and Scopus for studies published from January 2014 to December 2024, with the final search carried out in May 2025. The included studies were observational, comparative or biomarker validation studies evaluating ascitic fluid markers for diagnosing malignant and inflammatory ascites. The extracted outcomes included diagnostic accuracy metrics such as area under the curve (AUC), sensitivity and specificity. Risk of bias was evaluated using the ROBINS-I tool. Studies were excluded if they were case reports, animal studies, cytology-only analyses, or if they lacked biomarker data in ascitic or peritoneal fluid. Results: Forty-two studies met the inclusion criteria. CEA showed high diagnostic performance when measured in ascitic fluid. Combining markers or using ascitic-to-serum ratios improved diagnostic reliability. Inflammatory markers in ascitic fluid, such as CRP, IL-6 and VEGF added diagnostic value when cytology was inconclusive. Discussion and Conclusions: Evaluating biomarkers in ascitic fluid improved diagnostic accuracy. However, the included studies showed considerable methodological heterogeneity and moderate risk of bias. Full article

Background: Small intestinal neuroendocrine tumors (SI-NETs) are the most common malignancies of the small bowel. Although typically well differentiated and slow-growing, they may exhibit aggressive behavior, especially when diagnosed at an advanced stage. Objective: To illustrate the diagnostic and therapeutic challenges of advanced SI-NETs through a rare case presentation and a narrative review of recent studies in the literature. Methods: A narrative literature review was conducted using the PubMed database to examine the incidence, risk factors, diagnostic modalities, and treatment strategies for advanced-stage SI-NETs. The search included studies published between January 2010 and June 2025 and focused on human subjects, using keywords such as “small intestinal neuroendocrine tumor”, “metastasis”, “tumor grade”, and “treatment”. Results: We report the case of a 68-year-old man who presented with bowel obstruction. Imaging and surgical exploration revealed a jejunoileal SI-NET with extensive liver and peritoneal metastases, mesenteric fibrosis, and ascites. Histopathology confirmed a well-differentiated grade 2 tumor (Ki-67: 3%) positive for chromogranin A and CD56. Despite a low proliferative index, the tumor demonstrated aggressive clinical behavior. The patient underwent emergency enterectomy with ileostomy and was referred for further evaluation, including somatostatin receptor imaging and consideration for peptide receptor radionuclide therapy (PRRT). Conclusions: This case highlights the potential for aggressive progression in well-differentiated SI-NETs with low Ki-67 indices. Histological grade alone may not predict clinical behavior. Early diagnosis, comprehensive staging, and individualized multidisciplinary management—guided by functional imaging and receptor profiling—are critical to improving outcomes in advanced SI-NETs. Full article

Hyaloserositis, also known as the icing sugar phenomenon, may be commonly observed during autopsies; however, it is not a well-documented topic with varying nomenclature and etiology, which can be generally defined as an organ being covered with a shiny, fibrous hyaline membrane. In our work, we present the case of a 71-year-old female patient with alcohol-induced liver cirrhosis and subsequent ascites and recurrent peritonitis. During the autopsy, a cirrhotic liver and an enlarged spleen were observed, both exhibiting features consistent with hyaloserositis, accompanied by acute fibrinopurulent peritonitis. Histological examination revealed the classical manifestation of hyaloserositis, further proven by Crossmon staining. The cause of death was concluded as hepatic encephalopathy. During our literature review, a total of seven cases were found. It must be emphasized that no publication describing hyaloserositis from the perspective of a pathologist was discovered. Regarding etiology, abdominal presentations were most commonly caused by serohepatic tuberculosis, while pleural manifestation was observed following trauma. Hyaloserositis may prove to be a diagnostic difficulty in imaging findings, as it can mimic malignancy; therefore, a scientific synthesis is necessary. Full article

Background/Objectives: Carbohydrate antigen 125 (CA125) is a glycoprotein commonly overexpressed in epithelial ovarian cancer and widely recognized as a tumor marker. However, elevated CA125 levels are also observed in various non-malignant conditions, including diseases affecting mucosal surfaces, pleural or peritoneal effusions, cirrhosis (with or without ascites), endometriosis, uterine fibroids, adenomyosis, pelvic inflammatory disease, and pregnancy. This review aims to explore the role of CA125 in non-malignant serous effusions, highlighting its diagnostic and prognostic potential beyond the realm of oncology. Methods: A comprehensive literature search was conducted across multiple databases and clinical trial registries. Eligible studies included full-text original research articles, reviews, and case reports published in English over the past 10 years. Inclusion criteria were limited to studies involving human subjects and focused on the role of CA125 in non-malignant serous effusions. Results: CA125 is produced by coelomic epithelial cells lining the ovary, pleura, pericardium, and peritoneum. Its serum concentration is not significantly influenced by age, body weight, or renal function, even in the advanced stages of the disease. In peritoneal conditions, CA125 is synthesized by mesothelial cells and serves as a potential marker of peritoneal involvement. The prevailing pathophysiological mechanism suggests that mechanical stretching of mesothelial cells due to ascitic pressure stimulates CA125 release. Similarly, in heart failure, mesothelial cells of the pericardium produce CA125, which correlates with congestion severity, supports risk stratification, and may inform diuretic therapy. Conclusions: While a threshold of 35 U/mL is established for malignancy, no standardized cutoff exists for CA125 in non-malignant conditions. The utility of CA125 measurement in peritoneal, pleural, or pericardial effusions—and cardiovascular diseases such as acute heart failure—for purposes of differential diagnosis, treatment guidance, or prognostication warrants further investigation through prospective clinical trials. Full article

Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with limited treatment options in advanced stages. Recently, targeted therapies against fibroblast growth factor receptor 2 (FGFR2) fusions have emerged as a promising approach for selected patients. Tasurgratinib, a selective FGFR1–3 inhibitor, was approved in Japan in 2024 for second-line treatment of FGFR2 fusion-positive biliary tract cancer. We report the case of a 55-year-old female with advanced iCCA harboring an FGFR2-BICC1 fusion, who experienced a rapid clinical response to tasurgratinib following disease progression on gemcitabine, cisplatin, and durvalumab (GCD). Following the failure of GCD therapy, treatment with oral tasurgratinib was initiated at 140 mg/day and subsequently reduced to 105 mg/day due to Grade 2 diarrhea. Within weeks, imaging and tumor markers indicated a partial response, accompanied by a reduction in ascites, and improved performance status. The response sustained for several months without evidence of disease progression. Notably, no substantial clinical hyperphosphatemia or anorexia was observed during treatment. This is the first report to describe the real-world clinical efficacy of tasurgratinib in an iCCA patient with FGFR2-BICC1 fusion. Our findings suggest that tasurgratinib can provide a rapid and durable response with manageable toxicity in molecularly selected patients who have progressed on standard therapies. Full article

Background: PIPAC is an innovative treatment that delivers low-dose aerosolized chemotherapy into the abdominal cavity of patients with peritoneal surface malignancies (PSMs). However, its role in the multimodal management of PSMs is unclear. Methods: We retrospectively analyzed data from 64 patients who underwent PIPAC for PSMs of a primary or secondary origin between June 2020 and December 2024 (median age of 64 years). Primary tumor sites included gastric (42.2%), colorectal (23.4%), ovarian cancer (21.9%), and others (12.5%). The median PCI was 15 (IQR 9–25), with ascites present in 60.9% of cases and a positive cytology in 48.4%. Results: A total of 82 PIPAC sessions were performed in 64 patients. The mean operation time was 96 min. Severe adverse events, defined as the Common Terminology Criteria for Adverse Events (CTCAE) of a grade ≥ 2, occurred in four patients (6.2%). The median hospital stay was 3 days, and systemic chemotherapy was resumed within 14 days after the procedure in 27 patients. Among the entire cohort, 37.5% received bidirectional therapy and 62.5% received palliative treatment, with a lower peritoneal cancer index (PCI) in the bidirectional group (9.5 vs. 23). The median overall survival (OS) was 32 months from diagnosis. Sixteen patients (25%) underwent two or more PIPAC sessions and showed an advantage in survival compared to patients who underwent only one procedure (3-year OS: 63.2% vs. 38.4%, p 0.030). Conversion surgery was achieved in 34.4%. Patients treated with a bidirectional intent demonstrated a longer OS (3-year: 66.0% vs. 33.9%, p 0.011). Colorectal and ovarian tumors exhibited better long-term outcomes compared to gastric cancer. Conclusions: PIPAC is a promising treatment for PSMs, with a low morbidity rate. Its favorable safety and short interval to systemic therapy resumption support its use as part of a bidirectional strategy. Full article

CEA (carcinoembryonic antigen), which belongs to the acidic glycoproteins, is primarily produced during the fetal period. Following this stage, low levels of CEA are considered physiological, while elevated concentrations are associated with a range of both benign and malignant pathologies. The liver plays a key role in CEA metabolism. The most common material used to determine CEA concentrations by various techniques is blood, and measuring CEA in peritoneal fluid holds clinical value. CEA has been found to contribute to carcinogenesis, metastasis, and treatment resistance. Therefore, its serum concentration is widely used in oncology for prognosis, disease monitoring, and recurrence detection, despite its limited sensitivity and specificity, which prevent it from serving as a standalone diagnostic tool. Elevated serum CEA levels are linked to worse outcomes in lung, liver, breast, colorectal, and pancreatic cancers. Imaging and multi-marker panels that include CEA enhance diagnostic accuracy, but its role remains context-dependent and varies by cancer type. CEA levels in peritoneal fluid have been explored as a potential marker for detecting malignancy and predicting recurrence, particularly in gastric, gynecological, and colorectal cancers. Peritoneal fluid CEA has also been proven useful in differentiating the etiology of ascites. While cytology remains the standard for the detection of tumor cells in body fluids, its limited sensitivity provides a strong rationale for incorporating peritoneal fluid CEA measurements as a complementary diagnostic tool, potentially alongside other markers. Additionally, the lack of standardized measurement techniques and cut-off values underlines the methodological challenges that still need to be addressed in future research for both serum and peritoneal CEA levels. Full article

While locally advanced rectal cancer is the first clinical suspicion for severe rectal stenosis, in extremely unusual cases a lower bowel obstruction may be related to bladder metastasis. We present the case of a 64-year-old male who was admitted for occlusive rectal tumor (4 cm from the anal verge), for which an emergency loop-colostomy was performed. After two inconclusive endoscopic biopsies, a transanal rectal tru-cut biopsy allowed for the detection of high-grade urothelial carcinoma with signet ring cells. Furthermore, primary origin was detected in a small bladder tumor. In imaging reassessment after neoadjuvant chemotherapy, regression of the lesions both from the bladder and rectum was observed. Radical surgery with total pelvic exenteration was considered in the absence of other secondary tumors, but the patient declined and continued with radiotherapy. Subsequently he developed malignant chylous ascites and unfortunately died three months later. Reviewing the literature, we found twenty-five cases of urothelial metastasis to the rectum, originating from the bladder, including this newly present case. Rectal metastasis of urothelial origin poses a two-fold challenge in terms of both diagnosis and treatment. Determining the specific features of this uncommon manifestation of a common disease will improve future approaches. Full article

Background: Malignant bowel obstruction (MBO) is a common and distressing complication in advanced gastrointestinal cancers, significantly impacting patients’ quality of life. When conservative management fails, palliative decompression is essential to relieve symptoms such as nausea, vomiting, and abdominal distension. Venting gastrostomy is the most established method; however, anatomical challenges may necessitate alternative percutaneous approaches. Objective: This narrative review aims to provide a comprehensive overview of percutaneous gastrostomy techniques for palliative gastrointestinal decompression, including percutaneous endoscopic gastrostomy (PEG), interdisciplinary imaging-guided percutaneous or transhepatic gastrostomy, and percutaneous transesophageal gastrostomy (PTEG). Methods: A literature review was conducted to evaluate the indications, techniques, efficacy, and complications associated with these procedures. The role of a multidisciplinary approach, incorporating radiologic, endoscopic, and palliative care expertise, was also explored. Results: PEG remains the gold standard for venting gastrostomy, achieving symptom relief in up to 92% of cases, with a low complication rate. However, interdisciplinary imaging-guided percutaneous or transhepatic gastrostomy offers a viable alternative for patients with surgically altered anatomy or difficult percutaneous access. PTEG, a newer technique, has demonstrated high technical success and symptom improvement, particularly in patients with extensive peritoneal carcinomatosis or massive ascites, where transabdominal approaches are not feasible. Conclusions: Palliative percutaneous decompression provides effective symptom relief in advanced gastrointestinal cancer. The choice of technique should be individualized based on patient anatomy, clinical condition, and resource availability. A multidisciplinary approach remains crucial in tailoring decompression strategies to improve the quality of life in end-stage malignancies. Full article